title: Depression During Pregnancy and Adverse Birth Outcomes Among Predominantly Puerto Rican Women.
abstract: Objectives To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a population who experiences disparities in adverse birth outcomes and one of the highest infant mortality rates in the United States. Methods Proyecto Buena Salud (PBS) was a prospective cohort study conducted from 2006 to 2011 at a large tertiary care center in Western Massachusetts. Caribbean Islander (i.e., Puerto Rican and Dominican Republic) women were interviewed in early, mid and late pregnancy. Among 1262 participants, associations between depression, assessed using the Edinburgh Postnatal Depression Scale, and risk of preterm birth and small-for-gestational age (SGA) were evaluated. Results Women with at least probable minor depression [odds ratio (OR) = 1.77 (95% confidence interval (CI) = 1.02, 3.07)] or probable major depression [OR = 1.82 (95% CI = 1.01, 3.25)] in mid-pregnancy had an increased risk of SGA compared to non-depressed women in adjusted analyses. Borderline significant associations were observed between increasing levels of depressive symptom scores in early and mid-pregnancy [OR = 1.05 (95% CI = 1.00, 1.11) and OR = 1.04 (95% CI = 1.00, 1.09), respectively] and each additional trimester of exposure to probable major depression across mid- to late pregnancy [OR = 1.66 (95% CI = 1.00, 2.74)] and SGA. Late pregnancy depression was not associated with SGA; depression during pregnancy was not associated with preterm birth. Conclusions for Practice In this population of predominantly Puerto Rican women, mid-pregnancy depression increased risk for SGA. Findings can inform culturally appropriate, targeted interventions to identify and treat pregnant women with depression.
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA. kszegda@schoolph.umass.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Szegda
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Bertone-Johnson
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
authors.forename: Penelope
authors.initials: P
authors.lastname: Pekow
authors.affiliation: Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Powers
authors.affiliation: Baystate Medical Center, Springfield, MA, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Markenson
authors.affiliation: Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Dole
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Chasan-Taber
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology*; D004293:Dominican Republic; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy / Q000523:psychology*; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D037841:Pregnant People / Q000523:psychology*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D011647:Puerto Rico; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology / Q000208:ethnology
keywords: Birth outcomes; Latina perinatal health; Prenatal depression; Preterm birth; Small-for-gestational age