Download PDF
Am J Perinatol 2019; 36(10): 1009-1013
DOI: 10.1055/s-0038-1675770
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

Jessica Y. Shim
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Elisabeth L. Stark
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Carolyn M. Ross
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Emily S. Miller
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding This work was supported by the National Institute of Health grant 5K12HD050121-09 (ESM). This work was also supported, in part, by the National Institute of Health's National Center for Advancing Translational Sciences grant UL1TR000150.
Further Information

Publication History

03 May 2018

08 October 2018

Publication Date:
30 November 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance.

Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses.

Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99).

Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

keywords

depression - mental health - mood disorder - perinatal - postpartum visit

Note

The findings from this study were presented at the 66th Annual Clinical and Scientific Meeting of the American College of Obstetrics and Gynecologists in Austin, Texas, April 27–30, 2018.


 

  • References

  • 1 Optimizing postpartum care. Committee Opinion No. 666. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016; 127: e187-e192
    CrossrefPubMedSearch in Google Scholar
  • 2 Lu MC, Kotelchuck M, Culhane JF, Hobel CJ, Klerman LV, Thorp Jr JM. Preconception care between pregnancies: the content of internatal care. Matern Child Health J 2006; 10 (5, Suppl): S107-S122
    CrossrefPubMedSearch in Google Scholar
  • 3 American Academy of Pediatrics. Guidelines for Perinatal Care, 6th ed. Washington, DC: AAP, Elk Grove Village, IL; ACOG; 2007: 170-171
    Search in Google Scholar
  • 4 U.S. Department of Health and Human Services. Healthy People 2020, Objective FP5 and MCH-19. Washington, DC. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/Maternal-Infant-and-Child-Health/objectives#4855 . Accessed February 10, 2018
    PubMed
  • 5 Centers for Disease Control and Prevention (CDC). Postpartum care visits--11 states and New York City, 2004. Morb Mortal Wkly Rep 2007; 56 (50) 1312-1316
    PubMedSearch in Google Scholar
  • 6 Weir S, Posner HE, Zhang J, Willis G, Baxter JD, Clark RE. Predictors of prenatal and postpartum care adequacy in a Medicaid managed care population. Womens Health Issues 2011; 21 (04) 277-285
    CrossrefPubMedSearch in Google Scholar
  • 7 Henderson V, Stumbras K, Caskey R, Haider S, Rankin K, Handler A. Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers. Matern Child Health J 2016; 20 (Suppl. 01) 132-143
    CrossrefPubMedSearch in Google Scholar
  • 8 Wilcox A, Levi EE, Garrett JM. Predictors of non-attendance to the postpartum follow-up visit. Matern Child Health J 2016; 20 (Suppl. 01) 22-27
    CrossrefPubMedSearch in Google Scholar
  • 9 Bennett WL, Chang HY, Levine DM. , et al. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data. J Gen Intern Med 2014; 29 (04) 636-645
    CrossrefPubMedSearch in Google Scholar
  • 10 Bryant AS, Haas JS, McElrath TF, McCormick MC. Predictors of compliance with the postpartum visit among women living in healthy start project areas. Matern Child Health J 2006; 10 (06) 511-516
    CrossrefPubMedSearch in Google Scholar
  • 11 DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014: 530769
    CrossrefPubMedSearch in Google Scholar
  • 12 Moscrop A, Siskind D, Stevens R. Mental health of young adult patients who do not attend appointments in primary care: a retrospective cohort study. Fam Pract 2012; 29 (01) 24-29
    CrossrefPubMedSearch in Google Scholar
  • 13 Kelly RH, Danielsen BH, Golding JM, Anders TF, Gilbert WM, Zatzick DF. Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995. Psychiatr Serv 1999; 50 (12) 1584-1590
    CrossrefPubMedSearch in Google Scholar
  • 14 Kelly RH, Russo J, Holt VL. , et al. Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol 2002; 100 (02) 297-304
