1105 Edinburgh postnatal depression scores and postpartum healthcare utilization

Abstract

To investigate the association of antepartum Edinburgh Postnatal Depression Scores (EPDS) on postpartum healthcare utilization. This was a secondary analysis of a randomized, non-blinded trial comparing the timing of postpartum visits (PPV) in a single academic center. Prospective variables collected included demographics, delivery outcomes, postpartum visits to the emergency department (ED) and clinic and EPDS in the antepartum period and immediately postpartum prior to discharge from the hospital. Univariable receiver operating characteristics (ROC) curves and Spearman correlation were utilized. Multivariable logistic regression was performed to adjust for confounders of attendance at the clinic and ED. Between November 2018 and March 2020, 256 patients were randomized, and outcome data are available for 250. The patient population had multiple underlying comorbidities, notably obesity (53%), diabetes (30%), mental health disorders (22%) and hypertensive disorders (21%). Eighteen women (7%) in the cohort utilized the ED within 30 days of delivery with the median attendance on postpartum day 10 (IQR 7.5-20). An elevated antepartum EPDS score >10 was more common among patients who used the ED compared to those who did not (47% vs 17%, p=0.004) (Table 1) with an area under the curve (AUC) of 0.648. (Figure 1) Inpatient EPDS were not associated with postpartum ED usage. A consult with a social worker during the delivery hospitalization was more common among those who utilized the ED (72% vs 29%, p<0.001) and was the strongest predictor after adjusting for confounders (aOR 5.43 [1.38-21.4]). There were no other demographic and clinical variables predictive of ED usage. Twenty one women (8%) presented to the clinic for an urgent postpartum visit and were more likely to have an antepartum EPDS >13 (31% vs 12%, p=0.027, aOR 7.93 [1.32-47.7]) An elevated EPDS in the antepartum time period is associated with postpartum emergency department use and urgent clinic visits. Close postpartum follow-up may be warranted for women with elevated EPDS during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)