Pregnancy Intention and Postpartum Depressive Symptoms: An Analysis of PRAMS Data

Background: Understanding the effect of pregnancy intention on the prevalence of postpartum depressive symptoms (PPDS) and the influence of discussing depression risk during prenatal care can inform prenatal care provision and improve maternal and child health outcomes. Objective: The aims of the study were to measure the association between pregnancy intention and PPDS and to assess how this association is modified by the dissemination of postpartum depression information during pregnancy. Methods: We conducted a population-based cross-sectional study using a sample of 140,011 births in the United States. Using Center for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2009-2012, we compared those with PPDS (N=17,800) to those without PPDS (N=122,211). We defined pregnancy intention using the categories “wanted then”, “wanted sooner”, “wanted later”, “did not want then or at any time in the future”, and “was not sure”, as well as collapsed into 3 groups (unintended, mistimed, and intended). PPDS was defined by reporting “always” or “often” to any depressive symptoms on PRAMS Phase 7, or to a composite score ≥ 10 on PRAMS Phase 6 depression questions, compared with women reporting “sometimes, “rarely”, or “never” to all depressive symptoms. We estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using Poisson regression, controlling for marital status, maternal education, insurance status, and secular year. Results: Unintended pregnancy was significantly associated with PPDS, showing a nearly two-fold increase in prevalence of PPDS relative to those with an intended pregnancy (aPR: 1.92, 95% CI: 1.78, 2.08). Women with an unintended pregnancy who did not talk to their health care worker about depression during their pregnancy were more likely to have postpartum depression than those with an intended pregnancy (aPR: 2.05, 95% CI: 1.81-2.33). This risk was attenuated for women with unintended pregnancy who did talk to their health care worker about postpartum depression, compared to women whose pregnancy was intended (aPR: 1.45, 95% CI: 1.31-1.61). Conclusions: Unintended pregnancy is one of many factors that contribute to the risk of developing postpartum depression. Women with unintended pregnancy have an increased risk of developing postpartum depressive symptoms, and discussing the risk of developing depression during prenatal care reduces this risk. The data suggest that providers should routinely discuss risk of postpartum depression with women, especially those whose pregnancy was unintended.