Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss

Jade M Shorter, Nathanael Koelper, Sarita Sonalkar, Maria A Oquendo, Mary D Sammel, Courtney A Schreiber, Jade M Shorter, Nathanael Koelper, Sarita Sonalkar, Maria A Oquendo, Mary D Sammel, Courtney A Schreiber

Abstract

Objective: To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial.

Methods: We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment.

Results: Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15-3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15-3.55; adjusted OR 2.48; 95% CI 1.28-4.81).

Conclusion: Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care.

Clinical trial registration: ClinicalTrials.gov, NCT02012491.

Conflict of interest statement

Financial Disclosure Sarita Sonalkar reports that their institution received funding from the NIH. Maria A. Oquendo receives royalties for the commercial use of the Columbia Suicide Severity Rating Scale and owns shares in Mantra, INC. Her family owns stock in Bristol Myers Squibb. Courtney A Schreiber receives research funding from Sebela, Medicines 360, NICHD, and Bayer Pharmaceuticals. The other authors did not report any potential conflicts of interest.

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Fig. 1.. Frequency of total adverse childhood…
Fig. 1.. Frequency of total adverse childhood experience score by race.
Shorter. Disparities in Mental Health After Early Pregnancy Loss. Obstet Gynecol 2020.

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