PONE-D-21-04110

A systematic review of the association between perinatal depression and cognitive development in infancy in low and middle-income countries

PLOS ONE

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Reviewer #1: The question of whether or not maternal depression during the antenatal or postnatal periods influences cognitive development from birth to 3-years old in low- and middle-income countries is an important research question. This meta-analyses included 8 antenatal studies, 4 from South Africa, one from the Ukraine, one from China, one from Mexico and one from Vietnam. Postnatal studies were included from 8 countries, Pakistan, Bangladesh, Uganda, Barbados, South Africa, India, Brazil and Vietnam.

The study from Vietnam found that antenatal depression was associated with lower cognitive scores at 6 months after controlling for postpartum and concurrent depression symptoms. In China, maternal depression was associated with lower language scores on the Gesell Scale at 24 - 30 months.

Three other studies found a relationship between antenatal depression on cognitive outcomes but did not control for postnatal or concurrent maternal depression.

Authors reviewed 9 studies of the relationship of postnatal depression on infant cognition at different time points between birth and 36 months, depending on the study. Studies took place in Pakistan, Bangladesh, Uganda, Barbados, South Africa, India, Brazil and Vietnam. Of these studies, 2 were assessed as poor quality, 6 as fair quality and one as good quality. Four of the studies found a main effect of postnatal depression resulting in lower scores on infant language development.

The study also reviewed evidence for an effect of postnatal depression on infant development. In the settings of LMIC, these studies did not find an effect of postnatal depression on infant language development.

What does this study add?

Maternal depression during pregnancy adversely influences infant cognitive development. However, postnatal depression did not influence infant cognitive development in these settings. This finding raises questions about the role of environment in low and middle income countries on infant development and on the mother.

The reference list is comprehensive.

The focus on low and middle-income countries is important.

Reviewer #2: Review of --“ A systematic review of the association between perinatal depression and cognitive development in infancy in low and middle-income countries”.

By Matthew Bluett-Duncan, M. Thomas Kishore, Divya M. Patil, Veena A. Satyanarayana and Helen Sharp

The impact of perinatal depression on cognitive outcome of offspring is an important area that still blurred and requires more insights for the future-direction of child-focused interventions. The authors made a good attempt to review the existing assorted literatures on this complex topic and summarize the take-home messages.

The authors very clearly and elaborately described all the steps of the systematic review with references. They also detailed the working definitions of both exposure and outcome variables.

However, they are encouraged to address the following concerns:

•For simplifying the findings, the authors made lots of sub-headings in result and discussion section that caused repetition of similar information This repetition is distorted the flow of reading due to lack of customization. So, some sections could be merged, e.g. “key adjustment sections” does not need to be separately reported. Rather “adjustment information” can be blend with specific studies--- but the tables( 3 & 4) can be presented for better understanding.

• Table 1 & 2 on antenatal & postnatal findings, need to be more informative. At least those cab include positive/negative findings. Otherwise it is difficult to relate results and discussion on antenatal or postnatal findings with several tables in main paper and in supplementary document.

•Sample size of study population and their follow-up percentages need careful checking. For example, sample size and follow up % of the study done by Garman et al in Table-2 is not matching with the journal information. In the journal, at follow-up, 58% children were assessed for developmental measures. Please clarify if the sample size in the tables refers to the numbers of mother-child dyads.

•Reference numbers are wrong in many places e.g. page 17, section 3.3.1, 2nd line, reference 56 will be 58; page 19, ref of Rotheram-Fuller will be 55 etc.

• Throughout the write up please correct “BSID-III”-- It should be Bayley-III.

• Finally based on the nature of majority of the studies (mostly prospective or observational and sometimes 2ndary analysis), heterogeneous nature of the exposure/outcome assessments and huge drop-outs at follow up-- it will be better to say “significant association” of antenatal or postnatal depression with cognition, rather than “significant effect”, which is a more robust terminology.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review Comments_Perinatal Depression and ECD_PONE-D-21-04110.doc

A systematic review of the association between perinatal depression and cognitive development in infancy in low and middle-income countries

PONE-D-21-04110R1

Dear Dr. Bluett-Duncan,

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Kind regards,

Angela Lupattelli, PhD

Academic Editor

PLOS ONE