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Primary Submission Category: Reproductive health
Examining the Association between Stillbirth and Depression in Subsequent Pregnancies
Authors: Rebecca Woofter, Mark McGovern, Slawa Rokicki,
Presenting Author: Rebecca Woofter*
In the U.S., over 20,000 pregnancies result in fetal demise at 20+ weeks of gestation, also known as stillbirths. Existing literature has shown that those who experience stillbirths are at risk of depression following the stillbirth, but less is known about mental health in subsequent pregnancies. In this population-based retrospective cohort study, we examine the association between prior birth outcome (livebirth vs. stillbirth) and perinatal depression in the subsequent pregnancy.
We analyzed linked data for all birth records and hospital discharge records in New Jersey from 2016-2021. Stillbirths were identified in hospital records through ICD-10 diagnosis and procedure codes. Depressive symptoms were assessed in the immediate postpartum period based on scores of 10+ (out of 30) on the Edinburgh Postnatal Depression Scale (EPDS). New Jersey mandates screening with the EPDS in the hospital after delivery and prior to discharge and screening results are recorded on birth records. We compared EPDS scores for those who had a stillbirth followed by a live birth (N=463) with those who had a live birth followed by a live birth (N=175,401) using multivariable logistic regression.
While 3.6% of those with a prior live birth had depressive symptoms, 6.3% of those with a prior stillbirth had depressive symptoms. After matching those in each group by maternal sociodemographic (e.g., race/ethnicity, age, education) and health characteristics (e.g., delivery type, preterm birth, hypertension), those with a prior stillbirth had 52% higher odds (95%CI: 1.04-2.22) of depressive symptoms.
These findings demonstrate that those with prior stillbirths may be at greater risk of depression in a subsequent pregnancy. Identifying and treating perinatal mental health conditions is a key priority to improve maternal and infant health. Healthcare providers should ensure that patients with prior stillbirths are screened for mental health conditions and referred for treatment as needed.