The Functions of Postpartum Depression

4. There are large opportunity costs—investment in the offspring precludes investment in
other beneficial activities. In this case, investment directed toward the offspring would
be more profitably directed towards:

a. existing offspring.

b. the mother’s own survival, growth, and development, and thus her ability to invest
in future offspring.

c. finding a better mate.

During our evolutionary history, investment by others was key to reducing the costs of
child-rearing and increasing infant viability. Lack of social support, even in populations with
access to modern health care, correlated in one study with lower birth weight babies, lower
scores on the 5 minute Apgar test (which rates respiratory effect, muscle tone, heart rate, reflex
irritability, and skin color 5 minutes after delivery) and labor difficulties (Collins et al., 1993).

Numerous developmental problems can also significantly reduce infant viability. Poor
neonatal functioning should be associated with negative affect. In addition to obvious infant
problems, reliable predictors of infant problems, particularly those predictors that occur
prepartum, would be very useful to ancestral mothers attempting to evaluate offspring viability.
Pregnancy and delivery problems like gestational diabetes, pregnancy induced hypertension,
and abnormal presentation are significant predictors of high child malformation and mortality
rates even when mothers have access to modern medical care (see table 3; also see footnote 3
for possible confounding factors).

Study	Outcome
Acien, 1996	The perinatal mortality rates in breech presentations were more than twice those of the total number of deliveries in Latin America, and more than three times the total number in Spain and Portugal.
Ananth CV; Savitz DA; Bowes WA, 1995	Hypertensive disorders were found to have a strong adverse impact on stillbirth rates (North Carolina).
Beischer NA; Wein P; Sheedy MT; Steffen B, 1996	Gestational diabetes was associated with a significantly higher rate of perinatal mortality, especially if untreated (Australia).
de Courcy-Wheeler RH, et al., 1995	Small size for gestational age (itself a strong predictor of perinatal mortality) was significantly associated with proteinuric hypertension (Britian).
Gupta V; Bhatia BD; Mishra OP, 1996	20% of babies born through meconium stained amniotic fluid (MSAF) suffered severe birth anoxia (lack of oxygen) compared to 5.6% in the non-MSAF group (India).
Hawthorne G; Snodgrass A; Tunbridge M, 1994	The perinatal mortality (PNM) in women with gestational glucose intolerance was 49.2/1000 compared to a PNM in the background population of 11.6/1000. The fetal malformation rate was 17.3% for established diabetes, 9.8% in gestational glucose intolerance, and 2.2% in the background population (Britian).
Omu AE, et al., 1996	Despite the economic expenditure of about five times more for hypertensive women in pregnancy than in controls, both obstetric and neonatal outcome are still significantly worse in the former (Kuwait).
Schieber B, et al., 1994	Prematurity, malpresentation, and prolonged labor accounted for significant proportions of the observed peri-neonatal mortality (rural Guatemala).

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