The impact of maternal depression and anxiety on well-baby visit attendance: a retrospective cohort study of 6,699 PRAMS participants from 2016-2021.

PURPOSE: The objective of this study was to determine the independent effects of maternal mental health difficulties (MHD) during the preconception, prenatal, and postnatal periods on well-baby visit (WBV) attendance in a population-wide sample through retrospective analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data.

METHODS

This secondary analysis utilized data from the 2016 - 2021 New Jersey PRAMS, yielding 6,699 participants (mean age = 30.8 years). Survey-weighted means, confidence intervals, and percentages were used to describe sociodemographic, mental health, and WBV variables across all participants. Logistic regression with complex survey weights and multiple imputation of missing data was implemented to test associations between sociodemographic factors, maternal MHDs, and WBV attendance.

RESULTS

The weighted prevalence of missing the 1-week checkup or having never attended a WBV during the first six months postpartum was 4.3% (95% CI: 3.8% - 5.0%; n = 260) and 1.4% (1.1% - 2.0%; n = 98), respectively. Preconception depression (n = 553; 7.7%, 7.0% - 8.0%), prenatal depression (n = 481; 6.5%, 5.9% - 7.0%;), preconception anxiety (n = 1,007; 15.2%, 14.2% - 16.0%), and prenatal anxiety (n = 570; 8.44%, 7.7% - 9.0%) were not associated with 1-week checkup attendance. However, women with preconception depression were more than twice as likely to have never attended a WBV (OR = 2.43, 1.01 - 5.82). Multiple social determinants and demographic variables were associated with greater odds of missing WBVs, including middle household income, receiving government-issued health insurance or being uninsured, Hispanic ethnicity, and Spanish as a primary language.

CONCLUSIONS

Preconception depression, middle household income, receiving government-issued health insurance, being uninsured, Hispanic ethnicity, and Spanish as a primary language may decrease attendance of WBVs, and the mediating role of preconception depression in infant health outcomes warrants further investigation.