Prenatal depression screening increased from 2019 to 2024, but improvements were not equal across language groups, resulting in larger screening gaps by 2024 for individuals with non-English language preference. Screening probabilities were similar across language groups early in the evaluation period, indicating that disparities emerged as screening expanded rather than reflecting persistent baseline differences. Prenatal depression screening is typically conducted in obstetric care as a primary pathway through which perinatal depression is identified and patients are connected to mental health services.⁶ From a health-systems perspective, screening gaps represent missed opportunities for earlier intervention, including initiation of evidence-based psychotherapy and/or pharmacotherapy, care management, and collaborative care approaches. If screening is less consistently completed for people with non-English language preference, fewer patients may be identified during routine prenatal care, potentially leading to patients with non-English language preference presenting with higher-acuity mental health conditions.

That disparities emerged as screening expanded suggests that implementation improved overall completion without fully addressing language access. Incorporation of screening into performance metrics may increase uptake, but without routine stratification by language preference, aggregate reporting can obscure widening inequities. Screening programs often use EHR prompts, standardized workflows, and embedded instruments, which may be built first for English-preference patients. When interpreter support or translated tools are needed, screening can require additional steps, such as locating validated translations and different documentation processes, increasing burden for patients and clinical teams. The presence of many preferred languages with small counts highlights a structural challenge to equitable screening, as validated instruments may be unavailable for some language groups. In addition, small numbers across many languages can limit routine health system attention to any single group, even when the full patient population with non-English language preference is substantial.

Strengths of this study include the large cohort across multiple years within a diverse health system and use of EHR-derived measures to evaluate real-world screening implementation. The analytic approach accounted for individuals contributing multiple pregnancies and examined whether the association between language preference and screening changed over time, which directly addresses how inequities may emerge during program expansion. A limitation to this research is that screening was identified based on documentation of a screening instrument in the EHR; this may not fully capture whether screening was completed as intended, understood by the patient, or administered with interpreter support when needed. Second, language preference recorded in the EHR may not perfectly reflect language proficiency, literacy, or degree of need for language support services, and the “Another Language” category necessarily aggregates heterogeneous language groups. Third, this analysis evaluated receipt of screening rather than downstream steps such as severity of symptoms, follow-up, referral completion, or treatment initiation; therefore, we cannot directly quantify how screening gaps translated into differences in mental health service access or outcomes. Finally, results reflect a single health system and may not generalize to settings with different screening workflows or language-access resources.

In summary, prenatal depression screening increased substantially from 2019 to 2024, yet language-related inequities widened as screening expanded. Given that mental health–related morbidity is a substantial contributor to overall maternal morbidity and that screening is a key entry point to mental health services, equitable screening implementation is a health-systems and psychiatric care priority.^3,5 Stratifying quality metrics by language preference and designing multilingual screening workflows may help ensure that screening expansion translates into equitable access to essential perinatal mental health care.