1126: Early pregnancy stress and depression: differences among race and parity

Abstract

Socioeconomic deprivation, stress, and depression are associated with poor pregnancy outcomes. How race and parity interact with social deprivation to influence stress and depression is unknown. In this analysis, we examined the association between high deprivation and maternal stress and depression in early pregnancy, as influenced by race and parity. This analysis was part of a prospective cohort study designed to identify novel markers for preterm delivery. Area of deprivation index (ADI) was derived from participants’ address using the “Neighborhood Atlas” (University of Wisconsin) and state census data. ADI score is based on various factors contributing to socioeconomic advantage/disadvantage (education, housing etc.) The Perceived Stress Scale (PSS) quantified stress and the Edinburgh Perinatal Depression Scale (EDPS) identified women with depression. Risk for moderate to high stress and depression were compared by level of ADI and were stratified by race and parity. We included 848 women. Those with ADI above the median were significantly more likely to report moderate/high stress levels (RR 1.4, 95%CI 1.2-1.6) and nearly 3 times more likely to be diagnosed with depression in the 1st trimester (2.9, 95%CI 2.0-4.0). The relationships between perceived stress and depression with ADI both above and below the median were not significantly different between black and nonblack women. However, parity demonstrated a significant interaction in the relationship between stress with ADI. The relationship between deprivation and stress was stronger in nulliparas than multiparas, who had higher but more stable stress levels across deprivation scores. The relationship between deprivation and depression did not differ by race or parity. High ADI is associated with significantly increased rates of stress and depression in early pregnancy, with over half of women at high deprivation reporting moderate/high stress and 20% screening positive for depression. ADI is a clinically obtainable characteristic that can target women at risk for high stress and depression in early pregnancy.