Date Published: March 29, 2017
Publisher: Public Library of Science
Author(s): Vesile Senturk Cankorur, Berker Duman, Clare Taylor, Robert Stewart, Stephanie Brown.
Child gender preference is important in some cultures and has been found to modify risk for antenatal and postnatal depression. We investigated discrepancies in the child gender preference between participating women and other key family members and the extent to which these predicted perinatal depression.
In a large cohort study of perinatal depression in urban and rural Turkey, participants had been asked about child gender preferences: their own, and those of their husband, parents, and parents in-law. Of 730 participants recruited in their third trimester (94.6% participation), 578 (79.2%) were reassessed at a mean (SD) 4.1 (3.3) months after childbirth, and 488 (66.8%) were reassessed at 13.7 (2.9) months.
No associations were found between any gender preference reported in the antenatal period and depression at any examination. On the other hand, we found associations of antenatal depression with differences in participant-reported gender preference and that reported for their mother-in-law (OR 1.81, 1.08–3.04). This non-agreement also predicted depression at the 4 month (OR 2.24, 1.24–4.03) and 14 month (OR 2.07, 1.05–4.04) post-natal examinations. These associations with postnatal depression persisted after adjustment for a range of covariates (ORs 3.19 (1.54–6.59) and 3.30 (1.49–7.33) respectively).
Reported disagreement in child gender preferences between a woman and her mother-in-law was a predictor of post-natal depression and may reflect wider family disharmony as an underlying factor.
Postnatal and antenatal depression are common mental disorders. For postnatal depression, a meta-analysis concluded a period prevalence in the three months after birth of 19.2% , although there is potentially substantial international variation  with particularly high prevalences in Asian countries such as Israel (22.6%), Taiwan (36.6%), Turkey (33,1%; 26,1%) and Vietnam (29.9%) [3–7]. Multiple contributory factors include life stress, marital conflict, maternal self-esteem, and lack of social support [8,9]. Depression or anxiety during pregnancy, past history of psychiatric illness, adverse life events, social support deficits and marital relationship quality have been reported as moderate to strong risk factors for postnatal depression, with obstetric and socioeconomic factors exerting smaller influences [8, 10, 11]. For antenatal depression, life stress, lack of social support, and domestic violence have also been identified as independent risk factors .
Child gender preference is an important issue in some cultures [5,7] and it has been reported as a risk modifier for antenatal and postnatal depression in studies in some countries [7,17], although is generally under-researched. Findings to date have tended to come from societies where there are marked contrasts between the implications of a male or female child, and the exposure has received little or no investigation in Western settings where preferences, if present, are assumed not to have meaningful impact. We took advantage of a large Turkish cohort to investigate the issue in a potentially ‘intermediate’ setting, where there is recognised to be some level of gender preference but probably not as extreme as in other cultures. To our knowledge, ours is the first study to assess the association prospectively or across such a range of family members, although it has been investigated previously in cross-sectional studies .
In this cohort of women from urban and rural communities in Turkey followed from the third trimester of pregnancy through to the post-natal period, no association was found between gender preference reported by the woman, or that reported for any close relative, in the antenatal period and depression at any examination. On the other hand, we did find associations of antenatal depression with differences in gender preference reported by participants and those reported for their mother-in-law, which also predicted depression at 4- and 14-month post-natal examinations. These associations persisted after adjustment for a range of covariates. These reported disagreements in gender preference might reflect wider family disharmony and would be worth investigating further in cultures where extended family relationships are highly salient for women following childbirth. However, it should be borne in mind that numbers of multiparous women were not sufficient for subgroup analyses, taking into account child and sibling genders. These might well modify associations, but would need investigating in more specific cohorts.