(276) Association Between Disrespectful Maternity Care and Two-Month Postpartum Depression: A National Population-Based Study

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author(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

Coauthor(s)

AC

Anne A. Chantry, CNM, PhD

Professor
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
ST

Sarah Tebeka, MD, PhD

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

Anne Evrard

Collectif Interassociatif autour de la Naissance
Paris, Ile-de-France, France
AD

Alexandra Doncarli, PhD

Santé Publique France
Saint Maurice, 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

Presenting Author(s)

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) is a common condition, with potential deleterious effects on mother and child. The involvement of disrespectful maternity care in negative childbirth experiences is increasingly studied, but its potential link with PPD remains under-evaluated. The objective was to assess the association between disrespectful maternity care and PPD at 2 months postpartum using national population-based data.

Study Design: Women from the 2021 Enquête Nationale Périnatale (all births in France during one week) who completed the 2-month follow-up questionnaire were included. Two-month PPD was defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥13. Disrespectful care (healthcare professional’s inappropriate words, gestures or attitudes) during childbirth and/or postpartum were reported by women at 2 months postpartum. The association between disrespectful care and PPD was assessed using Poisson regression with robust variance, adjusted for confounders and weighted to account attrition. Sensitivity analyses were conducted using different EPDS cut-off and among subgroups of women at low pre-existing risk for PPD (antenatal well-being and no history of psychological / psychiatric care) or high pre-existing risk. Robustness against unmeasured confounding was assessed using E-value calculation.

Results: Among the 7189 women analyzed, 16.6% (95% confidence interval -CI- 15.7-17.6) had PPD at 2 months, and 24.9% (95% CI 23.8-26.0) reported experiencing disrespectful maternity care. After adjustment, women who reported disrespectful care were more likely to have 2-month PPD (adjusted relative risk –aRR 1.37; 95% CI 1.20-1.57, with E-value 2.08), including those at low pre-existing risk (aRR 1.69; 95% CI 1.34-2.15).

Conclusion: Experience of disrespectful care during childbirth or postpartum was associated with an increased prevalence of 2-month PPD. Given the concerning incidence of PPD and its consequences, these results underline the importance of raising awareness among healthcare professionals and enabling them to provide respectful care.