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Preterm birth and social support services for prenatal depression and social determinants

Rebecca Reno1, Johanna Burch2, Jodi Stookey3

  • 1Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America.

Plos One
|August 13, 2021
PubMed

Insights

Depression symptoms and social determinants of health (SDH) in high-risk pregnancies are linked to shorter gestational age. Behavioral health services may help increase gestational age at birth.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Mental Health
  • Health Disparities

Background:

  • Preterm birth (PTB) is a major cause of infant mortality and morbidity, with risk increasing as gestational age at birth decreases.
  • Psychosocial factors, including depression symptoms and social determinants of health (SDH), are potential contributors to PTB.
  • Understanding these risk factors is crucial for developing effective interventions to reduce PTB rates.

Purpose of the Study:

  • To investigate the association between depression symptoms, SDH, and gestational age at birth in a high-risk pregnant population.
  • To explore the impact of receiving behavioral health services on gestational age among women experiencing PTB risk factors.
  • To inform interventions aimed at mitigating PTB and associated health disparities.

Main Methods:

  • Retrospective cohort study of 47 English- and Spanish-speaking women presenting with preterm labor symptoms or admitted for PTB.
  • Qualitative data informed an exploratory quantitative analysis of depression symptoms, eight domains of SDH, and receipt of behavioral health services.
  • Statistical analyses included t-tests, Wilcoxon rank sum tests, and linear regression models to assess associations with gestational age at birth.

Main Results:

  • Participants with depression symptoms had an average gestational age 3.1 weeks shorter than those without symptoms, after covariate adjustment.
  • High adverse SDH (≥ 4 domains) showed a trend towards association with shorter gestational age (p=0.07).
  • Receipt of behavioral health services was associated with significantly longer gestational age: 5.5 weeks longer for depression, 3.5 weeks longer for high SDH, and 6 weeks longer for both.

Conclusions:

  • Both depression symptoms during pregnancy and co-occurring high adverse SDH are associated with shorter gestational age at birth in high-risk women.
  • Behavioral health services may serve as an effective intervention to counteract the negative effects of depression and SDH on gestational age.
  • These findings highlight the importance of addressing psychosocial factors and SDH to reduce PTB disparities.

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