Examining the Influence of Depression on Adverse Birth Outcomes: An Analysis of the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS), 2021.

Depression is relatively common across the population but is known to be more prevalent in females relative to males. Risk for depression in females doubles during pregnancy, which is thought to be due to a mixture of hormonal changes and a range of psychosocial factors that may continue to impact on mental health throughout the lifespan. Antenatal depression is associated with a number of poor maternal and infant outcomes, however, there remains a lack of focus on mental issues in antenatal care. This work examines the influence of depression on adverse birth outcomes, using Virginia PRAMS (Pregnancy Risk Assessment Monitoring System), a state-level, population-based survey, which annually collects data on maternal behaviors and perinatal experiences. We included a total of 4843 birthing persons, who had complete information on depression and birth outcomes. About 12.1% of those included reported having a diagnosis of depression prior to pregnancy. This rate remained the same during pregnancy, and increased to almost 13% during the postpartum period. Those rates were the highest among birthing persons who were under the age of 19, on Medicaid, unmarried, and have less than $22,000 annual income. The depression rates varied the most among birthing people of different races in the postpartum category only. Non-Hispanic Black birthing persons were more likely to be depressed than their non-Hispanic white counterparts. Birthing persons with a prior to pregnancy diagnosis of depression were 1.6 times more likely to have a preterm birth. The odds went up to 1.9 times for those with depression during pregnancy.
Given these findings there needs to be more support addressing depression before and during pregnancy such as increasing depression screening during prenatal care and continuing advocacy surrounding mental health. There is evidence that the COVID-19 pandemic could have exacerbated depression rates and it warrants continued attention given that we are seeing continued association between having depression before and during pregnancy and adverse birth outcomes.