Maternal well-being and infant outcomes in Massachusetts
Stone, Sarah Lederberg
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Post-partum depressive symptoms (PDS) are defmed by feelings of sadness, depression, and anhedonia during the year after giving birth. PDS ranges in severity from transient 'baby-blues' experienced by over 80% of mothers shortly after birth to 10-15% fulfilling criteria for a major depressive episode. PDS can have profound long-term consequences for mothers and families if left untreated, impairing mother-infant bonding, leading to delayed development in children. PDS may also impact the mother's use of infant health care. This dissertation explores risk factors for PDS and its consequences using population-based data from the Massachusetts Pregnancy Risk Assessment Monitoring System (MA-PRAMS). In study 1, we examined the association between common life stressors including partner-related, financial-related, traumatic-related, and emotional-related, and PDS prevalence. Common life stressors during pregnancy were associated with an increased prevalence of PDS, with the strongest association seen for partner-related stressors, the most commonly reported stressor. However, mothers with PDS who experienced partner-related stressors were also least likely to seek help for their depression, relative to mothers with other grouped stressors or no stressors. In study 2, we assessed the association between infertility treatment (1FT) and PDS risk. There was no appreciable association between 1FT use and PDS overall. However, we found that 1FT users who delivered multiples (e.g., twins or triplets) had a lower risk of PDS compared with non-users of 1FT who delivered multiples, persistent across mode of delivery. Among mothers with PDS, we found little evidence of an association between 1FT and seeking help for depression, regardless of plurality. lp study 3, we examined the association between PDS and mother's use of hospital-based infant healthcare (HIH) in the 24 months after birth, using MA-PRAMS data linked to the Pregnancy to Early Life Longitudinal Linkage (PELL) study. Overall, there was little evidence of an association between PDS and HIH. However, we observed significant differences across race/ethnic populations. Among White non-Hispanic and Hispanic mothers, PDS was associated with a small increased risk of HIH, while among Asian mothers, PDS was associated with an inverse risk of HIH. No appreciable association was found between PDS and HIH among Black non-Hispanic mothers.
Thesis (Ph.D.)--Boston University