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Preterm birth (PTB; <37 weeks gestation), is a leading cause of infant mortality and morbidity. Among those born preterm, risk increases as gestational age at birth decreases. Psychosocial factors such as depression symptoms and social determinants of health (SDH) may increase risk for PTB. Research is needed to understand these risk factors and identify effective interventions. This retrospective cohort study recruited English- and Spanish-speaking women presenting symptoms of preterm labor or admitted for PTB from an urban county hospital in the San Francisco Bay Area (n = 47). We used an iterative analytic approach by which qualitative data informed an exploratory quantitative analysis. Key exposures were presence of self-reported depression symptoms during pregnancy, SDH along eight domains, and receipt of behavioral health services. The outcome was gestational age at birth. T-tests, Wilcoxon rank sum tests, and linear regression models were used to test associations between the exposures and gestational age. Most participants were Black (25.5%) or Latina (59.6%). After adjusting for covariates, participants with depression symptoms had an average gestational age 3.1 weeks shorter (95% CI: -5.02, -1.20) than women reporting no symptoms. After adjusting for covariates, high number of adverse social determinants (≥ 4) suggested an association with shorter gestational age (p = 0.07, 1.65 weeks, 95% CI: -3.44, 0.14). Receipt of behavioral health services was associated with a significantly later gestational age; the median difference was 5.5 weeks longer for depression symptoms, 3.5 weeks longer for high social determinants, and 6 weeks longer for depression symptoms and high social determinants. Among a cohort of high-risk pregnant women, both depression symptoms during pregnancy and co-occurring with exposure to high adverse SDH are associated with shorter gestational age at birth, after controlling for psychosocial factors. Receipt of behavioral health services may be an effective intervention to address disparities in PTB.
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