326 - Leave Practices and Postpartum Depressive Symptoms Among Mothers of Infants with Prolonged Postnatal Hospitalization

Poster Number: 326
Publication Number: 326.1100

Background: Admission of an infant to the neonatal ICU is associated with increased rates of postpartum depression. Paid parental leave is associated with decreased rates of postpartum depression; however, use of paid leave differs significantly by income level, education, and race/ethnicity. Among mothers whose infants require prolonged hospitalization after birth, little is known about the presence of disparities in utilization of paid leave or how leave-taking is associated with postpartum depression in this high-risk group.

Objective: 1) Describe differences by socioeconomic factors and race/ethnicity in utilization of paid leave among mothers of infants with prolonged postnatal hospitalization, and 2) Analyze the relationship between postpartum depressive symptoms and leave-taking practices.

Design/Methods: Data were obtained from 19 states participating in the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2016–2021. We included respondents > 18 years of age with live births who reported working during pregnancy. Prolonged postnatal hospitalization was defined as hospitalization > 6 days or gestational age at delivery < 34 weeks. Participants reporting always or often feeling depressed or having no interest since birth were considered to have postpartum depressive symptoms. We fit adjusted logistic regression models for postpartum depressive symptoms to estimate odds ratios (ORs) associated with leave-taking. Analyses accounted for the PRAMS complex survey design.

Results: Among 7549 mothers whose infants had a postnatal hospitalization, 6% reported taking no maternity leave, 38% unpaid leave, and 56% paid leave. Compared to mothers taking unpaid or no leave, those who took paid leave were more likely to have at least some college education, be covered by private insurance, have a household income >$90k/year, and identify as white (Table 1). The prevalence of postpartum depressive symptoms was 16%. Mothers who reported taking unpaid leave (OR = 1.29; 95% CI = 0.96, 1.73) or no leave (OR = 1.59; 95% CI = 0.95, 2.65) were more likely to report symptoms of postpartum depression than those with paid leave (Table 2).

Conclusion(s): Among mothers of infants with prolonged postnatal hospitalization, paid leave utilization differed significantly by income, education, and race/ethnicity. Taking paid leave was associated with decreased postpartum depressive symptoms. These results suggest that broader paid leave policies may decrease disparities in maternal leave-taking among this group and may be associated with decreased rates of postpartum depressive symptoms.