Perinatal & Pediatric
Exploring what drives the association between maternal depression prior to pregnancy and preterm birth Caitlin Meyer Krause* Caitlin Meyer Krause Keegan Krause Rebecca Campbell
Background: Preterm birth (PTB, birth at <37 weeks’ gestation) is persistently high in US pregnancies, particularly among some minoritized populations, and causes infant mortality, morbidity, and long-term disability. Maternal prenatal depression increases the risk of PTB; whether pre-pregnancy depression influences PTB is unknown.
Objective: To examine the associations between maternal pre-pregnancy depression and PTB.
Methods: This study used 2016-2021 Region V (Illinois, Indiana, Michigan, Minnesota, Wisconsin) Pregnancy Risk Assessment Monitoring System data to assess PTB by pre-pregnancy depression status (n=24,048). Binary depression status was self-reported for the period three months before pregnancy. Prevalence ratios were estimated using survey-adjusted Poisson regression models adjusted for race/ethnicity, age, education, marital status, pregnancy intention, and parity. Effect modification by maternal race/ethnicity and by self-reported prenatal depression status was explored.
Results: PTB occurred in 8.7% of births; 15.4% reported pre-pregnancy depression; two-thirds of those with pre-pregnancy depression also reported prenatal depression. Compared to mothers with no pre-pregnancy depression, those with pre-pregnancy depression had 1.30 times the prevalence (95% CI: 1.15, 1.47) of PTB, adjusting for covariates, however, in stratified models the positive association persisted only in women who also reported prenatal depression. In models stratified by race/ethnicity, increased PTB risk with pre-pregnancy depression was apparent only for NH White mothers.
Discussion: Mothers reporting depression pre-pregnancy had a higher prevalence of PTB, but associations were observed only for those with depression that persisted during pregnancy and only among NH White mothers. Prospective studies using validated depression scales are needed to improve understanding of the contribution of maternal depression longitudinally to PTB risk and opportunities for intervention.