Antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner-city obstetric population

This study assessed the prevalence of antenatal psychiatric illness in low-income, ethnically diverse patients in an urban obstetric clinic and examined associations between positive psychiatric screens and inadequate utilization of prenatal care. Bilingual research assistants administered the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the Mood Disorder Questionnaire to 154 English- and Spanish-speaking pregnant patients attending routine prenatal visits. We assessed associations between patient characteristics, current and past psychiatric diagnoses, and utilization of prenatal care. Forty-five (29%) women screened positive for criteria for current psychiatric disorders with the highest rates for major or minor depression (26%) and anxiety disorders (10%). Inadequate prenatal care utilization was significantly associated with past psychiatric history and domestic abuse in the last year, but not with current psychiatric diagnosis, alcohol abuse, age, primiparity, marital status, receipt of government assistance, or unplanned pregnancy. Even after adjustment for possible confounding risk factors (e.g. past substance abuse, single marital status, unstable housing, education less than high school, and having other children), past psychiatric history was still significantly associated with inadequate prenatal care utilization and delayed initiation of care. A high percentage of disadvantaged pregnant women meet screening criteria for psychiatric disorders when screened during routine prenatal visits. Screening for past psychiatric history in routine prenatal visits could identify patients at risk for inadequate utilization of prenatal care.