The association of stillbirth with depressive symptoms 6-36 months post-delivery

Abstract

Background: Stillbirths (≥ 20 weeks' gestation), which account for about 1 in 200 US pregnancies, may grieve parents deeply. Unresolved grief may lead to persistent depression.

Methods: We compared depressive symptoms in 2009 (6-36 months after index delivery) among consenting women in the Stillbirth Collaborative Research Network's population-based case-control study conducted 2006-08 (n = 275 who delivered a stillbirth and n = 522 who delivered a healthy livebirth (excluding livebirths < 37 weeks, infants who had been admitted to a neonatal intensive care unit or who died). Women scoring > 12 on the Edinburgh Depression Scale were classified as currently depressed. Crude (cOR) and adjusted (aOR) odds ratios and 95% confidence intervals [CI] were computed from univariate and multivariable logistic models, with weighting for study design and differential consent. Marginal structural models examined potential selection bias due to low follow-up.

Results: Current depression was more likely in women with stillbirth (14.8%) vs. healthy livebirth (8.3%, cOR 1.90 [95% CI 1.20, 3.02]). However, after control for history of depression and factors associated with both depression and stillbirth, the stillbirth association was no longer significant (aOR 1.35 [95% CI 0.79, 2.30]). Conversely, for the 76% of women with no history of depression, a significant association remained after adjustment for confounders (aOR 1.98 [95% CI 1.02, 3.82]).

Conclusions: Improved screening for depression and referral may be needed for women's health care. Research should focus on defining optimal methods for support of women suffering stillbirth so as to lower the risk of subsequent depression.

Keywords: African Americans; Stillbirth; depression; follow-up studies; grief.

Figure 1. Study Enrollment and Inclusion in Edinburgh Analysis

This analysis compares Edinburgh results at follow up interview for women with stillbirth and women with healthy term live birth pregnancies. A pregnancy was categorized as a stillbirth pregnancy if there were any stillbirths delivered and a live birth pregnancy if all live births were delivered. Women could have been eligible for enrollment to the Stillbirth Collaborative Research Network (SCRN) for one or more deliveries occurring during the enrollment period for the study. However, the flow chart accounts for each individual woman once, as a woman enrolled to the study was eligible for only one follow-up interview based on her last enrollment to the SCRN. A fetal death was defined by Apgar scores of 0 at 1 and 5 minutes and no signs of life by direct observation. Fetal deaths were classified as stillbirths if the best clinical estimate of gestational age at death was 20 or more weeks. Fetal deaths at 18 and 19 weeks without good dating were also included as stillbirths.