Postpartum Depression Is Prevalent Among Women Who Have a Cesarean Delivery

One in 6 women experienced symptoms of postpartum depression 2 months after cesarean delivery, according to study findings published in the American Journal of Obstetrics and Gynecology.

Researchers conducted an ancillary prespecified analysis of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2; ClinicalTrials.gov Identifier: NCT03431805) trial in 27 maternity units in France between March 2018 and January 2020 to evaluate the prevalence of postpartum depression and its risk factors 2 months following cesarean delivery.

Adult women who underwent cesarean delivery at 34 and more weeks of gestation were randomly assigned to receive a 1 g injection of tranexamic acid or placebo immediately after delivery.

The primary outcome was postpartum depression provisional diagnosis 2 months post-cesarean delivery, which was assessed using the French version of the Edinburgh Postnatal Depression Scale (EPDS). A score of 13 and greater on the EPDS indicated high postpartum depression risk. To analyze associations between potential risk factors and postpartum depression, multivariate logistic regression was used.

A total of 2793 women (aged <35, 60.4%; born in Europe, 78.4%; primiparous, 42.1%; psychiatric history, 5.0%) were included in the study. At 2 months after cesarean delivery, the corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% CI, 14.9-18.0).

Pre-pregnancy characteristics that were linked to postpartum depression provisional diagnosis included young age (adjusted odds ratio [aOR] for each 5-year increase in maternal age, 083; 95% CI, 0.74-0.93) and non-European country of birth (North Africa: aOR, 2.58; 95% CI, 1.85-3.59; sub-Saharan Africa: aOR, 1.57; 95% CI, 1.09-2.26; other: aOR, 1.99; 95% CI, 1.28-3.1).

In multivariate analysis, cesarean-related characteristics associated with an increased risk for postpartum depression included an emergency cesarean prior to labor (aOR, 1.70; 95% CI, 1.15-2.50) and a cesarean during labor after labor induction (aOR, 1.36; 95% CI, 1.03-1.84).

Women who reported severe pain during the postpartum stay (aOR, 1.73; 95% CI, 1.32-2.26) and bad memories of delivery (aOR, 1.67; 95% CI, 1.14-2.45) on day 2 postpartum were also at higher risk for postpartum depression at 2 months post-cesarean delivery.

In contrast, women who had a person of support present in the operating room had a lower risk for postpartum depression (aOR, 0.73; 95% CI, 0.53-0.97).

In a sensitivity analysis that defined postpartum depression as an EPDS score of 11 and greater, the weighted prevalence of postpartum depression was 23.1% (95% CI, 21.4-24.9). Similar risk factors were identified.

Study limitations include the potential underestimation of postpartum depression prevalence, possible bias, and the inability to discern whether the depressive disorder preceded the obstetric events.

“Future research is needed to identify early interventions that could help reduce the incidence or severity of PPD [postpartum depression], including psychotherapy or pharmacotherapy,” the study authors concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.