Does Long-standing Depression/Anxiety Influence the Association Between Caesarean and Postnatal Psychological Distress?

Pavankumar Kamat

Disclosures

August 02, 2021

Takeaway

  • Women with long-standing depression/anxiety who underwent elective caesarean had a lower risk of postnatal psychological distress (PPD).

  • Furthermore, women with long-standing depression/anxiety who underwent emergency caesarean had a greater risk of actively treated depression/anxiety at 3 years.

Why this matters

  • Further studies to determine why the mode of delivery may affect women with long-standing depression/anxiety differently, to help inform interventions for improving care.

Study design

  • A study of 15,936 women from the UK-based Millennium Cohort Study who gave birth between 2000 and 2001.

  • Primary outcome: PPD at 9 months according to the Rutter Malaise Inventory.

  • Secondary outcome: ‘later treatment’ (self-reported active treatment for depression/anxiety at 3 years postnatally).

  • Funding: None disclosed.

Key results

  • Of 15,936 women, 2346 (13.4%) were diagnosed with PPD.

  • Women with long-standing depression/anxiety had a lower risk of PPD following elective caesarean birth (relative risk [RR], 3.25; 95% CI, 2.23-4.75) vs vaginal birth (RR, 4.36; 95% CI, 3.76-5.05) with relative excess risk due to interaction (RERI), −1.28 (95% CI, −2.73 to 0.16).

  • Women with long-standing depression/anxiety had a greater risk of later treatment following emergency caesarean birth (RR, 6.74; 95% CI, 4.87-9.32) vs vaginal birth (RR, 4.95; 95% CI, 3.86-6.34) with RERI, 1.79 (95% CI, −0.13 to 3.71).

  • There was no association between emergency caesarean and PPD and between elective caesarean and later treatment.

Limitations

  • Lack of a consistent measure of PPD enabling comparison at 9 months and 3 years.

 

Henderson I, Quenby S. The association between caesarean and postnatal psychological distress: Effect modification by mental health history. Paediatr Perinat Epidemiol. 2021 Jul 13 [Epub ahead of print]. doi: 10.1111/ppe.12791. PMID: 34255373.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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