Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes

Abstract

Background Relatively little is known about antepartum suicidal behaviour and pregnancy outcomes. We examined associations of antepartum suicidal behaviour, alone and in combination with psychiatric disorders, with adverse infant and obstetric outcomes. Methods We included 188 925 singleton livebirths from a retrospective cohort (1996‐2016). Suicidal behaviour, psychiatric disorders, and outcomes were derived from electronic medical records. We performed multivariable logistic regressions with generalised estimating equations to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results The prevalence of antepartum suicidal behaviour was 152.44 per 100 000 singleton livebirths. Nearly two‐thirds (64.24%) of women with suicidal behaviour also had psychiatric disorders. Compared to women without psychiatric disorders and suicidal behaviour, women with psychiatric disorders alone had 1.3‐fold to 1.4‐fold increased odds of delivering low birthweight or preterm infants and 1.2‐fold increased odds of experiencing obstetric complications. Women with suicidal behaviour alone had increased odds of preterm labour (aOR 2.05, 95% CI 1.16, 3.62). Women with both suicidal behaviour and psychiatric disorders had > twofold increased odds of delivering low birthweight (aOR 2.52, 95% CI 1.40, 4.54), preterm birth (aOR 2.44, 95% CI 1.63, 3.66), and low birthweight/preterm birth (aOR 2.30, 95% CI 1.54, 3.44) infants; the odds of preterm labour (aOR 1.62, 95% CI 1.06, 2.47), placental abruption (aOR 2.33, 95% CI 1.20, 4.51), preterm rupture of membranes (aOR 1.63, 95% CI 1.08, 2.46), and postpartum haemorrhage (aOR 1.93, 95%CI 1.09, 3.40) were elevated. Conclusions Antepartum suicidal behaviour, when co‐occurring with psychiatric disorders, is associated with increased odds of adverse infant and obstetric outcomes. Future studies are warranted to understand the causal roles of suicidal behaviour and psychiatric disorders in pregnancy.

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by the depressed mood

“…3,4 Based on epidemiological studies, several complications of labor linked to increased immune system activation during pregnancy-including pre-term birth, 5 preeclampsia, 6 hypertensive disorder of pregnancy, 7 HELLP syndrome, 8 and placental abruption 9 -were found to constitute risk factors for developing postpartum depression. 5,10 Furthermore, the latest metanalysis suggests that having a cesarean section increases a woman's risk of developing postpartum depression and that postpartum depression may be linked to the beginning of spontaneous labor. 11 The disturbance of the immune response could be the common element in the pathophysiology of these different complications.…”