Racial Variation in Prenatal Depression in a United States Population of Medicaid-Insured Pregnancies

OBJECTIVES: Depression is a common psychiatric disorder during the perinatal period; the incidence of prenatal depression has been estimated to be as high as 20-40%. Prenatal depression has also been associated with adverse pregnancy and infant outcomes which have been shown to vary by race. This study’s objective was to assess racial variation in prenatal depression in a U.S. population of Medicaid-insured pregnancies.

METHODS: Deliveries in female patients aged 15-50 between 01 January 2018 and 31 December 2022 in the Merative Multi-State Medicaid Database 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. Rates of prenatal depression per 100 pregnancies and associated 95% CI were calculated overall and by race (Black, White, Hispanic, Other).

RESULTS: 458,372 Medicaid-insured deliveries were included in this study. Most pregnancies were in White patients (47.3%) followed by Black (37.6%), Hispanic (5.3%) and other race patients (3.9%). The overall rate of prenatal depression was 5.36 per 100 (95% CI: 5.30-5.53). The rate of prenatal depression in pregnancies in Black patients was 4.64 per 100 (95% CI: 4.54-4.73) as compared to 6.11 per 100 pregnancies in White patients (95% CI: 6.01-6.21), 5.88 per 100 pregnancies in Hispanic patients (95% CI: 5.59-6.18), and 3.74 per 100 pregnancies in patients of other races (95% CI: 3.46-4.01).

CONCLUSIONS: Rate of prenatal depression was highest in pregnancies in White patients, which may reflect racial variation in screening for prenatal depression by race.