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. 2020 Feb 10;10(2):e031035.
doi: 10.1136/bmjopen-2019-031035.

Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study

Kamala Adhikari  1 , Scott B Patten  2 , Tyler Williamson  2 , Alka B Patel  2   3 , Shahirose Premji  4 , Suzanne Tough  2   5 , Nicole Letourneau  2   5   6   7 , Gerald Giesbrecht  2   5 , Amy Metcalfe  2   8   9
Affiliations

Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study

Kamala Adhikari et al. BMJ Open. .

Abstract

Objective: This study examined the association of anxiety alone, depression alone and the presence of both anxiety and depression with preterm birth (PTB) and further examined whether neighbourhood socioeconomic status (SES) modified this association.

Design: Cohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families; AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON) and neighbourhood SES data from the 2011 Canadian census.

Setting: Calgary, Alberta, Canada.

Participants: Overall, 5538 pregnant women who were <27 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. 3341 women participated in the AOF study and 2187 women participated in the APrON study, with 231 women participated in both studies. Women who participated in both studies were only counted once.

Primary and secondary outcome measures: PTB was defined as delivery prior to 37 weeks of gestation. Depression was defined as an Edinburgh Postnatal Depression Scale (EPDS) score of ≥13, anxiety was defined as an EPDS-anxiety subscale score of ≥6, and the presence of both anxiety and depression was defined as meeting both anxiety and depression definitions.

Results: Overall, 7.3% of women delivered preterm infants. The presence of both anxiety and depression, but neither of these conditions alone, was significantly associated with PTB (OR 1.6, 95% CI 1.1 to 2.3) and had significant interaction with neighbourhood deprivation (p=0.004). The predicted probability of PTB for women with both anxiety and depression was 10.0%, which increased to 15.7% if they lived in the most deprived neighbourhoods and decreased to 1.4% if they lived in the least deprived neighbourhoods.

Conclusions: Effects of anxiety and depression on risk of PTB differ depending on where women live. This understanding may guide the identification of women at increased risk for PTB and allocation of resources for early identification and management of anxiety and depression.

Keywords: epidemiology; mental health; neighbourhood socioeconomic status; preterm birth.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162–72. 10.1016/S0140-6736(12)60820-4 - DOI - PubMed
    1. Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379:2151–61. 10.1016/S0140-6736(12)60560-1 - DOI - PubMed
    1. Johnston KM, Gooch K, Korol E, et al. The economic burden of prematurity in Canada. BMC Pediatr 2014;14:93 10.1186/1471-2431-14-93 - DOI - PMC - PubMed
    1. Blencowe H, Cousens S, Chou D, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013;10:S2 10.1186/1742-4755-10-S1-S2 - DOI - PMC - PubMed
    1. Ward RM, Beachy JC. Neonatal complications following preterm birth. Bjog 2003;110:8–16. 10.1046/j.1471-0528.2003.00012.x - DOI - PubMed

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