Dissertation
Depression during the perinatal period: rurality, opioids and neurodevelopment
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2019
DOI: 10.17077/etd.v0h3-anmp
Abstract
<p>Depression during the perinatal time period is the most common medical condition related to pregnancy and childbirth. Based on previous research, this condition can have negative sequelae for mothers, their offspring, families and the community. Therefore, studies are needed to better understand risk factors and health outcomes among women with depression and the health outcomes among children born to mothers with depression.</p>
<p>We examined rurality as a risk factor for depression during the perinatal time period using data from the 2016 Pregnancy Risk Assessment Monitoring Survey (aim one). We found women who resided in rural communities, as defined by their individual states, had an increase in the odds of depression during the perinatal period by 21% (OR: 1.21; 95% CI 1.05,1.41) when compared to women who resided in urban communities. Based on the results from this study, future studies are warranted to examine mediators of this relationship to develop effective public health and clinical interventions.</p>
<p>Next, we examined the association between perinatal mental health conditions and postpartum prescription opioid use using private insurance claims data of women who delivered a baby in the state of Iowa 2005 to 2016 (aim two). Overall 38.63% of the women in our study filled at least one opioid prescription and 5.88% filled at least two prescriptions in the first 90 days postpartum. A significant interaction of having a perinatal mental health condition and delivery mode was observed for at least one (p=.04) and at least two opioid fills (<.0001). The presence of a mental health condition among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (OR: 1.48 95% CI 1.35, 1.63) and by almost 20% (OR: 1.19 95% CI: 1.00, 1.43) among women with a cesarean delivery. A mental health condition significantly increased the odds of filling at least two opioid prescriptions among women with a vaginal or cesarean delivery by 2.78 (95% CI: 2.32-3.33) and 1.66 (95% CI: 1.40,1.98). Based on findings from this study, more research is needed to improve our understanding of the relationship between perinatal mental health and prescription opioid use.</p>
<p>Finally, the association between perinatal depression and attention deficit hyperactivity disorder (ADHD) use was examined using private insurance claims data from mother-child pairs from the state of Iowa (aim three). Children were born during years 2004 through 2015. In our study children born to mothers with perinatal depression were at an increased odds of ADHD diagnosis by 170% (OR: 2.70; 95% CI 2.06, 3.55). We also evaluated how timing of depression (during pregnancy vs. postpartum) influenced the odds of ADHD diagnosis. While we found children born to mothers with depression during pregnancy and postpartum had an increased risk of ADHD diagnosis, we observed children exposed to depression during fetal development had the greatest risk overall. Research is needed to better understand the mechanisms of risk between perinatal depression and ADHD risk in offspring. Additionally, due to low power we were not able to evaluate how treatment of depression during pregnancy or postpartum may influence childhood outcomes, therefore more studies are needed in this area.</p>
<p>Overall, findings from each study illustrate the importance of maternal mental health and how a mental health condition during the perinatal period can influence maternal and child health outcomes. Future prospective population-based studies are needed to better understand the etiologies of perinatal mental health conditions and how such conditions can influence outcomes for maternal and child health. Results from future studies have the potential to shift clinical practice to improve prevention and intervention in turn improving overall maternal and child health outcomes.</p>
Details
- Title: Subtitle
- Depression during the perinatal period: rurality, opioids and neurodevelopment
- Creators
- Nichole Lynn Nidey - University of Iowa
- Contributors
- Kelli Ryckman (Advisor)George Wehby (Committee Member)Wei Bao (Committee Member)Knute Carter (Committee Member)Lane Strathearn (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Summer 2019
- DOI
- 10.17077/etd.v0h3-anmp
- Publisher
- University of Iowa
- Number of pages
- xiv, 87 pages
- Copyright
- Copyright © 2019 Nichole Lynn Nidey
- Language
- English
- Date submitted
- 11/07/2019
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 75-87).
- Public Abstract (ETD)
Depression during pregnancy and the postpartum period is the most common medical condition related to pregnancy and childbirth in the United States. This condition is important to study, as mothers with depression have been shown to have an increased risk of poor outcomes along with their children.
In aim one we found rural women have an increased risk of depression around the time of pregnancy when compared to women who live in urban areas. Based on this finding, more research is needed to better understand why rural women are at an increased risk to provide effective interventions.
In aim two we examined the association between prescription opioids and mental health. Despite being a population with a high likelihood of prescription opioid use and increased risk of mental health conditions, very little is known about how mental health influences the use of prescription opioids within the first few months after childbirth. Within our study population of privately insured women who gave birth in Iowa, we found women with a diagnosed mental health condition are more likely to fill opioid prescriptions than women without a mental health condition.
In aim three we examined perinatal depression as a risk factor for attention deficit hyperactivity disorder among offspring. Using data of privately insured mothers and children, we found children born to mothers who were depressed during pregnancy and postpartum had an increased risk of attention deficit hyperactivity disorder. Future studies are needed to better understand how exposure to perinatal depression influences health outcomes.
- Academic Unit
- Epidemiology
- Record Identifier
- 9983777160602771
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