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Relationship Between Postpartum Mood Disorder and Delivery Experience: A Prospective Observational Study
Abstract Number: BP-03
Abstract Type: Original Research
Development of psychological sequelae is common in the postpartum period, with the incidence of depression as high as 19.2%.(1) Although posttraumatic stress disorder (PTSD) is not traditionally screened for, the incidence is as high as 15.7%.(2) Evidence suggests that traumatic events, such as severe pain in labor and obstetrical emergencies, may contribute to a postpartum mood disorder but the contribution of the birth experience to these outcomes is unclear.(3,4)
We conducted a prospective, longitudinal, observational study to test the hypothesis that events related to birth experience would be associated with the risk of developing postpartum PTSD or depression. (Table 1) Women were assessed at different time points for depression and anxiety utilizing a smartphone text or email message containing a link to the Edinburgh Postnatal Depression Scale and Perinatal Posttraumatic Stress Disorder screening tools. Women completed their postpartum screenings at 6 weeks and 3 months. The primary outcomes were the presence or absence of depression or PTSD. The risk of developing depression or PTSD was assessed by fitting logistic regression models for each variable using generalized estimating equations.
We enrolled 600 antepartum women, 427 met inclusion criteria, 376 completed the entire study. The rate of depression at 6 weeks and 3 months postpartum was 15.9% and 12.7% respectively. The rate of PTSD at 6 weeks and 3 months postpartum was 6.2% and 5.1% respectively. Twenty-six women (8%) with a negative screening at 6 weeks later converted to a positive EPDS or PTSD screen at 3 months. Pre-existing history of anxiety or depression increased the risk of developing postpartum depression (OR 2.12 (1.30-3.47)) and PTSD (OR 3.15 (1.42-7.02)) at either 6 weeks or 3 months. Operative management of hemorrhage also increased the risk of developing PTSD (OR 4.44 (1.16-17.02)).
A pre-existing history of anxiety or depression and operative management of hemorrhage predicted postpartum PTSD and depression. Furthermore, depression and anxiety either persisted or had a new onset at 3 months postpartum. Our findings support screening of PTSD, as well as screening beyond the traditional 6 week time period.
1. Obstetrics and gynecology 2005;106(5 Pt 1):1071-83.
2. Clinical Psychology Review 2014;34(5):389-401.
3. ACTA Obstet. Gynecol. Scand. 2012;(91):1261-1272.
4. ACTA Obstet. Gynecol. Scand. 2004;(83):257-261.