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Primary Submission Category: Reproductive health
Preterm Birth and Postpartum Depression: The Role of Prenatal Care Adequacy and Maternal Nativity
Authors: Tenzin Khando,
Presenting Author: Tenzin Khando*
Preterm birth is a major public health concern associated with adverse maternal and infant outcomes, including postpartum depression (PPD), yet less is known about wheter prenatal care adequacy and maternal nativity shape this relationship. This study examines the association between preterm birth and postpartum depression and assesses whether prenatal care adequacy and nativity modify this association. Data come from the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2020–2021), a population-based surveillance system of mothers with recent live births in the United States (N = 56,778). Preterm birth was defined as delivery before 37 weeks of gestation. Postpartum depression was measured using PRAMS indicators of persistent sadness, hopelessness, or loss of interest after childbirth. Prenatal care adequacy was assessed using the Adequacy of Prenatal Care Utilization (APNCU; Kotelchuck) Index.
Survey-weighted logistic regression models showed that 9.1% of mothers experienced a preterm birth and 13.2% reported symptoms consistent with postpartum depression. In adjusted models, preterm birth was associated with higher odds of postpartum depression (OR = 1.31, 95% CI: 1.23–1.39). Prenatal care adequacy was modestly associated with PPD in partially adjusted models but did not significantly modify the association between preterm birth and postpartum depression. Predicted probabilities suggested persistent disparities in PPD risk among foreign-born mothers across prenatal care categories. These findings indicate that while preterm birth is associated with increased postpartum depression risk, adequacy of prenatal care visits alone may not mitigate this association, highlighting the role of broader structural and psychosocial factors shaping maternal mental health. Strengthening postpartum mental health screening and improving the quality and cultural responsiveness of perinatal care may help address disparities in maternal mental health outcomes.