Racial Disparities in Maternal Outcomes Among Pregnant Women With Major Depressive Disorder [35J

Abstract

INTRODUCTION: We sought to determine the differences in pregnancy outcomes among white, black, Hispanic, Asian/Pacific Islander, and Native American women with major depressive disorder (MDD). METHODS: A retrospective cohort of 14,489 women with MDD and singleton, non-anomalous gestations was used to examine maternal outcomes, assessed according to race. Maternal outcomes included pre-eclampsia/eclampsia (abbreviated “Any PET”), gestational diabetes (GDM), chorioamnionitis, blood transfusion, endometritis, 3rd or 4th degree lacerations, and postpartum hemorrhage (PPH). Multivariate regression analyses and χ2 tests were employed for statistical comparisons and a P-value of less than 0.05 was used to indicate statistical significance. RESULTS: Overall, race was associated with a statistically significant increase in the majority of investigated outcomes. Compared to white women, and after controlling for confounders, black women with MDD were more likely to experience PET, develop chorioamnionitis and endometritis, and require a blood transfusion, and trended towards greater rates of PPH. Hispanic women were more likely to develop GDM, chorioamnionitis, and endometritis, and trended towards greater rates of PET and PPH. Asian/Pacific Islander women were more likely to develop GDM, chorioamnionitis, endometritis, 3rd or 4th degree lacerations, and PPH, and trended towards lower rates of PET. Native American women had higher rates of PET and endometritis, and trended towards higher rates of GDM and PPH. CONCLUSION: Non-white women with MDD experience higher rates of obstetric complications than white women, with specific complications and rates varying across races. These data suggest disparities may exist in management of pregnant women with MDD across different races.