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Am J Perinatol 2022; 39(11): 1189-1195
DOI: 10.1055/s-0040-1721696
Original Article

Is Postpartum Patient Navigation Uniquely Beneficial for Women with Antenatal Depressive Symptoms?

Noelle G. Martinez
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Lynn M. Yee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Emily S. Miller
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding This program was supported by the Northwestern Memorial Foundation/Friends of Prentice FY2015 Grants Initiative. L.M.Y. was supported by the NICHD K12 HD050121-11 at the time of the study.
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Abstract

Objective Women with depression benefit substantively from the comprehensive postpartum visit yet are less likely to attend such visits. Postpartum patient navigation has been associated with improved postpartum visit attendance. Thus, the objective of this study was to determine whether patient navigation was associated with differential postpartum visit attendance for low-income, largely racial/ethnic minority women with antenatal depressive symptoms.

Study Design This is a secondary analysis of a prospective postpartum patient navigation program for adult, low-income, largely racial/ethnic minority women receiving prenatal care at a single university clinic (n = 474). Patient navigators assumed supportive and logistical responsibilities for patients between delivery and postpartum visit completion (“navigation cohort”); women in the navigation cohort were compared with women who would have been eligible for patient navigation but received care the year before program implementation (“pre-navigation cohort”). Women were considered to have antenatal depressive symptoms if they had a Patient Health Questionnaire-9 score above 9 prior to delivery. The primary outcome was attendance at the comprehensive postpartum visit by 12 weeks. Factors associated with this outcome were assessed in a prenavigation cohort of women and were subsequently evaluated in the total cohort (prenavigation and navigation groups) using multivariable models. An interaction term between antenatal depressive symptoms and navigation status was generated to evaluate for effect modification.

Results In the prenavigation cohort, antenatal depressive symptoms were more frequent among women who did not attend the postpartum visit (25.0 vs. 10.2%, p = 0.002) and remained a risk factor for postpartum visit nonattendance on multivariable analysis (adjusted odds ratio [aOR]: 0.39, 95% confidence interval [CI]: 0.18–0.83). In the navigation cohort (n = 218), the presence of antenatal depressive symptoms was not associated with attendance (p = 0.117). In multivariable analyses of the total cohort, the interaction term between antenatal depressive symptoms and navigation was statistically significant (aOR: 11.06, 95% CI: 1.21–101.08).

Conclusion Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms for increasing postpartum appointment attendance.

Key Points

  • Patient navigation has been associated with improved postpartum visit attendance.

  • Among low-income women, antenatal depressive symptoms are a risk factor for postpartum visit nonattendance.

  • Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms.

Keywords

antenatal depressive symptoms - postpartum appointment - patient navigation - health disparities

Note

This abstract was presented as a poster presentation at the 39th Annual Meeting of the Society for Maternal-Fetal Medicine in Las Vegas, NV, on February 11–16, 2019.




Publication History

Received: 29 April 2020

Accepted: 04 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

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