Relationship between postpartum mood disorder and birth experience: a prospective observational study. (November 2020)

• Record Type: Journal Article
• Authors: Kountanis, J.A.; Muzik, M.; Chang, T.; Langen, E.; Cassidy, R.; Mashour, G.A.; Bauer, M.E.
• Is Part Of: International journal of obstetric anesthesia. Volume 44(2020)
• Page Start: 90
• Page End: 99
• Publication Date: 2020-11
• Subjects: Pregnancy -- Depression, postpartum -- Stress disorders, post-traumatic -- Delivery, obstetric -- Postpartum hemorrhage; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2020.07.008
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Traumatic birth may contribute to postpartum mental illness. Nulliparity was associated with increased risk of post-traumatic stress. Operative management of hemorrhage increased the risk of post-traumatic stress. Symptoms continued to persist or had arisen at three months postpartum. Abstract: Background: This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. Methods: In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum. Results: We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02). Conclusion: Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.