Major depressive disorder, drug use complicating pregnancy, and preterm birth: An analysis of independent and interdependent effects
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Date
2024-05
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The Ohio State University
Abstract
Background. Preterm birth is the leading cause of neonatal death. Major depressive disorder and prenatal drug use have each been linked to heightened risk for preterm birth. However, the two commonly co-occur, making it difficult to isolate their effects, which is pertinent to optimizing healthcare interventions. Therefore, using data from a large, diverse prenatal cohort, we investigated these variables independently and interdependently in the prediction of preterm birth. Methods. Using a retrospective cohort design, we analyzed 18,042 de-identified medical records from a large Midwestern academic medical center. ICD-9 and ICD-10 codes identified individuals with a diagnosis of major depressive disorder and/or drug use complicating pregnancy. Preterm births were identified according to the estimated and actual date of birth in the medical record. Logistic regression models first examined each predictor independently. Next, an interaction term was included. Results. The sample was an average age of 29 (SD 5.7) and primarily White (60.1%). When examined independently, major depressive disorder (OR 1.13, 95%CI 0.995-1.277) and drug use (OR 1.23, 95%CI 0.997-1.529) were both marginally but not significantly associated with greater odds of preterm birth. However, we also identified a significant interaction between major depressive disorder and drug use in estimating the odds of preterm birth. Specifically, among individuals without major depressive disorder, drug use was associated with greater odds of preterm birth (OR 1.388, 95%CI 1.092-1.765). Similarly, among individuals without drug use, major depressive disorder was associated with greater odds of preterm birth (OR 1.159, 95%CI 1.019-1.318). Neither variable was associated with odds of preterm birth among individuals with a diagnosis of major depressive disorder that also engaged in drug use (OR 0.895, 95%CI 0.562-1.425). Conclusions. Findings add to literature that has primarily focused on the independent effects of major depressive disorder and drug use on odds of preterm birth. The identification of an interaction between the two variables in the prediction of preterm birth reinforces the complicated nature of the risk factors and the syndrome of preterm birth. Future research should aim to clarify the mechanisms linking these exposures to birth timing by directly measuring hypothesized biological mediators.
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Keywords
Major depressive disorder, drug use complicating pregnancy, preterm birth, drug use, pregnancy