254 Incidence and risk factors for postpartum depression among women with preterm prelabor rupture of membranes

Abstract

Women admitted for preterm prelabor rupture of membranes (PPROM) are more likely to have known risk factors for postpartum depression (PPD) including preterm delivery, low birthweight infants, and a stressful life event. However, limited data exist characterizing the development of PPD in women with PPROM. We aim to evaluate the incidence of PPD among women admitted with PPROM, as well as to identify risk factors specific to this high-risk population. Case control study of women admitted for PPROM in single health system between 2013-2019 with documented postpartum (PP) follow-up. Women with intrauterine fetal demise, missing PP follow-up, and missing Edinburgh Postnatal Depression Scale (EPDS) were excluded. Cases were defined by EPDS>13 or clinician documentation of PPD at the PP visit. Women without PPD were designated as controls. Demographic, antepartum/intrapartum/postpartum, and neonatal characteristics were compared. Bivariate statistics were used to compare outcomes and logistic regression was used to estimate adjusted odds ratios. Of 152 women, 30 (19.7%) had PPD. Factors associated with diagnosis of PPD included history of depression, anxiety, any prior mental health condition (Table 1). Earlier admission gestational age (GA), rupture of membranes <28 weeks, earlier delivery GA, neonatal morbidity, and neonatal necrotizing enterocolitis also were associated with PPD. PPROM latency, maternal PP length of stay (LOS), and NICU LOS were not associated (Table 2). In regression models, only a history of depression (OR 11.89, 95% CI 2.78-50.95) and neonatal morbidity (OR 5.01, 95% CI 1.15-21.89) remained associated with PPD. PPD was common among women admitted for PPROM. Preexisting depression and adverse neonatal outcomes strongly predicted PPD in women with PPROM. Maternal mental health must be high priority during PPROM antepartum admission. Further research is urgently needed to determine the most impactful strategies to optimize maternal mental health and mitigate the risk of PPD during inpatient admission for PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)