Investigating the role of distinct profiles of perinatal depression and anxiety in adverse perinatal outcomes : a population-based study in British Columbia

Antenatal depression and anxiety (DEP-ANX) are highly prevalent conditions that have been associated with increased risk for adverse outcomes. Most studies to this point have employed simplistic definitions to describe preconception and antenatal DEP-ANX. This thesis had three aims: (1) use population-based data to operationalize variables describing mental health histories; (2) evaluate variables’ ability to predict adverse perinatal outcomes, postpartum DEP-ANX (PPD) and preterm birth (PTB); and (3) employ these variables to investigate the relationship between DEP-ANX and gestational diabetes mellitus (GDM). We examined mental health services use of all birth parents who delivered a live infant in British Columbia, Canada between April 1, 2000, and December 31, 2013, and were registered with provincial Medical Services Plan (MSP) for >100 days/year for the respective study period. We operationalized variables to proxy severity, persistence, and frequency of DEP-ANX from preconception through pregnancy, then constructed predictive regression models for PPD and PTB. Based on our findings, we ran unadjusted and adjusted logistic regression models to estimate odds ratios (ORs) for GDM given antenatal DEP-ANX. We then ran conditional logistic regression models that matched birth parents to themselves (in subsequent pregnancy) based on discordance of exposure and outcome. We found that PPD and PTB predictive models performed better with inclusion of more detailed mental health histories. Incorporating dichotomous DEP-ANX indicators across preconception markedly improved predictive power and model fit. Detailed measures of mental health service use predicted PPD better than PTB and the utility of individual measures depended on the outcome. We observed that those with antenatal DEP-ANX had significantly higher odds of GDM. Apparent risk for GDM given antenatal DEP-ANX was highest among those with no DEP-ANX history. Associations estimated by matched sibling analysis were non-significant, but effect size among the no history group was consistent with unmatched analysis. Overall, our findings suggest that more nuanced approaches to classify antenatal DEP-ANX within population-based data are feasible. By accounting for mental health treatment, mental health history, and current mental health, we can better control for differences in underlying conditions and better understand more complex associations between antenatal mental health and perinatal outcomes.Medicine, Faculty ofObstetrics and Gynaecology, Department ofGraduat