A prospective study of perinatal depression and
trauma history in pregnant minority adolescents
Samantha Meltzer-Brody, MD, MPH; Sarah E. Bledsoe-Mansori, PhD; Nell Johnson, MD; Candace Killian, LCSW;
Robert M. Hamer, PhD; Christine Jackson, BS; Julia Wessel, BA; John Thorp, MD
Adolescent pregnancy is common and minority adolescents
are at high risk. We sought the following: (1) to prospectively assess preva-
lence of antenatal depression (AND) and postpartum depression (PPD) in
minority adolescents and (2) to examine the association of social support
and adjustment, trauma, and stress on depression status.
A total of 212 pregnant adolescents were recruited
from public prenatal clinics and administered a prospective research
survey during pregnancy and 6 weeks’ postpartum. Depression was
measured using the Edinburgh Postnatal Depression Scale. Univariate,
bivariate, and multivariable analyses were performed using logistic re-
gression to assess predictors of AND and PPD.
In our cohort, 20% screened positive for AND and 10% for
PPD. The strongest predictor of PPD was AND (odds ratio [OR], 4.89;
P Ͻ .001). Among adolescents with trauma history, there was a 5-fold
increase (OR, 5.01) in the odds of AND and a 4-fold increase (OR, 3.76)
in the odds of PPD. AND was associated with the adolescent’s poor so-
cial adjustment (P Ͻ .001), perceived maternal stress (P Ͻ .001), less
social support (P Ͻ .001), and a less positive view of pregnancy (P Ͻ
.001). PPD was signiﬁcantly associated with primiparity (P ϭ .002),
poor social adjustment (P Ͻ .001), less social support and involvement
of the baby’s father (P Ͻ .001), and less positive view of pregnancy
(P Ͻ .001).
Signiﬁcant independent risk factors for PPD include
AND, view of pregnancy, and social support. Trauma history was highly
prevalent and strongly predicted AND and PPD. Point prevalence de-
creased postpartum, and this may be due to transient increased social
support following the birth, warranting longer follow-up and develop-
ment of appropriate interventions in future work.
Key words: adolescents, perinatal depression, postpartum
depression, pregnancy, trauma
Cite this article as: Meltzer-Brody S, Bledsoe-Mansori SE, Johnson N, et al. A prospective study of perinatal depression and trauma history in pregnant minority
adolescents. Am J Obstet Gynecol 2013;208:211.e1-7.
dolescent pregnancy is a burden-
some public health issue in the
United States with a prevalence of 10%
of adolescent girls under the age of 21
In 2008, there were 68 adoles-
cent pregnancies per 1000 women in the
United States, and this was a record low.
The recent decline in prevalence may be
primarily attributed to improved con-
However, the US adoles-
cent pregnancy rate is among the highest
in the developed world, more than twice
as high as Canada and Sweden.
There are signiﬁcant risks associated
with adolescent pregnancy including poor
maternal weight gain, preterm birth, preg-
nancy-induced hypertension, low birth-
weight, and neonatal death.
lescent pregnancies are unintended,
this places adolescent mothers and their
children at increased risk for depression,
poverty, abuse, and neglect
both pregnancy and postpartum.
These negative outcomes are exacer-
bated in women who are characterized as
low income and racial/ethnic minority
status, which are common demographic
characteristics of adolescent mothers.
Adolescent mothers face signiﬁcant
obstacles including the simultaneous
developmental tasks of adolescence
and parenting an infant,
leading to in-
creased risk of depression, emotional
and behavioral problems, and parent-
Depression during pregnancy (antenatal
[AND]) and postpartum depression
(PPD) have a prevalence of 10-15% in
and are associated with
signiﬁcant morbidity to the mother, the
newborn, and the family.
signiﬁcant public health impact of perina-
tal depression (PND), the risk factors and
prevalence of PND in adolescent mothers
From the Departments of Psychiatry (Drs Meltzer-Brody and Hamer and Ms Jackson) and
Obstetrics and Gynecology (Drs Johnson and Thorp), School of Medicine; the School of Social
Work (Dr Bledsoe-Mansori, Ms Killian, and Ms Wessel); and the Department of Biostatistics,
Gillings School of Global Public Health (Dr Hamer), University of North Carolina at Chapel Hill,
Chapel Hill, NC.
Received Aug. 17, 2012; revised Nov. 16, 2012; accepted Dec. 10, 2012.
This study was supported, in part, by National Institutes of Health grant NIH K23 MH085165-01A1
(S.M.-B.) and National Institutes of Health grants NIH K12-HD001441 and NIH-2674 (S.E.B.-M.).
The authors report no conﬂict of interest.
Presented at the Annual District Meeting of the North Carolina Obstetrical Society, Charlotte, NC,
April 20-22, 2012, and the North American Society for Psychosocial Obstetrics and Gynecology,
Providence, RI, April 22-25, 2012.
Reprints: Samantha Meltzer-Brody, MD MPH, Director, University of North Carolina Perinatal
Psychiatry Program, University of North Carolina, Department of Psychiatry, Campus Box 7160,
Chapel Hill, NC 27599. email@example.com.
0002-9378/$36.00 • © 2013 Mosby, Inc. All rights reserved. • http://dx.doi.org/10.1016/j.ajog.2012.12.020
MARCH 2013 American Journal of Obstetrics & Gynecology