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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(10): 1396-1408
DOI: 10.1055/s-0043-1768132
Original Article

Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge

Julie A. Hofheimer 
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Elisabeth C. McGowan
2   Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
,
Lynne M. Smith
3   Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
,
Samantha Meltzer-Brody
4   Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Brian S. Carter
5   Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
,
Lynne M. Dansereau
6   Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
,
Steven Pastyrnak
7   Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
,
Jennifer B. Helderman
8   Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
,
Charles R. Neal
9   Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
,
Sheri A. DellaGrotta
6   Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
,
Thomas Michael D. O'Shea
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Barry M. Lester
10   Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
11   Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
› Author Affiliations
Funding This study was funded by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant no.: R01HD072267.
› Further Information
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Abstract

Objective To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants.

Study Design We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively.

Results Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1–2.2) and severe distress (RR: 1.6, 95% CI: 1.1–2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1–2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1–2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications.

Conclusion Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward.

Key Points

  • Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.

  • Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.

  • Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes.

Keywords

postpartum depression - severe psychological distress - prenatal marijuana use - very preterm infants

Authors' Contributions

All authors contributed to reviewing, revising, and approval of the final submitted manuscript, and agree to be accountable for all aspects of the work. In addition: J.A.H. conceptualized and designed this manuscript, co-led the overall conceptualization, design, and funding acquisition of the NOVI Study, and led the study site teams in protocol implementation and data collection. E.S.M., L.M.S., B..S.C., and C.R.N. contributed to the conceptualization and design of the manuscript and led their respective site teams in study implementation. S.M.-B. contributed to the design of the maternal data collection protocol and the development of the manuscript. L.M.D. developed the database for this manuscript and conducted statistical analyses. T.M.D.O. and B.M.L. co-led the conceptualization and design of the NOVI study. J.B.H. and S.P. led their respective site teams in study implementation. S.A.D. worked with the study site teams on protocol implementation and designed data collection instruments.


Role of the Funder

National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) had no role in the design and conduct of the study or the collection, management, analysis, and interpretation of the data. NICHD project officers reviewed and approved the human subjects protections and protocol funds initially and on annual reports.


Supplementary Material



Publication History

Received: 27 October 2022

Accepted: 03 February 2023

Article published online:
18 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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