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The Association between Antenatal Depression and Adverse Birth Outcomes among Women Receiving Medicaid in Washington State
Amelia R. Gavin, PhDSchool of Social WorkUniversity of Washington
Rationale
The field is poised to examine of the contribution of antenatal depression to increased risk of LBW, PTD, and SGANot all women who experience antenatal depression experience adverse birth outcomesIdentify the moderators of the association between antenatal depression and LBW, PTD, and SGA
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Washington State Maternity Care Services
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First Steps Program
From 1991-2004, 46% of all births in WA State were funded by Medicaid and nearly 350,000 women had received services through the First Steps ProgramDespite the implementation of First Steps, disparities still existMedicaid-eligible women and African Americans have higher prevalence of LBW
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Objectives
Examine the prevalence of ICD-9 depression diagnoses among women who received Medicaid-funded maternity services in Washington State and compare demographics, pregnancy complications, and birth outcomes (e.g., LBW, PTD, SGA) for women with and without an ICD-9 depression diagnosis, while controlling for known confounders for LBW, PTD, and SGADetermine whether mothers with and without ICD-9 depression diagnoses differ on antenatal risk factorsExamine potential moderators (e.g., race, citizenship, TANF-eligibility) of the association between ICD-9 depression diagnoses and LBW, PTD, and SGA
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Methods
DesignBirth data from the WA State First Steps Database for women receiving Medicaid at the time of delivery from 2006-08Birth certificate data for all live births to Washington State residents from 2006-08 will be linked with the Medicaid claims database from the same time intervalBirth certificate-Medicaid claims database will be linked with the Comprehensive Hospitalization Abstract Reporting System (CHARS)
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Methods
Selection criteria15 years or older who were Medicaid-eligible during the period 2006-08Women who received Medicaid-paid maternity services or at least 3 months of capitated payments in the 6 months prior to deliveryLow-income pregnant women enrolled in Washington State Basic Health Plan who meet Medicaid eligibility guidelines and were transferred into Medicaid for prenatal and postpartum careThose with birth hospitalization data available from the CHARS in WA StateWomen who are WA State residents who gave birth in WA State with infants with valid birth data recorded in the WA State Birth Certificate System
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Analysis
The analysis will follow a 2-step approach:Logistic regression modeling will be used to assess the association between antenatal depression and adverse birth outcomes while controlling for known risk factorsNext, a series of interaction terms will be created to examine whether the antenatal depression-adverse birth outcome association varied according to moderator status. Interaction terms will include:Antenatal depression*raceAntenatal depression*citizenship (U.S. citizen)Antenatal depression*TANF-eligible
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Gavin ppt_11-15-10