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

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.