Postpartum Depression Following a Substance-Exposed Pregnancy: The Roles of Age, Race/Ethnicity, and Prior Mental Health Experience

Objective: This study examines the impact of age, race/ethnicity, and depression history on the development of postpartum depression (PPD) among substance-using pregnant individuals. Design: This retrospective electronic medical record review examined maternal-child dyads from one university-affiliated pediatric clinic in Michigan to assess factors associated with PPD. Materials and Methods: A retrospective chart review was conducted at one university-affiliated pediatric practices in the Midwestern U.S., focusing on maternal-child dyads with children born since July 2016. Eligible participants had linked maternal prenatal/delivery records and pediatric medical records through age 3 and had self-report of or biochemically confirmed pregnancy substance use. The primary outcome was PPD, assessed using the Edinburgh Postnatal Depression Scale (EPDS) and maternal self-report of an external diagnosis. Results: Among 173 participants, 25.2% experienced PPD. Private insurance holders were over four times as likely to develop PPD (OR = 4.30, 95% CI: 1.36–13.58), and marijuana use increased risk nearly fivefold (OR = 4.91, 95% CI: 1.41–17.12). A history of mental health conditions was associated with a nearly fourfold increase in PPD risk but was not statistically significant after adjustment. Age and minority race/ethnicity were not significant predictors. Conclusions: Marijuana use and private insurance status were the strongest predictors of PPD in this substance-exposed population. While prior mental health history, age, and minority race/ethnicity were associated with increased PPD risk, these factors were not statistically significant. These findings highlight the need for targeted maternal mental health interventions and further research on socioeconomic and substance use-related risks. Support: This project is affiliated with Central Michigan University and was funded by NIH/NICHD grant: 1 R03 HD109588-01.