, Volume 12, Issue 3, pp 289-299
Date: 03 May 2011

Unintended Pregnancy and Perinatal Depression Trajectories in Low-Income, High-Risk Hispanic Immigrants

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Abstract

Perinatal depression is a prevalent and detrimental condition. Determining modifiable factors associated with it would identify opportunities for prevention. This paper: 1) identifies depressive symptom trajectories and heterogeneity in those trajectories during pregnancy through the first-year postpartum, and 2) examines the association between unintended pregnancy and depressive symptoms. Depressive symptoms (BDI-II) were collected from low-income Hispanic immigrants (n=215) five times from early pregnancy to 12-months postpartum. The sample was at high-risk for perinatal depression and recruited from two prenatal care settings. Growth mixture modeling (GMM) was used to identify distinct trajectories of depressive symptoms over the perinatal period. Multinomial logistic regression was then conducted to examine the association between unintended pregnancy (reported at baseline) and the depression trajectory patterns. Three distinct trajectory patterns of depressive symptoms were identified: high during pregnancy, but low postpartum (“Pregnancy High”: 9.8%); borderline during pregnancy, with a postpartum increase (“Postpartum High”: 10.2%); and low throughout pregnancy and postpartum (“Perinatal Low”: 80.0%). Unintended pregnancy was not associated with the “Pregnancy High” pattern, but was associated with a marginally significant nearly four fold increase in risk of the “Postpartum High” pattern in depressive symptoms (RRR=3.95, p<0.10). Family planning is a potential strategy for the prevention of postpartum depression. Women who report unintended pregnancies during prenatal care must be educated of their increased risk, even if they do not exhibit antenatal depressive symptoms. Routine depression screening should occur postpartum, and referral to culturally appropriate treatment should follow positive screening results.

Dr. Christensen completed this research for her doctoral dissertation at The Johns Hopkins Bloomberg School of Public Health and is currently employed by Mathematica Policy Research. Funding for this study was provided by grant R40 MC 02497 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services (PI: Le). Dr. Christensen’s time was supported by a dissertation grant (1R36DP001880-01) from the Centers for Disease Control and Prevention. Dr. Stuart’s time was partially supported by Award K25MH083846 from the National Institute of Mental Health.