Perinatal & Pediatric
Does lifetime racial discrimination modify the impact of prenatal depression on risk of preterm birth among non-Hispanic Black, non-Hispanic White, and Hispanic women in the United States? Ashley Judge* Ashley Judge Kelli Ryckman Christina Ludema
Introduction: Experiences of racial discrimination are associated with increased risk of both depression and preterm birth; depression may also be associated with increased risk of preterm birth. We aimed to investigate the association between depression during the first and late second trimesters and preterm birth, and whether lifetime experience of racial discrimination modified this relationship.
Methods: We used prospective cohort data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be which recruited between October 2010 and September 2013 from eight clinical, US sites. We fitted marginal structural log-binomial models with inverse probability weights to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association between depressive symptoms in first and late second trimesters on the risk of preterm birth for non-Hispanic (NH) Black, NH White, and Hispanic women, separately. We further stratified our models by lifetime experience of racial discrimination measured in early second trimester. Missing data was accounted for using multiple imputation.
Results: Among an average of 1453 NH Black, 5697 NH White, and 1602 Hispanic women across four multiple imputed datasets, depressive symptoms in first trimester were associated with an increased risk of preterm birth only among NH Black women (RR: 1.52 (CI: 1.19, 1.95)). Among NH Black women, compared to if everyone had low depressive symptoms at both time points, having high depressive symptoms at both time points was associated with a 1.64 (1.05, 2.57) increased risk of preterm birth. In all models, the p-values for multiplicative and additive interaction between depressive symptoms at both time points were well above the specified 0.05 alpha level. With this cumulative measure of discrimination, there was a statistically significant difference between NH Black and NH White women in the high-high depressive symptoms, no discrimination group.
Conclusion: The association between prenatal depressive symptoms and preterm birth varied by race/ethnicity. Our findings suggest screening and intervention for depressive symptoms early in pregnancy may reduce the risk of preterm birth among NH Black women. Future studies with larger sample sizes may yield more insights into effect modification by racial discrimination.
