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CC BY-NC-ND 4.0 · Am J Perinatol 2023; 40(04): 356-362
DOI: 10.1055/a-1960-2919
SMFM Fellowship Series Article

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

Nina K. Ayala 
1   Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Lauren Schlichting
2   Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
,
Adam K. Lewkowitz
1   Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Martha B. Kole-White
1   Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Annie Gjelsvik
2   Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
3   Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
4   Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
,
Karine Monteiro
5   Rhode Island Department of Health, Providence, Rhode Island
,
Siraj Amanullah
2   Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
4   Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
6   Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
7   Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
› Author Affiliations Funding None.
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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% (n = 11,896) reported AD and 29.8% (n = 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.

Keywords

antenatal depression - perinatal depression - mode of delivery - cesarean delivery

Note

This study was presented at The Society for Maternal Fetal Medicine National Conference, January 31–February 5, 2022.




Publication History

Received: 07 June 2022

Accepted: 22 September 2022

Accepted Manuscript online:
13 October 2022

Article published online:
15 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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