risk behaviors. In addition, the patterns of parenting with parental depression often influence how parents supervise, monitor, and model healthy behaviors.

Depression in the parent usually does not exist as a sole factor explaining health-related outcomes in these studies, as in studies of other outcomes. As has been described elsewhere in this report, depression is often accompanied by the circumstances of social disadvantage, marital difficulties, and other coexisting mental health and substance use disorders, and it is acknowledged that any or all of these factors may play a role (independent, additive, mediating, or moderating) in determining health-related and other adverse outcomes for the children of depressed parents. Only a few studies have addressed all of these multiple factors. When the interaction of these factors has been addressed, they are noted. Most studies have investigated depressive symptoms in mothers, not the clinical diagnosis of depression. Except for adolescent reports, data on the impact of depression in fathers or depression in both parents are not available. Given the centrality of developmental issues, we review this literature from that perspective.

Antenatal depression, as well as stressful life events and anxiety, which often co-occur with depression, have been linked to complications of pregnancy or delivery (e.g., preeclampsia) and adverse pregnancy outcomes (e.g., low birth weight), at least partially as a function of poor prenatal care and unhealthy habits (smoking, alcohol, drugs) (see the review by Bonari et al., 2004). Among low-income African American women, those with a high level of depressive symptoms were nearly twice as likely to have spontaneous preterm births (Orr, James, and Blackmore Prince, 2002). This was true even after controlling for other health risks related to premature birth. In a more recent, large, prospective cohort study that began early in pregnancy (Li, Liu, and Odouli, 2009), clinically significant levels of depressive symptoms were associated with almost twice the risk of preterm delivery relative to women with no depressive symptoms. Further, the risk for preterm delivery increased with higher levels of severity of depressive symptoms and the results were not associated with the use of antidepressants although they were associated with obesity and stress. Thus depressive symptoms in the mother, although associated with other health risks, played the central role in association with the negative outcomes for infants. The adverse effects of fetal and newborn elevated cortisol that occur with perinatal maternal depression are discussed later in this chapter. In addition, mothers with depressive symptoms are also less likely to continue to breastfeed (Kendall-Tackett, 2005). Another concern about antenatal depression is fetal exposure to the mother’s antidepressant medication or substance