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Medical/Surgical/Diseases/Complications

Poster Session 3

(845) Mode of delivery and postpartum depressive symptoms among nulliparous people with antenatal depression

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee

    Primary & Presenting Author(s)

  • Nina K. Ayala, MD, ScM (she/her/hers)

    Assistant Professor
    Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
    Providence, RI, United States

    • Coauthor(s)

  • LS

    Lauren Schlichting, PhD

    Hassenfeld Child Health and Innovation Institute of Brown University
    Providence, RI, United States

  • Emily S. Miller, MD, MPH (she/her/hers)

    Director, Division of Maternal-Fetal Medicine
    Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
    Providence, RI, United States

  • Anna Whelan, MD (she/her/hers)

    University of Massachusetts Chan Medical School
    Grafton, MA, United States

  • Martha B. Kole-White, MD

    Assistant Professor
    Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
    Providence, RI, United States

  • Adam K. Lewkowitz, MD, MPH

    Assistant Professor
    Warren Alpert Medical School of Brown University, Women & Infants Hospital Rhode Island
    Providence, RI, United States

Objective: Antenatal depression (AD) and cesarean delivery (CD) are both independent risk factors for postpartum depression (PPD); however, it is unknown whether mode of delivery impacts progression from AD to PPD.

Study Design: The 2016-2019 Multistate Pregnancy Risk Assessment Monitoring System (PRAMS) data was used to identify first-time parturients with AD (reported depression in the 3 months prior to or at any point during pregnancy).  Mode of delivery was obtained through the birth record. The primary outcome was self-reported PPD symptoms (positive response on the PHQ-2) and was compared between those undergoing a spontaneous vaginal delivery (SVD) to those who underwent operative birth (CD plus operative vaginal delivery). Maternal demographics, pregnancy characteristics and delivery characteristics were compared between groups. Population-weighted multivariable regression was performed, adjusting for a priori confounders.

Results: Of the 15,317 people who met the inclusion criteria, 9,405 (63.6%) had a SVD and 5,912 (36.4%) had an operative birth. Parturients who underwent operative birth were older, had higher levels of education, were more likely to be married, had higher BMIs, more medical comorbidities (hypertension and diabetes), and higher rates of preterm birth than those who had a SVD (Table). After adjustment for confounders, there was no difference in the odds of PPD symptoms between those with AD who had a vaginal delivery compared with operative birth (aOR 1.08, 95% CI 0.95-1.24).

Conclusion: In this large, population-based, nationally representative study of first-time parturients with AD, there was no association between mode of delivery and risk of PPD symptoms. This is important for counseling those with AD, who are often concerned about the risk for development or progression of PPD.