Effects of a recent pregnancy loss on maternal mental health among women with a recent live birth, PRAMS, 2012-2016 Público
Smith, Julie A. (Spring 2019)
Abstract
Background: Approximately 20% of women experienced a pregnancy loss in the United States between 1990 and 2011 (1). Much is known about the adverse association between a pregnancy loss and postpartum depression, but less is known about the experience of postpartum depression after a subsequent live birth. Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), we sought to (1) estimate the proportion of women with a recent live birth who experienced a pregnancy loss in the 12 months prior to conception and (2) determine if there are differences in self-reported postpartum depression for mothers of a recent live birth who experienced a pregnancy loss in the year before conceiving compared to those without a recent pregnancy loss.
Methods: Bivariate and multivariable associations were estimated using predicted marginals from log-binomial regression models. We controlled for confounding by marital status; maternal age, race, and education; previous number of live births; and stress. Additionally, we stratified our multivariable analyses by history of depression/anxiety and by pregnancy intention of the subsequent pregnancy. To account for the complex survey design in PRAMS, all analyses were conducted using SAS-callable SUDAAN.
Results: Among women with a recent live birth in the United States, 12.8% conceived their infant within 12 months of a pregnancy loss (SE = 0.4). For these mothers, there was a 15% increase in the prevalence of postpartum depression compared to women with a recent live birth and no recent pregnancy loss (aPR: 1.15, 95% CI: 0.98, 1.36). The effect of a previous pregnancy loss on postpartum depression was stronger for women with a history of depression or anxiety and for those who had not intended to become pregnant.
Conclusions: A substantial number of women in the United States with a recent live birth had experienced a pregnancy loss in the 12 months prior to conception. These women may be at an increased risk for postpartum depression, particularly if they have a history of depression or if the subsequent pregnancy was unintended.
Table of Contents
Distribution Agreement………………………………………………….....…………..1
Abstract……………………………………………………………………….......…....….4
Chapter I: Background………………………………………………………….....…....8
Pregnancy Loss…………………………………………………………………....…...8
Postpartum Depression and Anxiety………………………………….....…......13
Intersection of Pregnancy Loss and Postpartum Depression/Anxiety.....17
Statement of Need……………………………………………………………....…...24
Chapter II: Manuscript…………………………………………………………......….26
Introduction………………………………………………………………….......……26
Methods………………………………………………………………………........…..28
Results……………………………………….…………………………………........…32
Discussion………………………………….……………………………….......……..35
References………………………………………………………………………........…..40
Tables……………………………………………………………………………..........….49
Chapter III: Summary, Public Health Implications,
Possible Future Directions………………………………………………….....…...52
Appendix………………………………………………………………………….........…54
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