Prenatal depressive symptoms and social support: An examination of their role in prenatal care adequacy, birth outcomes, and risk for postpartum depressive symptoms among low-income urban women

Abstract

Background. Decreasing the prevalence of inadequate prenatal care, poor birth outcomes, and postpartum depression are public health priorities. Objectives. To examine, in a low-income, racially diverse, urban clinic-based sample the associations of: 1) Social support and depressive symptoms with prenatal care adequacy. 2) Social support and depressive symptoms with poor birth outcomes. 3) Prenatal and postpartum depressive symptoms, as well as their magnitude, and correlates of occurrence. Methods. The study sample was women who received prenatal care at five community health centers from 2005-2009. Maternal data from prenatal and postpartum risk screening tools were linked to data from their infants’ birth certificates. We examined the associations of social support and prenatal depressive symptoms with late and less than adequate prenatal care (Paper 1, n = 2,341) and preterm birth, low birthweight, and small size for gestational age (Paper 2, n = 2,868). We also characterized depressive symptoms in the prenatal and postpartum periods (Paper 3, n = 594). For all papers, multivariable analyses included personal, social, behavioral, and environmental risk factors associated with maternal and infant health. Results. Lack of social support was associated with inadequate prenatal care. Women with poor partner support and depressive symptoms were at the highest risk for starting care late. Neither prenatal depressive symptoms nor social support were independently associated with birth outcomes. There was an association between prenatal and postpartum depressive symptoms. Over half of women with postpartum symptoms had elevated symptoms prenatally. Variability in risk markers suggest unique risk factors are associated with experiencing depressive symptoms in either or both time periods. Conclusions. This study assessed understudied psychosocial risks with public health priority outcomes in a sample of women served by the public health system. Findings support efforts to increase screening for prenatal depression to better identify those at risk of postpartum depression.