# Postpartum Depression in a High-Risk Population: An Exploratory Pilot Study Examining Family Composition Factors in Mothers With Substance Use During Pregnancy

## TL;DR

This pilot study explores how family composition factors affect postpartum depression risk in mothers with substance use during pregnancy.

## Contribution

It is the first to examine coparenting and presence of other children in a high-risk population with documented substance use.

## Key findings

- 28.7% of mothers screened positive for probable postpartum depression.
- Mothers with other children had four times higher odds of PPD screening positive.
- Coparenting status was not significantly associated with PPD risk.

## Abstract

Background: Postpartum depression (PPD) affects approximately 10%-15% of mothers globally and represents a significant mental health concern. While most research shows first-time mothers are at higher risk for PPD, little is known about how family composition factors influence PPD risk in high-risk populations. This exploratory pilot study examined whether the presence of other children in the household and coparenting status predict PPD screening results among mothers with substance use during pregnancy.

Material and methods: This retrospective chart review included 101 mother-infant dyads from a university-affiliated pediatric practice in the Midwestern United States. All mothers had documented substance use during pregnancy, with the most commonly documented substances being marijuana (45.5%) and tobacco (36.6%). The majority (94.1%) were Medicaid recipients. PPD screening was conducted using the Edinburgh Postnatal Depression Scale (EPDS) during pediatric well-child visits within the first six months postpartum. Logistic regression analyses examined associations between PPD screening results and family composition factors (coparenting status and presence of other children).

Results: Among the 101 mothers screened, 28.7% screened positive for probable PPD. The prevalence was notably higher among mothers with other children (34.1%) compared to first-time mothers (15.8%). In adjusted models, mothers with other children had four times higher odds of screening positive for PPD (odds ratio(OR) = 4.09, 95% confidence interval (CI): 1.10-15.19), although the wide confidence interval indicates considerable uncertainty. Coparenting status was not significantly associated with PPD risk (adjusted OR = 1.02, 95% CI: 0.44-2.38).

Conclusions: This exploratory pilot study suggests that the relationship between family composition factors and PPD screening results may differ in high-risk populations compared to general samples. The association with multiparity warrants further investigation, although unmeasured confounding, particularly prior psychiatric history, limits causal interpretation. These preliminary findings highlight the need for larger prospective studies with comprehensive measurement of confounders to understand PPD risk factors in vulnerable populations and inform targeted interventions.