The Association of Antenatal Depression and Cesarean Delivery Among First-Time Parturients: A Population-Based Study

Overview

Journal Am J Perinatol

Specialty Gynecology & Obstetrics

Date 2022 Oct 13

PMID 36228650

Authors

Nina K Ayala

Lauren Schlichting

Adam K Lewkowitz

Martha B Kole-White

Annie Gjelsvik

Karine Monteiro

Siraj Amanullah

Affiliations

Soon will be listed here.

Abstract

Objective: Antenatal depression (AD) has been considered a risk factor for cesarean delivery (CD); however, the supporting data are inconsistent. We used a large, nationally representative dataset to evaluate whether there is an association between AD and CD among women delivering for the first time.

Study Design: We utilized the 2016 to 2019 Multistate Pregnancy Risk Assessment Monitoring System (PRAMS) from the Centers for Disease Control. First-time parturients who reported depression in the 3 months prior to or at any point during their recent pregnancy were compared with those who did not. The mode of delivery was obtained through the birth certificate. Maternal demographics, pregnancy characteristics, and delivery characteristics were compared by the report of AD using bivariable analyses. Population-weighted multivariable regression was performed, adjusting for maternal age, race/ethnicity, insurance, pregnancy complications, preterm birth, and body mass index (BMI).

Results: Of the 61,605 people who met the inclusion criteria, 18.3% ( = 11,896) reported AD and 29.8% ( = 19,892) underwent CD. Parturients with AD were younger, more likely to be non-Hispanic white, publicly insured, use tobacco in pregnancy, deliver earlier, have lower levels of education, higher BMIs, and more medical comorbidities (hypertension and diabetes). After adjustment for these differences, there was no difference in risk of CD between those with AD compared with those without (adjusted odds ratio: 1.04; 95% confidence interval: 0.97-1.13).

Conclusion: In a large, population-weighted, nationally representative sample of first-time parturients, there was no association between AD and CD.

Key Points: · Antenatal depression is increasingly common and has multiple known morbidities.. · Prior data on antenatal depression and cesarean delivery are mixed.. · We found no association between depression and cesarean delivery..

References

Shulman H, DAngelo D, Harrison L, Smith R, Warner L . The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology. Am J Public Health. 2018; 108(10):1305-1313. PMC: 6137777. DOI: 10.2105/AJPH.2018.304563. View

Josberger R, Wu M, Nichols E . Birth Certificate Validity and the Impact on Primary Cesarean Section Quality Measure in New York State. J Community Health. 2018; 44(2):222-229. DOI: 10.1007/s10900-018-0577-y. View

Spong C, Berghella V, Wenstrom K, Mercer B, Saade G . Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012; 120(5):1181-93. PMC: 3548444. DOI: 10.1097/aog.0b013e3182704880. View

Chung T, Lau T, Yip A, Chiu H, Lee D . Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001; 63(5):830-4. DOI: 10.1097/00006842-200109000-00017. View

White VanGompel E, Main E, Tancredi D, Melnikow J . Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study. BMC Pregnancy Childbirth. 2018; 18(1):184. PMC: 5975533. DOI: 10.1186/s12884-018-1756-7. View

Bayrampour H, Salmon C, Vinturache A, Tough S . Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res. 2015; 41(7):1040-8. DOI: 10.1111/jog.12683. View

McKee K, Admon L, Winkelman T, Muzik M, Hall S, Dalton V . Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015. BMC Womens Health. 2020; 20(1):150. PMC: 7376899. DOI: 10.1186/s12905-020-00996-6. View

Haight S, Byatt N, Moore Simas T, Robbins C, Ko J . Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000-2015. Obstet Gynecol. 2019; 133(6):1216-1223. PMC: 6842065. DOI: 10.1097/AOG.0000000000003291. View

. ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstet Gynecol. 2019; 132(5):e208-e212. DOI: 10.1097/AOG.0000000000002927. View

10.

Simonovich S, Nidey N, Gavin A, Pineros-Leano M, Hsieh W, Sbrilli M . Meta-Analysis Of Antenatal Depression And Adverse Birth Outcomes In US Populations, 2010-20. Health Aff (Millwood). 2021; 40(10):1560-1565. DOI: 10.1377/hlthaff.2021.00801. View

11.

Zochowski M, Kolenic G, Zivin K, Tilea A, Admon L, Hall S . Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders. Health Aff (Millwood). 2021; 40(10):1585-1591. PMC: 9014312. DOI: 10.1377/hlthaff.2021.00780. View

12.

Hassanzadeh R, Abbas-Alizadeh F, Meedya S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M . Fear of childbirth, anxiety and depression in three groups of primiparous pregnant women not attending, irregularly attending and regularly attending childbirth preparation classes. BMC Womens Health. 2020; 20(1):180. PMC: 7429472. DOI: 10.1186/s12905-020-01048-9. View

13.

Sliwerski A, Kossakowska K, Jarecka K, Switalska J, Bielawska-Batorowicz E . The Effect of Maternal Depression on Infant Attachment: A Systematic Review. Int J Environ Res Public Health. 2020; 17(8). PMC: 7216154. DOI: 10.3390/ijerph17082675. View

14.

Ahluwalia I, Ding H, Harrison L, DAngelo D, Singleton J, Bridges C . Disparities in influenza vaccination coverage among women with live-born infants: PRAMS surveillance during the 2009-2010 influenza season. Public Health Rep. 2014; 129(5):408-16. PMC: 4116368. DOI: 10.1177/003335491412900504. View

15.

Palladino C, Singh V, Campbell J, Flynn H, Gold K . Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol. 2011; 118(5):1056-1063. PMC: 3428236. DOI: 10.1097/AOG.0b013e31823294da. View

16.

Toth S, Rogosch F, Sturge-Apple M, Cicchetti D . Maternal depression, children's attachment security, and representational development: an organizational perspective. Child Dev. 2009; 80(1):192-208. PMC: 2785452. DOI: 10.1111/j.1467-8624.2008.01254.x. View

17.

Yedid Sion M, Harlev A, Weintraub A, Sergienko R, Sheiner E . Is antenatal depression associated with adverse obstetric and perinatal outcomes?. J Matern Fetal Neonatal Med. 2015; 29(6):863-7. DOI: 10.3109/14767058.2015.1023708. View

18.

Martin J, Osterman M, Kirmeyer S, Gregory E . Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate. Natl Vital Stat Rep. 2015; 64(5):1-20. View

19.

Ayala N, Lewkowitz A, Gjelsvik A, Monteiro K, Amanullah S . Antenatal Depression and Cesarean Delivery Among Recently-Delivered Nulliparous Women in Rhode Island. R I Med J (2013). 2022; 105(1):32-36. PMC: 10304038. View

20.

Clark E, Silver R . Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011; 205(6 Suppl):S2-10. DOI: 10.1016/j.ajog.2011.09.028. View