Depression Screening in Early Pregnancy and Associations With Pregnancy Outcomes Among a Diverse Cohort [32J]

INTRODUCTION:: Depression is a common perinatal occurrence, yet research regarding how early depression can be identified and whether it differs by pregnancy outcome (delivery/abortion) is limited. METHODS:: English- or Spanish-speaking women, aged 15–44, <24 weeks gestation seeking pregnancy testing or abortion care were enrolled in a prospective cohort study from 2014 to 2015. The Edinburgh Depression Scale (EDS) assessed depression at enrollment and 3 months later. Participants with positive depression screen (EDS ≥13) received mental health referral. Pregnancy outcomes were assessed via phone interviews and medical chart review. Women with miscarriage were excluded from this analysis. RESULTS:: Among 100 participants with complete EDS data, women averaged 26.8 (±6.3) years and 9.3 (±4.6) weeks gestation. Seventy-nine percent presented for walk-in pregnancy testing; 21% for abortion. Participants were culturally diverse: 48.0% Hispanic, 30.6% Black, non-Hispanic, 14.3% White, non-Hispanic and 7.1% multiracial. Most (66%) continued pregnancy, 44% chose abortion. At enrollment, 21% screened positive for depression, and women choosing delivery (17%) were not statistically different from women choosing abortion (29%) (P=.138). At 3-month follow-up, 18% screened positive for depression; no difference was observed between women choosing delivery (14%) compared to abortion (27%) (P=.114). The overall proportion of women with a positive screen for depression remained stable from enrollment to 3-month follow-up (P=.549), and remained stable among women choosing delivery (P=.727) and abortion (P=>.999). CONCLUSION:: Antenatal depression is common amongst women early in pregnancy, whether choosing delivery or abortion. Early screening may provide opportunities for early interventions. Future research should test early interventions

A Multidimensional and Longitudinal Exploratory Study of the Stability of Pregnancy Contexts in the United States

Objective: Evaluate the longitudinal stability of six pregnancy contexts, including intention, in a diverse cohort of individuals experiencing delivery, abortion, or miscarriage. Methods: We enrolled individuals 16?44 years of age with pregnancies <24 weeks gestation in this longitudinal study between June 2014 and June 2015 in four US urban clinics. We assessed six pregnancy contexts (intention, wantedness, planning, timing, desirability, and happiness) at enrollment and 3-month follow-up. We constructed three-level categorical measures for each context defined as favorable, ambivalent, or unfavorable. We used Wilcoxon sign tests to evaluate changes in paired observations between pregnancy context measures over time and by pregnancy outcome. Results: Among 121 participants at median gestational age of 7 weeks and 3 days, we found intention, wantedness, planning, timing, and happiness remained unchanged from enrollment in early pregnancy to 3-month follow-up. Individuals demonstrated changes in desirability; pregnancy assessments shifted toward less desirable from enrollment to follow-up (p?=?0.01) (i.e., desired to ambivalent, or ambivalent to undesired). Among participants choosing delivery (57%), assessments shifted toward more favorable planning (i.e., unplanned to ambivalent, or ambivalent to planned) (p?<?0.01), and less favorable desirability (i.e., desired to ambivalent or ambivalent to undesired) (p?<?0.01) at follow-up. Among participants choosing abortion (28%), assessments shifted toward more unfavorable planning (i.e., planned to ambivalent, or ambivalent to unplanned) at follow-up (p?<?0.01). Conclusion: In multidimensional, longitudinal assessment, pregnant participants' perspectives on five of six pregnancy contexts remained unchanged between enrollment and 3-month follow-up; only desirability shifted. Pregnancy planning perspectives differed by pregnancy outcome. Human Research Subjects Protection Program: 1310012926

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women.

ObjectiveTo contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts.Study designCross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014-June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics.ResultsAmong 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28-0.91), PROMIS GSF-derived utility (0.66-0.75), SG (0.985-1.00) or TTO (0.9990-0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts.ConclusionsUnintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts.ImplicationsDecision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts