224399 Postpartum Depression: Is the rate higher in women at risk for substance abuse during pregnancy?

Wednesday, November 10, 2010

Debbie A. Postlethwaite, RNP, MPH , Division of Research, Kaiser Permanente, Oakland, CA
MaryAnne Armstrong, MA , Division of Research, Kaiser Permanente, Oakland, CA
Lue-Yen Tucker, BA , Division of Research, Kaiser Permanente, Oakland, CA
Judith Lamberti, MD , Department of Ob-Gyn, Kaiser Permanente, Northern California, Oakland, CA
In the US, 12% of women report alcohol use during pregnancy with 1.9% reporting binge drinking. Overall, 12% of US women report postpartum depressive disorders with 6% reporting postpartum depression (PPD). In a California managed care setting, pregnant women are routinely screened for substance abuse by a voluntary program called Early Start. PPD screening was routinely performed during the study period using the Edinburgh Postpartum Depression Screening questionnaire (EPDS).

A retrospective cohort study of 4011 postpartum women were evaluated for evidence of screening for substance abuse during pregnancy and for PPD. Using the EPDS scores, rates of PPD were compared between women with or without risk for substance abuse using Chi-square and Fisher Exact tests. Logistic regression models were used to evaluate other contributing risk factors for PPD.

Out of 1888 women with an EPDS, 109 (5.8%) had scores of 14 or higher (high risk for PPD) and 1779 (94.2%) scored lower. PPD rates were higher but not significantly different in women at risk for substance abuse compared to women not at risk (8.2% vs. 5.6%, p=0.17). History of depression (OR 2.4) or Black race (OR 2.1) were significant predictors of PPD but age, income, marital status, pregnancy intention and education were not.

The PPD rate for this managed care cohort was similar to the reported national rate, with race and history of depression as significant predictors. The slightly higher rate of PPD among women with a history of substance abuse may also be clinically meaningful.

Learning Areas:
Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Discuss and review the results of the study comparing postpartum depression rates between women with and without risks for substance abuse during pregnancy. 2. Discuss and contrast predictors for postpartum depression found in this study's results compared to the published literature.

Keywords: Substance Abuse, Perinatal Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was an investigator on the study and primary author of the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.