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Delineating the association between mode of delivery and postpartum depression symptoms: A  longitudinal study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. (Obstetrik)ORCID iD: 0000-0001-7948-7912
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece .
Department of Biostatistics, Harokopio University, Athens, Greece.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 301-311, article id 29215162Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Although a number of perinatal factors have been implicated in the etiology of postpartum depression, the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. MATERIAL AND METHODS: In a longitudinal-cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self-reported postpartum depression symptoms (Edinburgh Postnatal Depression Scale >/=12) at 6 weeks postpartum was investigated through logistic regression models and path analysis. RESULTS: The overall prevalence of postpartum depression was 13%. Compared with spontaneous vaginal delivery, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04-2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of postpartum depression and led more frequently to elective cesarean section; however, it was associated with a positive delivery experience. CONCLUSIONS: Mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.

Place, publisher, year, edition, pages
2018. Vol. 97, no 3, p. 301-311, article id 29215162
Keywords [en]
Postpartum depression, cesarean section, delivery experience, mode of delivery, vacuum extraction
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-343030DOI: 10.1111/aogs.13275ISI: 000426055500009OAI: oai:DiVA.org:uu-343030DiVA, id: diva2:1185466
Projects
Basic
Funder
Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg FoundationAvailable from: 2018-02-25 Created: 2018-02-25 Last updated: 2018-10-08Bibliographically approved
In thesis
1. Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism
Open this publication in new window or tab >>Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Even though most pregnancies and deliveries are uncomplicated, still fifteen percent of all women in developed countries suffer pregnancy-related complications. The aim of this thesis was to explore the associations between perinatal complications and perinatal maternal health, with emphasis on postpartum depressive symptoms (PPDS) and neuroticism taking into account potential confounding or mediating factors such as history of depression, antenatal depressive symptoms and delivery experience.

In the first study (n=446), the association between heavy postpartum haemorrhage and PPDS at six weeks postpartum was delineated by using path-analysis in order to provide insight into the complex mediating roles of several consequences of postpartum haemorrhage. There was no direct association between postpartum haemorrhage and PPDS, only an indirect one via anaemia at discharge and negative delivery experience.

The second study (n=3888) examined the association of mode of delivery with PPDS at 6 weeks postpartum. The results indicate that the association between elective caesarean section and PPDS is highly confounded by history of depression and fear of delivery, while emergency caesarean section and vacuum extraction increase odds for PPDS by leading to postpartum complications and negative delivery experience.

The third study (n=1503) investigated the association between the use of epidural analgesia during delivery and PPDS. A positive association in the crude analysis was no longer present after adjustment for sociodemographic, psychosocial and obstetrical variables, indicating that pain relief through epidural analgesia is not likely to affect risk for PPDS.

In the last study (n=1969), the association between neuroticism and perinatal complications was explored. Neuroticism was not associated with adverse perinatal outcomes, except for gestational diabetes mellitus. The association, however, became statistically non-significant after adjusting for psychiatric morbidity.

In summary, the current studies do no find evidence for a direct association between perinatal complications and postpartum depressive symptoms or neuroticism. However, several important mediators have been identified, among which postpartum anaemia and negative delivery experience deserve special attention. Also, earlier psychiatric history needs to be addressed as an important confounder.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 87
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1503
Keywords
antenatal depression, ceasarean section, delivery complications, Edinburgh postnatal depression scale, EPDS, epidural analgesia, gestational diabetes mellitus, instrumental delivery, neonatal complications, neuroticism, obstetric complications, personality, perinatal complications, postpartum depression, postpartum haemorrhage, pregnancy complications, vacuum extraction, vaginal delivery
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Research subject
Obstetrics and Gynaecology; Psychiatry
Identifiers
urn:nbn:se:uu:diva-362566 (URN)978-91-513-0466-3 (ISBN)
Public defence
2018-11-30, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-11-01 Created: 2018-10-08 Last updated: 2018-11-19

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Eckerdal, PatriciaWikström, Anna-KarinHögberg, UlfSkalkidou, Alkistis
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