Traumatic Childbirth, Postpartum Depression More Common in Black/Latinx Women Than White Women During COVID-19

Research at Massachusetts General Hospital has established that mothers who give birth during COVID-19 are more likely to experience traumatic childbirth than those who delivered before the pandemic began.

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Ananya S. Iyengar, a research student in the Dekel Laboratory, and Sharon Dekel, PhD, a principal investigator in the Department of Psychiatry at Massachusetts General Hospital, and colleagues now report in the International Journal of Gynecology and Obstetrics that traumatic childbirth experiences, postpartum depression and lack of exclusive breastfeeding during the COVID-19 pandemic are more likely among Black and Latinx women than white women in the U.S.

Methods

Beginning on April 2, 2020, women who had given birth to a live baby within the past six months were recruited via social media, professional organizations, and hospital announcements.

They completed an anonymous survey about their recent childbirth, current mental health, maternal–infant behaviors, and trauma and mental health history.

The current analysis included 236 Black/African American or Hispanic/Latinx women, all free of COVID-19 during childbirth, who were matched to 236 non-Hispanic white women. Additional factors taken into account includes maternal age, marital status, employment, education, income, country of residence, month postpartum and survey completion date.

Applying a control-group matching procedure, allowed the investigators to understand whether the ethnic and racial status of a woman predicts her birth outcomes after "removing" other factors that may differ between the groups and are associated with birth outcomes.

Additionally, for measuring group differences in mental health outcomes, logistic regression analyses was used to control for mental health and abuse history, prior pregnancy complications (miscarriage, stillbirth, and premature birth), and complications associated with recent delivery (e.g., unplanned Cesarean delivery, obstetrical complications, neonatal ICU admission).

As part of the larger survey, the participants completed two questionnaires:

• The Peritraumatic Distress Inventory (PDI) for assessment of acute traumatic stress in childbirth (a score ≥17 was considered clinically relevant)
• The Edinburgh Postnatal Depression Scale (EPDS) (a score ≥12 was considered clinically relevant)

Results

Compared with the white matched group, the Black/Latinx group was:

• More likely to report clinically relevant acute traumatic stress in childbirth (OR, 2.90; 95% CI, 1.69–5.10; P<0.001)
• More likely to report clinically relevant postpartum depression (OR, 1.97; 95% CI, 1.29–3.04; P<0.01)
• More likely to deliver via unplanned Cesarean than vaginally (OR, 1.70; 95% CI, 1.05–2.76; P<0.05
• Less likely to report exclusive breastfeeding (OR, 0.67; 95% CI, 0.45–0.98; P<0.05)

Other significant differences were that the Black/Latinx group was more likely to have unplanned Cesarean delivery, less likely to have skin-to-skin contact after delivery, and less likely to have their infant's room with them in the hospital.

Commentary

The racial/ethnic disparities in postpartum mental health noted here are not explained by socio-demographics or stressors (medical complications) in childbirth and infant health. Structural inequities and racism may contribute to negative maternal outcomes by functioning as psychosocial stressors.

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