Pregnancy is a critical period when women experience various physical, psychological and social changes. The changes can result in negative emotions in women’s lives, and which may lead to irreversible psychological problems (Duman and Kocak, 2013). According to WHO data, 10% of pregnant women and 13% of women after giving birth experience varying levels of mental disorders worldwide (WHO, 2015). Anxiety and depression are two of the most common mental disorders during pregnancy (Duman et al., 2013). After delivery, postpartum depression can occur. Postpartum depression affects 10-20 percent of women (Kim, Connolly and Tamim, 2014). Therefore, the mental health of pregnant women is a critical topic that is of great concern physicians and researchers.

Psychological problems during pregnancy are associated with factors such as culture, socio-demographics and the relationship with the husband (Duman et al., 2013). Lack of social support causes adverse mental health problems (Duman et al., 2013). Social support can be defined broadly as support that people get or receive from others. It can be from family members, friends, partners, and mental health professionals. According to Seeman (2008), social support is classified into emotional and instrumental support. Emotional support is usually the non-tangible types of assistance involving making people feel loved and cared for (Seeman, 2008). Instrumental support involves providing physical assistance, including, money, childcare or housekeeping (Seeman, 2008).

Researches have shown that women with poor social support are likely to experience difficulty adapting to the changes resulting from pregnancy (Duman et al., 2013). Some studies determined that social support is likely to reduce symptoms of depression during and after pregnancy (Kim et al., 2014). Regarding the link between social support accorded to pregnant women and child development, studies have shown that mothers with poor social support tend to have babies a with lower birth weight (Elsenbruch, Benson, Rücke, Rose, Dudenhausen, Pincus-Knackstedt, Klapp and Arck, 2007). However, there is a limited number of research articles on the connection between mothers with social support and infant development. Also, the findings of association are not consistent across studies (Polanska, Krol, Merecz-Kot, Jurewicz, Makowiec-Dabrowska, Chiarotti, Calamandrei and Hanke, 2017).

From evaluating previous studies, it is observed that there is a link between social support, mental health of the mother, and infant growth. However, there is a need to better examine whether strong support networks can improve prenatal depression, birth outcomes and postnatal depression to encourage provision of better prenatal and postnatal care.

Literature Review

This literature review will discuss the current knowledge on the effect of prenatal social support on depressive symptoms of women during pregnancy, birth outcomes of newborn babies and postpartum depression. The paper will focus on depression because it “has shown robust association with adverse outcomes” (Nylen and O’Hara, 2011).

Social Support and Depression of Women during Pregnancy

Depression is one of the most prevalent mental health conditions that women develop during pregnancy. Moshki and Cheravi (2016) conducted a study to determine the relationship between social support and maternal depression. The article used the Edinburgh Postnatal Depression Scale (EPDS) to detect prenatal depression. According to the data analysis, the study indicates that social support has a significant effect on depression “in the linear regression models”.  The researchers conclude that “by providing support during pregnancy”, depression symptoms in pregnant women may be decreased. However, the study population was only from urban areas, and which may not be representative of the situation in the general population.

Similar results were arrived at in the study that Elsenbruch et al (2007) conducted. The study states that social support is negatively associated with depression during pregnancy. The “Center for Epidemiological Studies Depression Scale (CES-D)” was used to measure depression symptoms. The data shows that women with low levels of social support demonstrated significantly greater depressive symptoms than women with medium and high levels of social support. The paper had adjustments of covariates by analyzing a mother’s age, height and weight.

Both studies used a scale to detect depression symptoms, and which would increase the accuracy. Both studies were cross-sectional, therefore, the association between social support and maternal depression “cannot be interpreted as casual inferences” (Moshki et al., 2016). Thus, there are no findings on whether strong social support is effective in reducing depressive symptom and preventing women from developing mental disorders. On the other hand, covariates were not mentioned in Moshki and Cheravi’s work. Proper use of covariates can “increase the accuracy of the estimates and power of the statistical test” (Streiner, 2016). Depending on specific study types and previous studies, covariates can be used to minimize bias.

