Association between antepartum admission and postpartum depressive symptoms

Background

Postpartum depression affects 14% of pregnant individuals and is a leading cause of preventable maternal mortality. Complications of pregnancy, such as preterm labor or pre-eclampsia, may require hospitalization for close monitoring and management. The impact of an antenatal hospitalization during pregnancy on postnatal depression remains understudied.

Objective

To evaluate whether hospital admission during pregnancy was associated with postpartum depressive symptoms in individuals who were enrolled in a collaborative care model and to evaluate whether enrollment in the collaborative care model during pregnancy mitigated this association.

Study Design

This secondary analysis of a prospective cohort study included perinatal people enrolled in a collaborative care model at a quaternary academic center between 2017 and 2021. The primary outcome was presence of moderately severe or severe postpartum depressive symptoms at 6 weeks postpartum defined as a score of 15 or greater on a PHQ-9. The prevalence of symptoms of this severity was compared between those who experienced an antepartum hospitalization and those who did not using bivariable and multivariable analyses. A Breslow Day test was used to evaluate whether any observed association between antepartum hospitalization and postpartum depressive symptoms differed based on timing of enrollment in the collaborative care model.

Results

During the study period, 1897 individuals met inclusion criteria. Of these, 162 (8.5%) were admitted to the hospital during pregnancy. Of those with an antepartum hospitalization, 20 (12.4%) developed moderately severe to severe postpartum depressive symptoms compared to 136 (7.8%) of those who were not hospitalized (p=.046). After adjustment for confounders identified through use of a directed acyclic graph, this difference did not persist in multivariable analysis (aOR 1.55, 95% CI [0.87−2.75]). A Breslow Day test demonstrated heterogeneity across enrollment timing, so subgroup analyses were performed for those enrolled during pregnancy (n=930) vs postpartum (n=967). Hospital admission was associated with higher rates of moderately severe to severe postpartum depressive symptoms in those enrolled in the collaborative care model postpartum (19.7% vs 10.6%, p=.015, aOR 2.25, 95% CI [1.07−4.71]), but not those enrolled antenatally (5.8% vs 5.0%, p=.735, aOR 1.09, 95% CI [0.38−3.19]).

Conclusion

Antepartum hospital admission was associated with higher rates of moderately severe to severe depressive symptoms. This association did not exist among individuals enrolled in collaborative care model during pregnancy, suggesting a potential protective effect afforded by engagement in a mental health support programming.