(1056) Perinatal outcomes in patients with diagnosed and undiagnosed depression

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Jessica Britt, PhD

Biostatistician
Prisma Health
Prisma Health, SC, United States

Coauthor(s)

MH

Moonseong Heo, BA, MA, PhD

Clemson University
Clemson, South Carolina, United States
LZ

Lu Zhang, BA, MPH, PhD

Clemson University
Clemson, South Carolina, United States
Amy Crockett, MD, MSPH (she/her/hers)

Professor
Prisma Health and University of South Carolina School of Medicine
Greenville, South Carolina, United States

Objective: Each year in the US, 20% of pregnant people suffer from perinatal mental health conditions; up to 75% never receive treatment. The adverse impact of undiagnosed depression is likely underestimated. We aimed to examine the association between diagnosed and undiagnosed depression and birth outcomes.

Study Design: This is a secondary analysis of the CRADLE randomized clinical trial which compared birth outcomes in group vs. individual prenatal care. Patients were included if they completed the Center for Epidemiological Studies-Depression (CES-D) tool and birth outcome data were available. A CES-D score ≥23 was considered positive, and the clinical team was blinded to results. Clinically diagnosed depression (CD) was identified via chart review. Providers used patient history or the Edinburgh Postnatal Depression tool if CD was suspected; universal screening was not being utilized at the time. Patients were classified based on CD during pregnancy and CES-D scores: 1) no depression (no CD and negative CES-D; CON); 2) depression (CD with any CES-D score; DIAG); 3) undiagnosed depression (no CD but positive CES-D; CESD+). The primary outcome was preterm birth (< 37 weeks). Secondary outcomes were low birthweight (< 2,500g), NICU admission, and APGAR < 7 at 1 and 5 minutes. Multivariable logistic regression was performed with CON as the reference and adjustments for race, maternal age, nulliparity, and pregnancy intention.

Results: 1765 patients were included: 1380 (78%) in the CON group, 202 (12%) in DIAG, and 184 (10%) in CESD+. CESD+ patients were more likely to be younger, Black, nulliparous, and have an unintended pregnancy (Table 1). CESD+ patients had increased odds of preterm birth (OR 2.50, 95% CI 1.53-4.10) compared to CON. CESD+ patients had increased odds of all secondary outcomes compared to CON while DIAG had increased odds of low birthweight and NICU admission (Table 2).

Conclusion: Diagnosed and undiagnosed depression is associated with adverse birth outcomes. Increased screening efforts using validated instruments during pregnancy are warranted and may help improve racial equity.