(453) Association between instrumental vaginal delivery and the risk of postpartum depression

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

CYRIELLE PRAT BALAGNA, N/A (she/her/hers)

Resident
INSERM UMR 1153, Obstetrical , Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris
PARIS, Ile-de-France, France

Coauthor(s)

Marianne Jacques, CNM, MSc (she/her/hers)

PhD Student
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé) - Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Inserm
Paris, Ile-de-France, France
MV

Marie Viaud, CNM

Statistician
INSERM UMR 1153, Obstetrical , Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris
Paris, Ile-de-France, France
ST

Sarah Tebeka, MD, PhD

Psychiatrist
Department of Psychiatry, AP-HP, Louis Mourier Hospital
Colombes, Ile-de-France, France
AS

Aurélien Seco, MSc

Statistician
Université Paris Cité, Inserm, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé),
Paris, Ile-de-France, France
NL

Nathalie Lelong, MSc

Project manager
INSERM UMR 1153, Obstetrical , Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris
Paris, Ile-de-France, France
Camille Le Ray, MD, PhD (she/her/hers)

Professor
INSERM 1153, APHP, Port Royal maternity unit, Université de Paris
Paris, Ile-de-France, France

Objective: Postpartum depression(PPD) affects 10-20% of women and previous studies have identified instrumental vaginal birth(VB) as a risk factor. Our study aimed to test this association, in full-term pregnancies with a trial of vaginal delivery, and to explore mediating factors.

Study Design: We used data from the observational nationwide population-based study ENP 2021, including women who completed the Edinburgh Postnatal Depression Scale(EPDS) at 2-month. Multiple pregnancies, non-cephalic presentations, preterm births and planned cesareans were excluded. An EPDS score ≥ 13 was used as a validated proxy for PPD. Mode of delivery (spontaneous VB/instrumental VB/cesarean), type and indication of the instrument were collected. The association between instrumental VB and PPD was studied using univariate and multivariate analyses and weighted to account for 2-month attrition. Mediation analyses were conducted after identification of intermediate factors: maternal composite criterion (postpartum hemorrhage+/-obstetric anal sphincter injury), episiotomy, neonatal composite criterion (Apgar score ≤ 7+/-neonatal transfer), pain and disrespectful care during delivery. Two sensitivity analyses were performed among women at low psychiatric risk and using an EPDS score ≥ 11.

Results: The study population included 6084 women: 4473(73.5%) had spontaneous VB, 915(15.0%) instrumental VB and 696 (11.5%) cesareans. PPD prevalence was 16.3%[15.3-17.3] reaching 19.3% for instrumental VB (aOR 1.35[1.10-1.66]) compared with 15.6% for spontaneous VB (reference) and 16.7% for cesareans (aOR 1.05[0.83-1.33]). Fetal heart rate abnormalities indication was associated with higher PPD prevalence. The indirect effect mediated by disrespectful care during delivery explained 18% of the association between instrumental VB and PPD (aOR of indirect effect: 1.04[1.01-1.07]). We found no significant mediation effect for other factors. Sensitivity analyses found similar results.

Conclusion: The prevalence of PPD was significantly higher with instrumental VB, an association partly mediated by disrespectful care during delivery.