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Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss
- Source :
- Obstetrics and Gynecology
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- The risk for major depression is common 30 days after treatment for early pregnancy loss, especially among Black women.<br />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.
- Subjects :
- Adult
medicine.medical_specialty
Early Pregnancy Loss
Black People
law.invention
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
Adverse Childhood Experiences
Pregnancy
law
Epidemiology
medicine
Humans
030212 general & internal medicine
Healthcare Disparities
Original Research
Depressive Disorder, Major
030219 obstetrics & reproductive medicine
business.industry
Obstetrics
Obstetrics and Gynecology
General Medicine
Odds ratio
medicine.disease
Abortion, Spontaneous
Clinical trial
Mental Health
Cohort
Gestation
Contents
Female
business
Stress, Psychological
Subjects
Details
- ISSN :
- 00297844
- Volume :
- 137
- Database :
- OpenAIRE
- Journal :
- Obstetrics & Gynecology
- Accession number :
- edsair.doi.dedup.....71a8c7535edc283528faf8f12db4c3fc