(398) Unplanned Cesarean Delivery is Associated with Higher Risk of Postpartum Depression and Engagement in Care

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Alexandra N. Mills, MD (she/her/hers)

Resident Physician
Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai
New York, NY, United States

Coauthor(s)

Nicola F. Tavella, MPH (he/him/his)

Research Director
Icahn School of Medicine at Mount Sinai
New York, NY, United States
Rachel Meislin, MD

Assistant Professor, Maternal Fetal Medicine
Icahn School of Medicine at Mount Sinai
New York, NY, United States
Chelsea A. DeBolt, MD, MSCR

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States

Objective: Postpartum depression (PPD) is a serious pregnancy complication, affecting 10-15% of postpartum people. Studies suggest an association between method of delivery (MOD) and PPD. Intrapartum experiences may contribute to PPD development and affect patient engagement in healthcare after birth through attendance at the six week postpartum visit (PPV). This study aims to interrogate the associations between MOD and PPD as well as PPV attendance in a large national pregnancy dataset.

Study Design: This was a retrospective study using the Pregnancy Assistance Monitoring Systems (PRAMS) national dataset by the United States Centers for Disease Control and Prevention (CDC). The cohort includes patients for whom MOD, demographic, and outcome data was available. The outcome of interest was PPD (via survey-administered PHQ-2 and patient-reported via survey), and attendance at the 6-week PPV (patient-reported via survey). The predictor variable was MOD: vaginal delivery (VD), planned cesarean delivery (CD), or unplanned CD. Chi-squared tests examined differences between groups and logistic regression models adjusting for maternal factors estimated adjusted odds ratios (aOR) of outcomes given MOD.

Results: This study included 6078 pregnancies: 3481 VDs (57.3%), and 2597 CDs (42.7%). Of the CDs, 1066 were planned CDs while 1531 were unplanned CDs. These groups differed significantly by maternal age, years of education, and household income. While those who delivered by planned CD did not have increased odds of PPD compared to VD, those who delivered by unplanned CD had increased odds of PPD as compared to VD (aOR 1.19 (1.04, 1.44)), and were significantly more likely to attend a postpartum visit (aOR 1.22 (1.05, 1.56)).

Conclusion: This study found that participants who delivered by unplanned CD but not planned CD are at increased odds of developing PPD and attending PPV compared to VD. Future work should focus on the physical and psychosocial stressors of an unplanned CD that may contribute to PPD development and postpartum care engagement.