OBJECTIVE: Depression is associated with a number of risks in pregnancy including increased rates of cesarean delivery, pretermbirth, and preeclampsia. This study aimed to examine how access to prenatal care prior to the third trimester affected these outcomes in pregnancy. STUDY DESIGN: This is a retrospective cohort study of linked vital statistics and hospital discharge data among singleton, non-anomalous births in California between 2005 and 2008 to compare outcomes of all women with depression who received prenatal care prior to the third trimester versus women who received no prenatal care. Outcomes included birthweight, intrauterine fetal demise, neonatal demise, severe preeclampsia, preterm delivery at 32 weeks and neonatal death. To compare outcomes we used bivariate statistics (chisquare) and multivariate logistic regression, controlling for age, parity, gestational age, ethnicity, socioeconomic status, and substance abuse. RESULTS: Of the 14,247 women with depression in our sample, those with no prenatal care prior to third trimester of gestation had higher risk of intrauterine fetal demise (9.6 per 1,000 vs. 2.7 per 1,000, p=0.011), neonatal death (7.3 per 1,000 vs 1.4 per 1,000, p=0.003), preterm delivery before 32weeks (2.6%vs 1.2%, p=0.009) and severe preeclampsia (3.2%vs 1.6%, p=0.016).When controlling for potential confounders, the differences seen in the bivariate analyses persisted in the multivariable results, except for FGR (<10%for gestational age). There were no statistical differences seen in rates of cesarean. CONCLUSION: In women with depression during pregnancy, a lack of prenatal care prior to the third trimester of pregnancy is associated with greater odds of neonatal and maternal morbidities, as well as fetal and neonatal mortality. These associations should be considered when providing care to pregnant women with depression, especially if first presenting late in gestation. Additionally, further examination of the obstacles limiting access to early prenatal care in this patient population should be pursued. (Table Presented).
Wetzel, S., Valent, A., Aviram, A., Ameel, B., & Caughey, A. B. (2016). 658: The impact of prenatal care on pregnancy outcomes in women with depression. American Journal of Obstetrics and Gynecology, 214(1), S349. https://doi.org/10.1016/j.ajog.2015.10.704