Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge

Apr 18, 2023American journal of perinatology

Risk Factors for Postpartum Depression and Severe Stress in Mothers of Very Early Born Infants Leaving the NICU

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Abstract

Among 562 mothers of very preterm infants, 13.5% screened positive for and 18.1% for at nursery discharge.

Mothers with previous depression or anxiety had a risk ratio of 1.6 for positive screens for postpartum depression and severe psychological distress.
Infants born to mothers with depression or severe distress were delivered at younger gestational ages and had a higher prevalence of bronchopulmonary dysplasia.
Mothers of male infants showed a higher risk of depression with a risk ratio of 1.7.
Prenatal marijuana use was associated with a significantly increased risk of severe psychological distress, with a risk ratio of 1.9.
Socioenvironmental and obstetric adversities did not significantly predict postpartum depression or severe distress after accounting for prior mental health and infant medical issues.

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OBJECTIVE: To identify psychological, medical, and socioenvironmental risk factors for maternal (PPD) and (SPD) at intensive care nursery discharge among mothers of very preterm infants.

STUDY DESIGN: We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively.

RESULTS: Unadjusted analyses indicated mothers with positive screens for depression ( = 76, 13.5%) or severe distress ( = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. n n

CONCLUSION: Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward.

KEY POINTS: · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..

Key numbers

1.6

Increase in Risk

Risk ratio for positive EPDS screen among mothers with prior mental health issues.

1.9

Increase in Risk

Risk ratio for positive BSI screen linked to prenatal marijuana use.

1.7

Increase in Depression Risk for Male Infants

Risk ratio for positive EPDS screen among mothers of male infants.

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Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge

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