Objective To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. Study Design This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Results Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31–1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06–3.61). Conclusion Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.
Objective This study was aimed to determine the association between antenatal depression and breastfeeding initiation and continuation at 6 weeks postpartum. Study Design This retrospective cohort study included all live-born deliveries after 24weeks' gestation at a single tertiary care institution between 2009 and 2014 with a documented antenatal depression screen using the Patient Health Questionnaire-9 (PHQ-9). During the study period, it was recommended that routine screening occur during both the first and third trimesters. A positive screen was defined as a PHQ-9 score ≥ 10. Breastfeeding initiation and continuation until 6 weeks' postpartum were compared between women with and without a positive screen using bivariable analyses. Stepwise backward elimination regressions were used to identify whether a positive screen was independently associated with breastfeeding rates after controlling for confounders. Results Among the 2,871 women meeting inclusion criteria, 302 (10.5%) were screened positive for antenatal depression. After adjusting for confounders, there were no differences in breastfeeding initiation (adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.52–1.16), but women with a positive antenatal depression screen were significantly less likely to continue breastfeeding at 6 weeks' postpartum (aOR= 0.67, 95% CI: 0.48–0.96). Conclusion A positive antenatal depression, screened in the first or third trimester, is a significant risk factor for early breastfeeding cessation.
INTRODUCTION: Perinatal depression complicates 1 in 7 pregnancies and has adverse consequences when untreated. These may include failure to breastfeed and its known adverse effects on mother and offspring. This study sought to determine whether maternal antenatal depression was associated with the likelihood of breastfeeding initiation and continuation until the 6-week postpartum visit. METHODS: This retrospective chart study included all deliveries after 20 weeks gestation at a single tertiary care institution between 2008 and 2015 with a documented antenatal depression screen using the Patient Health Questionnaire-9 per standard obstetric care. Breastfeeding initiation and continuation until 6 weeks postpartum were compared between women with and without a positive screen using bivariable analyses. Stepwise backwards elimination regressions were used to identify whether antenatal depression was independently associated with breastfeeding initiation and continuation. RESULTS: Of 2,871 women meeting inclusion criteria, 302 (10.5%) screened positive for antenatal depression. Women with antenatal depression were more likely to be younger, a racial/ethnic minority, obese, have public insurance or medical co-morbidity, and deliver preterm than women without depression. Women with antenatal depression were less likely to initiate breastfeeding (81.0% versus 86.3% P=.014) and continue breastfeeding at 6 weeks postpartum (54.7% versus 68.9% P<.001). After controlling for confounders, antenatal depression was not independently associated with breastfeeding initiation (aOR 0.78, 95% CI 0.52–1.16) but did remain significantly associated with reduction in breastfeeding continuation (aOR 0.67, 95% CI 0.48–0.96). CONCLUSION: Antenatal depression is a significant risk factor for early breastfeeding cessation. Further interventions to improve breastfeeding rates should include evaluation of maternal mental health.
Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed “diabesity”) and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity. Finally, we present future directions for research and clinical intervention.
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