Duration of Maternal Stress and Depression: Predictors of Newborn Admission to Neonatal Intensive Care Unit and Postpartum Depression.
BACKGROUND
Maternal psychosocial factors contribute to adverse pregnancy outcome, but very few studies have assessed associations of duration and experiences of stress, depression, and intimate partner violence (IPV) with maternal and newborn outcomes.


OBJECTIVE
It was hypothesized that duration and level of maternal stress, depression, and IPV would predict increased risk of adverse maternal/newborn outcomes.


METHODS
A secondary data analysis of a population-based data set collected by the Utah Department of Health Pregnancy Risk Assessment and Monitoring System and birth certificates for 4682 live births was conducted, reflecting a total population size of 143,373 live births in 2009-2011. Exposures of interest were experiences and duration of maternal stress, depression, and IPV before and during pregnancy. Outcomes were gestational age, birth weight, newborn admission to the neonatal intensive care unit (NICU), and postpartum depression (PPD) symptoms and diagnosis.


RESULTS
After controlling for maternal demographics, body mass index, and smoking, women with greater duration of depression before and during pregnancy showed an increase in admission of their newborn to NICU (adjusted odds ratios [aORs] = 1.66-2.48, p < .001), PPD symptoms (aORs = 3.94-9.13, p < .001), and diagnosis of PPD (aORs = 7.72-59.60, p < .001). More kinds of experiences of maternal stress were associated with higher odds of PPD symptoms (aORs = 1.34-5.51, p < .001), but not PPD diagnosis or NICU admissions.


CONCLUSIONS
Longer lasting maternal depression and stress are associated with poorer outcomes for mothers and newborns. Future prospective studies should evaluate the usefulness of preconception and continuous prenatal risk identification of maternal depression and stress. This would facilitate timely psychosocial interventions as an approach to improving maternal/newborn outcomes for these higher risk women.
Gwen Latendresse, CNM, PhD, FACNM, is Associate Professor; Bob Wong, PhD, is Director of Applied Statistics; Jane Dyer, CNM, FNP, MBA, PhD, FACNM, is Assistant Professor; and Barbara Wilson, PhD, RNC-OB, is Associate Professor, University of Utah College of Nursing, Salt Lake City. Laurie Baksh, MPH, is Manager, Maternal and Infant Health Program, Utah Department of Health, Salt Lake City. Carol Hogue, MPH, PhD, is Professor, Rollins School of Public Health, Emory University, Atlanta, GA.
Gwen
G
Latendresse
Bob
B
Wong
Jane
J
Dyer
Barbara
B
Wilson
Laurie
L
Baksh
Carol
C
Hogue
D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D019992:Databases as Topic; D003863:Depression / Q000453:epidemiology*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology*; D017579:Domestic Violence; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009035:Mothers / Q000523:psychology*; D010343:Patient Admission; D011247:Pregnancy; D018570:Risk Assessment; D012494:Sampling Studies; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014589:Utah / Q000453:epidemiology; D055815:Young Adult