Poster Session 2
.jpg "Samantha L. Kruger, MA, MD photo")
Samantha L. Kruger, MA, MD
Resident
Stanford University
Palo Alto, California, United States
Nicola C. Perlman, MD (she/her/hers)
Clinical Fellow in Maternal-Fetal Medicine
Stanford University
Palo Alto, CA, United States
Elizabeth B. Sherwin, MPH
Biostatistician
Stanford University
Palo Alto, California, United States
Yasser Y. El-Sayed, MD
Director, Maternal-Fetal Medicine
Stanford University
Stanford, California, United States
Deirdre J. Lyell, MD
Professor
Stanford University
Palo Alto, California, United States
Elliott K. Main, MD
Professor
Stanford University
Stanford, California, United States
Suzan L. Carmichael, PhD
Professor
Stanford University
Palo Alto, California, United States
Katherine L. Wisner, MD, MS
Children's National Hospital
Washington, District of Columbia, United States
Pervez Sultan, MD (he/him/his)
Professor
Stanford University
Palo Alto, California, United States
Stephanie A. Leonard, PhD (she/her/hers)
Assistant Professor
Stanford University
Palo Alto, California, United States
Danielle M. Panelli, MD, MS (she/her/hers)
Instructor
Stanford University
Palo Alto, California, United States
Birth trauma is an increasingly recognized and prevalent problem, yet the relationship between potentially traumatic birth events (such as unplanned mode of delivery) and postpartum mental health conditions is understudied. We evaluated associations between unplanned delivery modes and new onset postpartum mental health conditions.
This was a retrospective cohort study of singleton live births between 2008-2022 from the MarketScan® Commercial Database. We excluded births with mental health conditions diagnosed during pregnancy, discontinuous insurance enrollment, preterm birth ( < 37 weeks), contraindications to labor, and planned cesareans. The exposure was spontaneous vaginal delivery (SVD), successful operative vaginal delivery (OVD) with vacuum or forceps, unplanned cesarean without OVD attempt, or cesarean after failed OVD. The outcome was a mental health condition (depression, anxiety, post-traumatic stress disorder (PTSD), or other serious psychiatric conditions) diagnosed between delivery and 6 months postpartum. Multivariable logistic regression models were conducted to assess associations between mode of delivery and any postpartum mental health condition, adjusting for confounders. Secondarily, models were replicated to evaluate each individual mental health condition as an outcome. A total of 829,917 births were included. Compared with SVD, postpartum mental health conditions were increased after unplanned cesarean without OVD [adjusted odds ratio (aOR) 1.15, 95% confidence interval (CI) 1.13-1.18] and after unplanned cesarean with failed OVD (aOR 1.20, 95% CI 1.03-1.38, Table 1). Prevalence of PTSD was significantly increased in all modes of delivery compared to SVD, most notably for failed OVD (aOR 1.60 95% CI 1.09-2.26, Figure 1).
Results:
Conclusion:
Postpartum mental health conditions were increased among people with unplanned cesarean births, most notably PTSD in those with failed OVD. Screening for PTSD should be considered, especially for people who have failed OVD attempts that result in cesarean birth.