Social Support and Birth Outcome of Newborn Babies

There is common agreement that mothers’ health will affect their kids’ health from conception and continuously have an impact on fetal development. Birth outcomes often refer to birth weight, gestational age and anthropometric measures (Chen and Millar, 1999). Poor fetal growth and preterm low birth weight tend to “have implications not only for infant morbidity and mortality but also for their health later in life” (Feldman, Dunkel-Schetter, Sandman and Wadhwa, 2000). Therefore, it is necessary to understand the association between prenatal social support and birth outcomes.

Feldman et al. (2000) tested the association between social support and fetal growth by conducting a prospective study. Socio-demographic and obstetric risk factors were controlled in the study. Also, various types of scales were applied to measure social support. The research indicates that women with multiple types of support during pregnancy have babies with higher birth weight. The result was similar after controlling for the length of the gestational period and obstetric risk factors. Their findings also suggest that multiple types of social support are more likely to influence birth weight and fetal growth. However, it is in doubt whether multiple types of social support can be considered as a strong support network.

Hodnett and Fredericks (2010) also investigated the effect of maternal social support on birth outcomes. It is worth noting that they offered additional support to pregnant women and the results on gestation and birth weight were assessed. As stated in the paper, additional support was defined as both emotional and tangible support, including but not limited to counseling, home visits and transportation to the clinic. Researchers used the double data entry method to conclude that individual participants had improvements in their mental health during pregnancy, but additional support is unlikely to reduce the risk of having preterm or low birth weight babies. With respect to this literature, a certain amount of socials support should be provided to pregnant women, but the provision of additional support is unnecessary. This somehow contradicts the idea that people should provide more care to pregnant women. Therefore, it is important to know whether additional support helps improve birth outcomes.

Social Support and Postpartum Depression of Women

Parental mental problems after childbirth should also not to be neglected. It not only disturbs mother’s normal life but also has negative effects on children’s health and growth (Field, 2010). Postpartum depression is one of the possible mental disorders. Kim et al. (Kim et al., 2014) examined the relationship between social support during pregnancy and postpartum depression after childbirth. The paper is one of the first few studies that investigated the effect of social support during pregnancy on postpartum depression. Kim’s study shows that “higher levels of support are associated with a lower prevalence of postpartum depression among mothers”. Therefore, social support enables people to reduce depression symptoms. However, Kim et al. state that in the future, there is a need to determine whether low levels of support increase the risk of postnatal depression.

The association that Kim et al. state is consistent with the research that Hetherington and her collogues conducted. Through a questionnaire-based study with consideration of covariates, Hetherington et al. (2018) conclude that low social support is associated with an increased risk of depression after birth. They also identify that emotional support has a significantly high impact on postpartum anxiety. However, no evidence clearly shows an effect on postpartum depression.  Therefore, further studies are needed to confirm the relationship.

Conclusion

Overall, the literature reviewed shows an association between social support and prenatal depression, birth outcomes and postpartum depression. Pregnant women with social support tend to have better mental health, in this case, lower prenatal and postnatal depression than those with poor support. Mothers with complex support systems have newborn babies with higher a birth weight and better growth, compared to those who receive simple social support. The topic that has been investigated using  various approaches, and thus there are some conflicts between the findings of different papers.

To investigate the effect of social support, a prospective study that follows pregnant women at the beginning of pregnancy period to 1 year after birth delivery is required. In accordance with previous studies, covariates such as income, self-reported ethnic background, parity and previous mental health can be controlled throughout the study (Hetherington et al., 2018). Data measures can also use scales tor increase accuracy. What’s more, each research has a sample from a specific population as research participants. In order to have a large sample size, the main population that is chosen to be studied should be pregnant women in lower mainland, BC.

Although an association between social support and mental well-being was found, the question whether strong social support during pregnancy improves the maternal depression, birth outcomes and postpartum depression deserves further study (Elsenbruch et al., 2007).  By understanding and solving this question, people can know if giving additional support to pregnant women who are already receiving support is justified. If it is not, additional support should be given to those who are still struggling and getting little or no help.

 
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