The Association between Prenatal Care and Postpartum Depression in the United States.

Authors' Affiliations

Michael Smith, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, TN. Debbi Slawson, Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, TN.

Location

D.P. Culp Center Room 304

Start Date

4-5-2024 1:30 PM

End Date

4-5-2024 2:30 PM

Name of Project's Faculty Sponsor

Amal Khoury

Faculty Sponsor's Department

Health Services Management and Policy

Competition Type

Competitive

Type

Oral Presentation

Presentation Category

Health

Abstract or Artist's Statement

Background Postpartum depression (PPD) occurs in 10 to 24% of pregnant women and is associated with high risk during pregnancy, including increased rates of preterm birth, cesarean delivery, and preeclampsia. Timely and quality prenatal care is thought to decrease adverse outcomes in pregnancy. This study aimed to examine how delayed access to prenatal care and quality of prenatal experience influence postpartum depression outcomes in a cohort of women who had live births. Method This cross-sectional study used the Pregnancy Risk Assessment Monitoring Systems (PRAMS) to examine the relationship between having PPD and women who had late or no prenatal care and asked or counseled for depression during their prenatal care. Women are categorized into three groups based on their timing for prenatal care initiation: first trimester (1-12 weeks), second trimester (13-27 weeks), and late or no prenatal care (3rd trimester, 40 and 43 weeks). Women who responded yes to being asked if they were feeling down or depressed during their prenatal care were categorized as screened or counseled for depression. A chi-square test for independence was examined to determine the association between having PPD and the timing of prenatal care or being asked about depression. Multivariable regression analysis was also performed while controlling for sociodemographic characteristics and interaction effects. Also, an index construction of questions asked during prenatal care was created to quantify the quality of prenatal care by proxy. Results A total of 242,573 women participated in the Phase 8 PRAMS survey; all states (including DC) participated except California, Idaho, and Ohio, with a 14.4% cumulative prevalence of PPD. About 24% proportion of women who commenced prenatal care late or had no prenatal care reported PPD compared to the first (13.6%) and second (18.1%) trimester. When adjusting for other variables of interest, there was an association between late or no prenatal care and PPD (aOR: 1.54; 95% CI: 1.21, 1.85), and not being counseled or asked about depression is associated with PPD (aOR: 1.26; 95% CI: 1.21, 1.32). Women who had a history of previous depression before pregnancy had higher odds of PPD. The margin from the interaction also showed an increased margin amongst those who had a history of depression compared to those who did not. Conclusion This study buttresses the value of prenatal care and the need to ensure the quality of care, particularly for women suffering from or who have a history of depression. Additionally, this study shows that irrespective of substance use, co-morbid disease, race, or ethnicity, timely commencement of prenatal care reduces the risks of maternal mortality and morbidity. It is recommended that prevention and treatment packages for prenatal care package these areas when rolling out public health implementation programs.

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Apr 5th, 1:30 PM Apr 5th, 2:30 PM

The Association between Prenatal Care and Postpartum Depression in the United States.

D.P. Culp Center Room 304

Background Postpartum depression (PPD) occurs in 10 to 24% of pregnant women and is associated with high risk during pregnancy, including increased rates of preterm birth, cesarean delivery, and preeclampsia. Timely and quality prenatal care is thought to decrease adverse outcomes in pregnancy. This study aimed to examine how delayed access to prenatal care and quality of prenatal experience influence postpartum depression outcomes in a cohort of women who had live births. Method This cross-sectional study used the Pregnancy Risk Assessment Monitoring Systems (PRAMS) to examine the relationship between having PPD and women who had late or no prenatal care and asked or counseled for depression during their prenatal care. Women are categorized into three groups based on their timing for prenatal care initiation: first trimester (1-12 weeks), second trimester (13-27 weeks), and late or no prenatal care (3rd trimester, 40 and 43 weeks). Women who responded yes to being asked if they were feeling down or depressed during their prenatal care were categorized as screened or counseled for depression. A chi-square test for independence was examined to determine the association between having PPD and the timing of prenatal care or being asked about depression. Multivariable regression analysis was also performed while controlling for sociodemographic characteristics and interaction effects. Also, an index construction of questions asked during prenatal care was created to quantify the quality of prenatal care by proxy. Results A total of 242,573 women participated in the Phase 8 PRAMS survey; all states (including DC) participated except California, Idaho, and Ohio, with a 14.4% cumulative prevalence of PPD. About 24% proportion of women who commenced prenatal care late or had no prenatal care reported PPD compared to the first (13.6%) and second (18.1%) trimester. When adjusting for other variables of interest, there was an association between late or no prenatal care and PPD (aOR: 1.54; 95% CI: 1.21, 1.85), and not being counseled or asked about depression is associated with PPD (aOR: 1.26; 95% CI: 1.21, 1.32). Women who had a history of previous depression before pregnancy had higher odds of PPD. The margin from the interaction also showed an increased margin amongst those who had a history of depression compared to those who did not. Conclusion This study buttresses the value of prenatal care and the need to ensure the quality of care, particularly for women suffering from or who have a history of depression. Additionally, this study shows that irrespective of substance use, co-morbid disease, race, or ethnicity, timely commencement of prenatal care reduces the risks of maternal mortality and morbidity. It is recommended that prevention and treatment packages for prenatal care package these areas when rolling out public health implementation programs.