Country of Birth, Race, Ethnicity, and Prenatal Depression.

Importance: Non-US-born pregnant individuals have demonstrated better perinatal outcomes compared with their US-born counterparts, yet limited literature has explored this association among mental health conditions in pregnancy and across racial and ethnic groups. Objective: To examine the differences in prenatal depression diagnosis and moderate to severe depression symptoms between non-US-born and US-born individuals across racial and ethnic subgroups. Design, Setting, and Participants: Cross-sectional study of members of Kaiser Permanente Northern California (KPNC), an integrated health care delivery system, who attended at least 1 prenatal care visit and delivered a live birth between January 1, 2013, and December 31, 2019. Data were analyzed from September 2023 to January 2024. Exposures: Self-reported race, ethnicity, and country of birth. Country of birth was used to define maternal nativity (US-born vs non-US-born). Main Outcomes and Measures: Prenatal depression diagnosis (PDD) defined by International Classification of Diseases, Ninth Revision and Tenth Revision codes and moderate to severe depression symptoms defined by self-reported Patient Health Questionnaire-9 (PHQ-9) scores of 10 or greater documented in the KPNC electronic health records (EHR) between the first day of the last menstrual period to the day before live birth. Results: Among the 252 171 participants (168 605 [66.7%] US-born and 83 566 [33.1%] non-US-born), adjusted models showed non-US-born pregnant individuals had an equivalent or significantly lower risk of PDD compared with their US-born counterparts within racial and ethnic subgroups. Non-US-born individuals presented a higher risk of moderate to severe depression symptoms compared with US-born individuals among certain Hispanic (eg, adjusted relative risk [aRR] for other Hispanic individuals, 1.30; 95% CI, 1.01-1.67), and Asian (eg, aRR for Japanese individuals, 3.62; 95% CI, 2.08-6.30) subgroups as well as among White pregnant individuals (aRR, 1.17; 95% CI, 1.10-1.25). Non-US-born Black pregnant individuals presented lower risk of PDD (aRR, 0.30; 95% CI, 0.25-0.36) and moderate to severe depression symptoms (aRR, 0.75; 95% CI, 0.65-0.86) compared with US-born Black individuals. Conclusions and Relevance: Across racial and ethnic groups, PDD and moderate to severe depression symptoms varied by maternal nativity in this cross-sectional study. The observed advantage among non-US-born individuals across other maternal and neonatal outcomes may not uniformly apply to prenatal mental health conditions when race and ethnicity are considered. Future research should explore sociocultural factors that may influence this association.