Racial disparities in mental health outcomes among women with early pregnancy loss

Awarded 2019
Complex Family Planning Fellowship Research
Jade Shorter, MD
University of Pennsylvania

Objective: Black race is associated with higher rates of poor pregnancy outcomes, including pregnancy loss and perinatal depression. However, the association between race and adverse mental health outcomes in an early pregnancy loss (EPL) population is not well described. This study aimed to examine the relationship between race and psychometric variables among participants in an EPL clinical trial.
Methods: We performed a planned secondary analysis of a randomized trial comparing treatments for medical management of EPL. We hypothesized that Black participants would have higher odds of major depression 30 days after EPL 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 (ACE) scores. Our primary outcome was major depressive disorder (MDD) 30 days after EPL treatment. Depressive symptoms and childhood adversity were measured with the Center for Epidemiological Studies-Depression (CES-D), and ACE scales. Participants who endorsed at least 2 items on the ACE scale were classified as having a high ACE score.
Results: Almost a quarter of participants met criteria for major depressive disorder after EPL treatment. Black race was associated with an increased risk of MDD 30 days after EPL treatment when compared to non-Black race, after adjustment for baseline depression and ACE scores.
Conclusions: MDD was common 30 days after treatment for EPL especially among Black participants. Black race was an independent risk factor for major depression 30 days after EPL treatment. These findings highlight additional racial disparities in the pregnant population, and the need for appropriate mental health resources for women undergoing EPL care.