(903) Impact of Pre-Pregnancy Depressive Disorders on Adverse Perinatal Outcomes

The rate of mental health disorders continues to rise in the United States. While post-partum mental health for pregnant patients is often examined, the impact of pre-pregnancy mental health on perinatal outcomes is also large. We sought to examine the impact of a pre-pregnancy depressive disorder diagnosis on adverse perinatal outcomes.

Study Design:

This is a retrospective cohort study of singleton non-anomalous pregnancies from 23-42 weeks gestation in the state of California from 2008-2019. We further excluded patients with Type 1 diabetes and Type 2 diabetes mellitus. Multivariable logistic regressions were also conducted to further evaluate the relationship between a diagnosed depressive disorder and adverse perinatal outcomes while controlling for maternal age, BMI, race/ethnicity, education, prenatal care, insurance status, and parity.

Results:

In our cohort of 4,902,521 pregnancies, 87,556 (1.79%) had a diagnosis of a prenatal depressive disorder. Patients with a pre-pregnancy depressive disorder had increased odds of delivery before 32 weeks (1.65 (1.55, 1.76), delivery before 37 weeks (1.54 (1.51, 1.58)), preeclampsia (1.42 (1.38, 1.47)) as well as severe maternal morbidity (1.83 (1.74, 1.93)). Odds of cesarean delivery were found to be decreased in multiparous women who had a prior cesarean delivery (0.76 (0.71, 0.81)), and increased in those without a prior cesarean delivery (1.71 (1.13, 1.21)). When examining neonatal outcomes, patients with a pre-pregnancy depressive disorder had increased odds of NICU admission (1.15 (1.12, 1.18)), APGAR scores of < 7 at 5 minutes (2.00 (1.89, 2.10)), hypoglycemia (1.58 (1.51, 1.65)), respiratory distress syndrome (1.78 (1.72, 1.85)), neonatal death (1.59 (1.30, 1.95)) and infant death (1.59 (1.39, 1.81)) (Table 1).

Conclusion: Depressive disorders are associated with significantly increased risks of several adverse maternal and neonatal outcomes. This indicates that prioritizing mental health treatment can lead to improved perinatal outcomes.