Birth parents were followed from 10-years preconception to one-year postpartum. In this retrospective cohort study, we examined data from all births in British Columbia (BC), Canada between April 1, 2000, and December 31, 2013. We then examined how well these variables predicted two outcomes that have been previously associated with antenatal and/or preconception depression/anxiety, one with a more direct connection (postpartum depression or anxiety ) and one with a more indirect connection (preterm birth ). We sought to operationalize variables that describe different aspects of care from 10-years preconception through pregnancy based on the presence of depression/anxiety diagnostic codes, including: any use of health services, frequency of outpatient visits, inpatient hospitalization, any psychiatry care, and persistence. Herein, we aim to determine whether longitudinal data on mental health services use could be leveraged to better differentiate between distinct phenotypes of depression/anxiety. While these codes are validated in identifying psychiatric conditions, this approach misses an opportunity to capture different experiences of depression/anxiety that may be differentially associated with outcomes of interest, thus better controlling for the underlying condition. Despite an advancing understanding of the heterogeneity of depression/anxiety, most population-based studies operationalize a dichotomous definition of perinatal depression/anxiety based on presence of a diagnostic code during a single period. These trajectories have been shown to be differentially associated with outcomes such as preterm birth, and gestational age. Within pregnancy, studies report distinct, symptom-based trajectories that describe diverse experiences of perinatal depression. Įvidence from non-perinatal populations suggests that depression and anxiety are dynamic, varying in severity and propensity to remit. In one study, nearly half of those experiencing antenatal depression had a prior history of major depressive disorder. Prior history of depression and anxiety has been demonstrated as a strong predictor of perinatal (both antenatal and postnatal) mood disorder. By accounting for differing profiles of mental health treatment, mental health history, and current mental health, we can better control for severity of underlying conditions and thus better understand more complex associations between antenatal mental health and adverse outcomes.ĭepression and anxiety affect up to 18.4% and 20.7% of pregnant and postpartum people, respectively, and research has suggested that they increase risk for adverse outcomes, ranging from pre-term delivery to postpartum depression. We report a feasible method for developing and applying more nuanced definitions of depression/anxiety within population-based data. Variables characterizing use of outpatient psychiatry care and outpatient visit frequency within the first five years preconception were most useful in predicting postpartum depression/anxiety and preterm birth, respectively. Our detailed measures of mental health service use predicted postpartum depression/anxiety much better than preterm birth. Incorporating dichotomous indicators for depression/anxiety across preconception markedly improved predictive power and model fit. Predictive modeling of postpartum depression/anxiety and preterm birth revealed better predictions and stronger performance with inclusion of a more detailed preconception mental health history. ![]() We operationalized variables to proxy severity, persistence, and frequency of depression/anxiety from preconception through pregnancy, then constructed predictive regression models for postpartum depression/anxiety and preterm birth. Using population-based, administrative datasets, we examined individual-level mental health services use of all birth parents who delivered a live infant in British Columbia, Canada between April 1, 2000, and December 31, 2013, and who were registered with the provincial Medical Services Plan for over 100 days per year from 10-years preconception to 1-year postpartum. In this study, we sought to investigate whether population-based data can be used to build complex, longitudinal mental health histories that improve our ability to predict adverse pregnancy and birth outcomes. ![]() Depression and anxiety are highly prevalent within the perinatal period and have been associated with myriad adverse pregnancy and birth outcomes.
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