title: Lengthened predelivery stay and antepartum complications in women with depressive symptoms during pregnancy.
abstract: Abstract Background: It is crucial to understand the timing and mechanisms behind depression's effect on peripartum stay because attempts to intervene will vary based on the time period involved. We designed this study to compare predelivery and postdelivery length of stay in women with and without elevated depressive symptoms during pregnancy.
  
  
  METHODS
  This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D) during pregnancy at a mean of 25.8 weeks' gestation. We used time-stamped data to compare total peripartum, predelivery, and postdelivery lengths of stay in women with and without elevated depressive symptoms during pregnancy. In addition, we used a Cox proportional hazards regression model to evaluate potential mechanisms for depression's effect on length of stay.
  
  
  RESULTS
  The study sample included 802 pregnant women. Overall, 18% of study subjects scored ≥16 on the CES-D. Bivariate analyses demonstrated a significant association between elevated depressive symptoms and longer predelivery stays (time from admission to delivery). Interaction analyses demonstrated a significant interaction effect between depressive symptoms and parity, such that depressive symptoms were significantly associated with predelivery length of stay in multiparas but not so in primiparous subjects. In a multivariate model of multiparous subjects, depression's effect on length of stay was partially influenced by sociodemographic confounders but remained significant until antepartum complications were added to the model.
  
  
  CONCLUSIONS
  Depressive symptoms during pregnancy are significantly associated with a subsequent increase in predelivery length of stay, and this association is mediated in part by antepartum complications, even after controlling for sociodemographic factors. These longer hospital stays can present significant burdens to the patient, her family, and the healthcare system. Future studies should evaluate whether interventions for depression during pregnancy can impact this relationship among depressive symptoms during pregnancy, antepartum complications, and extensive predelivery hospitalizations.
authors.affiliation: Department of Obstetrics and Gynecology, Georgia Health Sciences University, 1120 15th Street, Augusta, GA 30912, USA. cpalladino@georgiahealth.edu
authors.forename: Christie Lancaster
authors.initials: CL
authors.lastname: Palladino
authors.forename: Heather A
authors.initials: HA
authors.lastname: Flynn
authors.forename: Caroline
authors.initials: C
authors.lastname: Richardson
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Marcus
authors.forename: Timothy R B
authors.initials: TR
authors.lastname: Johnson
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008824:Michigan / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology*; D011256:Pregnancy Outcome; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D055815:Young Adult