    PubMedSearch in Google Scholar
  • 15 Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol 2000; 183 (03) 759-769
    CrossrefPubMedSearch in Google Scholar
  • 16 Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282 (18) 1737-1744
    CrossrefPubMedSearch in Google Scholar
  • 17 Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med 2007; 22 (11) 1596-1602
    CrossrefPubMedSearch in Google Scholar
  • 18 Kroenke K, Spitzer RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatr Ann 2002; 32: 509-521
    CrossrefPubMedSearch in Google Scholar
  • 19 Wisner KL, Sit DK, McShea MC. , et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70 (05) 490-498
    CrossrefPubMedSearch in Google Scholar
  • 20 Gaynes BN, Gavin N, Meltzer-Brody S. , et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 2005; (119) 1-8
    PubMedSearch in Google Scholar
  • 21 Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt) 2003; 12 (04) 373-380
    CrossrefPubMedSearch in Google Scholar
  • 22 Yonkers KA, Vigod S, Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstet Gynecol 2011; 117 (04) 961-977
    CrossrefPubMedSearch in Google Scholar
  • 23 Almeida ND, Basso O, Abrahamowicz M, Gagnon R, Tamblyn R. Risk of miscarriage in women receiving antidepressants in early pregnancy, correcting for induced abortions. Epidemiology 2016; 27 (04) 538-546
    CrossrefPubMedSearch in Google Scholar
  • 24 Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2010; 67 (10) 1012-1024
    CrossrefPubMedSearch in Google Scholar
  • 25 Hu R, Li Y, Zhang Z, Yan W. Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis. PLoS One 2015; 10 (03) e0119018
    CrossrefPubMedSearch in Google Scholar
  • 26 Siu AL, Bibbins-Domingo K, Grossman DC. , et al; US Preventive Services Task Force (USPSTF). Screening for depression in adults: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 315 (04) 380-387
    CrossrefPubMedSearch in Google Scholar
  • 27 American College of Nurse-Midwives. Position statement: depression in women. 2003 . Available at: http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000061/Depression%20in%20Women%20May%202013.pdf . Retrieved November 28, 2016
    PubMed
  • 28 Kendig S, Keats JP, Hoffman MC. , et al. Consensus bundle on maternal mental health: perinatal depression and anxiety. Obstet Gynecol 2017; 129 (03) 422-430
    CrossrefPubMedSearch in Google Scholar
  • 29 Committee on Obstetric Practice. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol 2015; 125 (05) 1268-1271
    CrossrefPubMedSearch in Google Scholar
  • 30 Morgan I, Hughes ME, Belcher H, Holmes Jr L. Maternal sociodemographic characteristics, experiences and health behaviors associated with postpartum care utilization: evidence from Maryland PRAMS Dataset, 2012-2013. Matern Child Health J 2018; 22 (04) 589-598
    CrossrefPubMedSearch in Google Scholar
  • 31 Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt) 2010; 19 (03) 477-490
    CrossrefPubMedSearch in Google Scholar
  • 32 Smith MV, Rosenheck RA, Cavaleri MA, Howell HB, Poschman K, Yonkers KA. Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv 2004; 55 (04) 407-414
    CrossrefPubMedSearch in Google Scholar
  • 33 Kelly R, Zatzick D, Anders T. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry 2001; 158 (02) 213-219
    CrossrefPubMedSearch in Google Scholar
  • 34 Himes KP, Donovan H, Wang S, Weaver C, Grove JR, Facco FL. Healthy beyond pregnancy, a web-based intervention to improve adherence to postpartum care: randomized controlled feasibility trial. JMIR Human Factors 2017; 4 (04) e26
    CrossrefPubMedSearch in Google Scholar
  • 35 McKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women's health care in the United States. Am J Obstet Gynecol 2018; 218 (03) 280-286
    Search in Google Scholar
  • 36 Yee LM, Martinez NG, Nguyen AT, Hajjar N, Chen MJ, Simon MA. Using a patient navigator to improve postpartum care in an urban women's health clinic. Obstet Gynecol 2017; 129 (05) 925-933
    CrossrefPubMedSearch in Google Scholar