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APHA Scientific Session and Event Listing

Recorded presentation

Louise H. Flick, DrPH¹, Cynthia A. Loveland Cook, PhD², Jen Jen Cheng, PhD³, Sharon M. Homan, PhD³, Claudia Campbell, PhD⁴, Maryellen McSweeney, PhD⁵, Lisa Parnell, MSW⁶, Mary Elizabeth Gallagher, PhD⁷, and Leigh Tenkku, MPH⁸. (1) School of Nursing, Southern Illinois University Edwardsville, Box 1066, Edwardsville, IL 62026-1066, 314-692-2383, lflick@siue.edu, (2) School of Social Service, St. Louis University, 3550 Lindell Blvd., St. Louis, MO 63103-1024, (3) School of Public Health, St. Louis University, 3545 Lafayette Ave, St. Louis, MO 63104, (4) School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA 70112-2824, (5) School of Nursing, Professor Emeritus, St. Louis University, 3525 Caroline Mall, St. Louis, MO 63104, (6) Social Services, St. Luke's Hospital, 337 Winchester Drive, , MO, Winchester, MO 63021, (7) Mission and Ministry, St. Louis University, 3711 West Pine Mall, St. Louis, MO 63108, (8) School of Medicne, St. Louis University, 1320 South Grand Blvd., St. Louis, MO 63104-1087

While studies suggest associations between prenatal psychiatric disorders and poor birth outcomes, most address only a few diagnoses and few adequately control for confounding variables. This community cohort study examines associations between birth outcomes and having a current psychiatric disorder and chronicity and severity of distress, measured as high lifetime symptoms across diagnoses. A representative sample of 744 pregnant women, recruited from urban and rural WIC nutrition sites, received a standardized diagnostic psychiatric interview (DIS-IV) covering 20 diagnoses. Analyses used 605 cases with live births and complete birth certificate data. Thirty percent had prenatal psychiatric disorders, 9.8% low birth weight (LBW<2500 gm) and 1.6% very low birth weight (VLBW<1500 gm) births, with 15.6% born preterm (<37 completed weeks), 2.5% very preterm (<32 completed weeks), 13.5% small for gestational age (SGA< the 10th percentile by gender and race) and 2% both preterm and SGA. Hierarchical logistic regression tested associations while controlling for confounders and variables on the causal path (maternal weight gain for BMI and number of cigarettes). Pregnant women with current disorders delivered 4.6 times more VLBW babies than healthy women (95% CI 1.13, 14.90), independent of race, age, abruptio placenta, weight gain and number of cigarettes. Mothers with high lifetime symptoms had 4.4 times more VLBW births (95% CI 1.18, 16.48) and both variables were significantly associated with 3 times the risk of births that were both SGA and preterm. The findings support the importance of prenatal psychiatric screening and further research to identify the associated mechanism.

Learning Objectives:

• Recognize the prevalence of psychiatric disorder in pregnancy.
• Articulate current knowledge about the risks of poor birth outcomes associated with psychiatric disorder in pregnancy.
• Discuss potential mechanisms for a relationship between prenatal psychiatric disorder and birth outcomes.

Keywords: Psychiatric Epidemiology, Pregnancy Outcomes

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation