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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 4

(1214) Antepartum depressive symptoms and severe maternal morbidity

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: The relationship between maternal mental health during pregnancy and consequent severe maternal morbidity (SMM) remains to be investigated. Therefore, we examined whether antepartum depressive symptoms in early pregnancy were associated with SMM at delivery hospitalization.

Study Design: This was a secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. Nulliparous pregnant individuals were followed from the first trimester through delivery at 8 centers in the United States. The Edinburgh Postnatal Depression Scales (EPDS) was administered at 11-13 weeks’ gestation. The EPDS was assessed categorically at ≥10 and ≥13, which are thresholds commonly used in clinical practice. The outcomes were SMM (including transfusion) and SMM (without transfusion) at delivery hospitalization. SMM was identified based on the Centers for Disease Control and Prevention definition. Modified Poisson regression with robust error variance was used and adjusted for age, insurance status, tobacco use, and Area Deprivation Index.

Results: Among 8,784 nulliparous individuals, 2.3% experienced any SMM and 0.5% had non-transfusion SMM. In early pregnancy (median gestational age: 12.0 weeks; IQR: 11.0,13.0), 17.2% of individuals had EPDS scores ≥10 and 7.1% ≥13. In univariable analysis, having an EPDS ≥10 was associated with a greater frequency of SMM (3.0% vs 2.1%; RR: 1.42; 95% CI: 1.02, 1.96), although this did not remain statistically significant after adjustment (Table). Individuals who met the higher EPDS threshold of ≥13 had a statistically significant increase in risk of SMM without transfusion in both univariable (1.1% vs. 0.4%, RR 2.53, 95% CI: 1.13, 5.67) and multivariable analyses (aRR: 3.12; 95% CI: 1.11, 8.81).

Conclusion: In a prospective cohort of nulliparous individuals from across the US, depressive symptoms in early pregnancy, defined by an EPDS score ≥13 was associated with an increased risk of SMM without transfusion.