Preterm birth and social support services for prenatal depression and social determinants

Rebecca Reno; Johanna Burch; Jodi Stookey; Rebecca Jackson; Layla Joudeh; Sylvia Guendelman

doi:10.1371/journal.pone.0255810

Preterm birth and social support services for prenatal depression and social determinants

PLoS One. 2021 Aug 13;16(8):e0255810. doi: 10.1371/journal.pone.0255810. eCollection 2021.

Authors

Rebecca Reno¹, Johanna Burch², Jodi Stookey³, Rebecca Jackson², Layla Joudeh², Sylvia Guendelman¹

Affiliations

¹ Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America.
² Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
³ San Francisco Department of Public Health, San Francisco, California, United States of America.

Abstract

Preterm birth (PTB; <37 weeks gestation), is a leading cause of infant mortality and morbidity. Among those born preterm, risk increases as gestational age at birth decreases. Psychosocial factors such as depression symptoms and social determinants of health (SDH) may increase risk for PTB. Research is needed to understand these risk factors and identify effective interventions. This retrospective cohort study recruited English- and Spanish-speaking women presenting symptoms of preterm labor or admitted for PTB from an urban county hospital in the San Francisco Bay Area (n = 47). We used an iterative analytic approach by which qualitative data informed an exploratory quantitative analysis. Key exposures were presence of self-reported depression symptoms during pregnancy, SDH along eight domains, and receipt of behavioral health services. The outcome was gestational age at birth. T-tests, Wilcoxon rank sum tests, and linear regression models were used to test associations between the exposures and gestational age. Most participants were Black (25.5%) or Latina (59.6%). After adjusting for covariates, participants with depression symptoms had an average gestational age 3.1 weeks shorter (95% CI: -5.02, -1.20) than women reporting no symptoms. After adjusting for covariates, high number of adverse social determinants (≥ 4) suggested an association with shorter gestational age (p = 0.07, 1.65 weeks, 95% CI: -3.44, 0.14). Receipt of behavioral health services was associated with a significantly later gestational age; the median difference was 5.5 weeks longer for depression symptoms, 3.5 weeks longer for high social determinants, and 6 weeks longer for depression symptoms and high social determinants. Among a cohort of high-risk pregnant women, both depression symptoms during pregnancy and co-occurring with exposure to high adverse SDH are associated with shorter gestational age at birth, after controlling for psychosocial factors. Receipt of behavioral health services may be an effective intervention to address disparities in PTB.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Depression / ethnology
Depression / pathology*
Female
Gestational Age
Humans
Linear Models
Pregnancy
Premature Birth / psychology*
Retrospective Studies
Self Report
Social Determinants of Health / ethnology
Social Support*

Grants and funding

This study was supported by the Preterm Birth Initiative at the University of California, San Francisco. https://pretermbirthca.ucsf.edu/ Funding was awarded to RJ and JS. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.