254 - Peripartum Depressive Symptoms and Safe Sleep Practices

Publication Number: 254.6460

Rebecca F. Carlin, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Susan Rosenthal, Columbia University Irving Medical School, New York, NY, United States; Ariel de Roche, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Eve R.. Colson, WashU Medicine, Saint Louis, MO, United States; Rachel Y. Moon, University of Virginia School of Medicine, Charlottesville, VA, United States; Ann Kellams, University of Virginia, Charlottesville, VA, United States; Fern R. Hauck, UVA, Charlottesville, VA, United States

Background: Sudden Unexpected Infant Deaths (SUID) are the leading cause of postneonatal mortality in the US. SUID prevention relies on interventions promoting universal use of safe sleep practices. Most parents are aware of these recommendations; yet families face many barriers to implementation. Peripartum (during pregnancy or the postpartum period) depression (PPD) affects up to 20% of new mothers and is associated with lower breastfeeding initiation and duration. However, little is known about how PPD affects other infant care practices, specifically sleep practices.

Objective: To determine, using population-based data, if mothers with self-reported PPD (diagnosis, treatment or positive screen), and/or history of depression are more likely to report using unsafe sleep practices than those with neither.

Design/Methods: The CDC Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 database provides population-based survey data on mothers of infants in 50 jurisdictions accounting for 81% of US live births. Mothers retrospectively reported depressive symptoms/treatment before and during pregnancy and completed a modified PHQ-2 to assess depressive symptoms at the time of the survey. Mothers were divided into 4 groups: chronic depression (CD) (history + PPD); only PPD (PPD), only history of depression (HD); and neither (ND). Sleep practices were measured by 11 individual items assessing sleep position, location, surface, and soft bedding use. We compared depression status with reported infant sleep practices using bivariate logistic regression (Table 1).

Results: Between 2018-2021, 231,412 mothers were living with their child at survey completion (median infant age 4 mos; range 2-11). Of these, 16% had CD, 7% had PPD, 7% had HD, and 70% had ND. Mothers with CD and PPD were less likely to follow recommendations to put infants supine, and to use a recommended surface (e.g. crib). They were also more likely to use an unsafe surface (e.g. swing) and soft bedding. Mothers with CD, PPD and HD were all less likely to always place infants on their own surface to sleep, yet those with CD and PPD were more likely to follow the recommendation to room share without bedsharing.

Conclusion(s): PPD symptoms may play a unique role in the use of unsafe sleep practices beyond depressive history and place infants at increased risk for SUID. Limitations include self-report data and lack of demographic covariates. Further research is needed to help elucidate the mechanisms of this relationship and the effects of sociodemographics on it. Interventions can then be designed to more effectively educate and support women with PPD.

Table 1. Use of Safe Sleep practices by reported depression group: (1) chronic: report history of depression and depression during pregnancy and/or positive PHQ screen (2) peripartum only: report of depression during pregnancy and/or positive PHQ-2 screen (3) history only: and (4) never: no report of either. Bivariate Logistic Regression Models (N= 231,412)
Table 1 Carlin 1104.pdf