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)

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.

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
  • 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
  • 3 American Academy of Pediatrics. Guidelines for Perinatal Care, 6th ed. Washington, DC: AAP, Elk Grove Village, IL; ACOG; 2007: 170-171
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 11 DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014: 530769
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 18 Kroenke K, Spitzer RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatr Ann 2002; 32: 509-521
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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