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Depression during Pregnancy and Adverse Birth Outcomes among Predominantly Puerto Rican Women


Szegda, Kathleen; Bertone-Johnson, Elizabeth R.; Pekow, Penelope S.; Powers, Sally; Markenson, Glenn R.; Dole, Nancy; & Chasan-Taber, Lisa (2017). Depression during Pregnancy and Adverse Birth Outcomes among Predominantly Puerto Rican Women. Maternal and Child Health Journal, 21(4), 942-952. PMCID: PMC6287608


Objectives: To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a population who experiences disparities in adverse birth outcomes and one of the highest infant mortality rates in the United States.
Methods: Proyecto Buena Salud (PBS) was a prospective cohort study conducted from 2006 to 2011 at a large tertiary care center in Western Massachusetts. Caribbean Islander (i.e., Puerto Rican and Dominican Republic) women were interviewed in early, mid and late pregnancy. Among 1262 participants, associations between depression, assessed using the Edinburgh Postnatal Depression Scale, and risk of preterm birth and small-for-gestational age (SGA) were evaluated.
Results: Women with at least probable minor depression [odds ratio (OR) = 1.77 (95% confidence interval (CI) = 1.02, 3.07)] or probable major depression [OR = 1.82 (95% CI = 1.01, 3.25)] in mid-pregnancy had an increased risk of SGA compared to non-depressed women in adjusted analyses. Borderline significant associations were observed between increasing levels of depressive symptom scores in early and mid-pregnancy [OR = 1.05 (95% CI = 1.00, 1.11) and OR = 1.04 (95% CI = 1.00, 1.09), respectively] and each additional trimester of exposure to probable major depression across mid- to late pregnancy [OR = 1.66 (95% CI = 1.00, 2.74)] and SGA. Late pregnancy depression was not associated with SGA; depression during pregnancy was not associated with preterm birth.
Conclusions for Practice: In this population of predominantly Puerto Rican women, mid-pregnancy depression increased risk for SGA. Findings can inform culturally appropriate, targeted interventions to identify and treat pregnant women with depression.


Reference Type

Journal Article

Year Published


Journal Title

Maternal and Child Health Journal


Szegda, Kathleen
Bertone-Johnson, Elizabeth R.
Pekow, Penelope S.
Powers, Sally
Markenson, Glenn R.
Dole, Nancy
Chasan-Taber, Lisa