New Onset Depression During Pregnancy in Commercially-Insured and Medicaid-Insured Pregnancies in the United States

OBJECTIVES: Depression is a common psychiatric disorder during the perinatal period. Though the estimated prevalence of prenatal depression in the United States is similar to the estimated prevalence of postpartum depression, studies of pregnancy-related mood disorders often focus on postpartum period. This study’s objective was to characterize new onset depression during pregnancy in commercially-insured and Medicaid-insured pregnancies.

METHODS: Deliveries in female patients aged 15-50 between 01 January 2018 and 31 December 2022 in the Merative MarketScan Commercial and Multi-State Medicaid Databases were identified. Pregnancies included in the study were required to have continuous enrollment for 480 days prior to the delivery date. The 300 days prior to the delivery were considered the prenatal period and 180 days prior to the prenatal period were considered the pre-pregnancy period. Those with non-diagnostic claims for depression in the pre-pregnancy period were excluded from the analysis. Prenatal depression was identified in patients with a non-diagnostic medical claim for depression during the prenatal period. Patient characteristics and delivery outcomes were compared in pregnancies with and without prenatal depression.

RESULTS: 601,170 commercially-insured and 458,372 Medicaid-insured deliveries were included in this study. The rate of prenatal depression increased from 2.1% in 2018 to 3.1% in 2022 in commercially-insured pregnancies. The rate of prenatal depression in Medicaid-insured pregnancies was highest in 2020 (5.6%) and lowest in 2018 (4.9%). In both populations, preterm birth was more common in pregnancies with prenatal depression (Commercial: 12.0% vs. 8.7%, p<.0001; Medicaid: 16.6% vs. 12.8%, p<.0001). Other delivery complications were also more common in pregnancies with prenatal depression (Commercial: 27.6% vs, 24.8%, p<.0001; Medicaid: 26.2% vs. 24.4%, p<.0001).

CONCLUSIONS: Increases in the rate prenatal depression were observed in commercially-insured pregnancies during the study period. Preterm birth and other delivery complications were more common in pregnancies with prenatal depression in both commercially-insured and Medicaid-insured pregnancies.