(110) Postpartum Depression and Infant Vaccination Completion: A Real-World Data and Health Equity Perspective

Background: Maternal postpartum depression (PPD) may affect timely preventative care measures for infants. However, receiving a PPD diagnosis requires adequate access to mental healthcare.

Objectives: To evaluate the relationship between maternal PPD diagnosis and the completion of recommended infant vaccinations, controlling for measures that may impact health equity.

Methods: Women aged 12-55 with evidence of childbirth from 1/1/2016-6/30/2023 and their infants were identified in a mother-infant linked US dataset that includes administrative and claims data for over 3 million mother-infant pairs across commercial payors, Medicare Advantage and Medicaid. Mothers were required to have one year of continuous enrollment pre/post delivery and infants were required to have one year of continuous enrollment following birth. A cohort of mother-infant pairs with maternal PPD (identified by a combination of PPD-related diagnosis, procedure, and/or treatment 1 year post-delivery) were propensity score matched to mother-infant pair controls without PPD. Mothers with baseline psychosis, bipolar disorder, or schizophrenia were excluded. The primary outcome was the completion of all vaccine doses recommended by the US Centers for Disease Control and Prevention by 1 year of age for the following: hepatitis B, polio, pneumococcal conjugate, rotavirus, diphtheria, tetanus, and pertussis (DTaP), and Haemophilus influenzae type b. A logistic regression was used to compare the likelihood of vaccine completion among infants of women with PPD to those without, controlling for baseline demographic and clinical characteristics, year of delivery, pre-delivery healthcare expenditures, payor type, history of maternal immunization, and evidence of postpartum mental health screening.

Results: 78,505 mother-infant pairs with evidence of maternal PPD were matched to 149,654 controls. Those with a PPD diagnosis were more likely to complete recommended first-year infant vaccinations than those without (odds ratio [OR] = 1.11, 95% CI, 1.09-1.13), as well as those with any maternal immunization in the year prior to delivery (OR = 2.07, 95% CI, 2.03-2.11) and those receiving a postpartum mental health screening (OR = 1.17, 95% CI, 1.14-1.21). Those with Medicaid were less likely to complete recommended first-year vaccinations than those with commercial insurance (OR = 0.28, 95% CI, 0.27-0.29).

Conclusions: Mothers with PPD had a higher likelihood of completing recommended first-year infant vaccinations than those without. However, further research is needed to conclude if this association is mediated by factors related to socioeconomic status and healthcare access, which demonstrated a stronger effect on vaccine completion among a large cohort of US mother-infant pairs.