Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference?

Abstract

Whether the mode of birth delivery correlates with the incidence of postpartum depression (PPD) is still under debate. This study seeks to clarify such a correlation and to further investigate if there are any differences in the likelihood of PPD medical care use among women with and without a history of depression. A logistic regression at two assessment points (6-month and 12-month postpartum) on the National Health Insurance Database in Taiwan is performed. In total, 32,729 women were included who gave first birth from 2007 to 2011 via cesarean section (CS), elective CS, and vaginal delivery, of whom 3580 (10.9%) were diagnosed with a history of depression. Findings show that CS was associated with a higher likelihood of PPD doctor visits regardless of whether the women have a history of depression or not, but elective CS tended to have different impacts for these two groups of women. Mentally healthy women who experienced elective CS had 1.36- and 1.64-times higher risk of PDD medical care use than those who delivered vaginally, whereas previous depressive women undertaking an elective cesarean birth had no significant difference observed in incidences. A notably higher risk of elective CS delivery versus vaginal delivery for mentally healthy women suggests that elective CS is not clinically appropriate, yet it might be an alternative to vaginal delivery with careful counseling for pregnant women who experience a history of depression.

Meta-analysis of association between caesarean section and postpartum depression risk

“…The analysis of both CS and PPD in each of the seven largest studies ( 21 – 23 , 25 , 31 , 33 , 34 ) revealed that they accounted for more than 99% of the total cases in this meta-analysis, with a sample size exceeding 10,000. A weaker correlation (OR=1.19, 95% CI: 1.11-1.27, I 2 = 24%, P<0.001) was observed between CS and PPD for the group with over 10,000 participants, compared to the group with fewer than 10,000 participants (OR=1.44, 95% CI: 1.26-1.64, I 2 = 0%, P<0.001) ( Table 3 ).…”

“…There were 14 cohort studies and 4 case-control studies, with the sample size ranging from 60 to 511,422 participants. Specifically, eleven studies ( 11 , 24 , 26 – 30 , 32 , 35 – 37 ) had <10,000 participants, while the remaining seven studies ( 21 – 23 , 25 , 31 , 33 , 34 ) had >10,000 participants. Furthermore, ten studies ( 21 , 23 , 26 , 28 – 31 , 34 , 36 , 37 ) were conducted in Asia, whereas seven studies ( 22 , 24 , 25 , 27 , 32 , 33 , 35 ) were carried out in Europe, one studies ( 11 ) were conducted in North America.…”

“…Specifically, eleven studies ( 11 , 24 , 26 – 30 , 32 , 35 – 37 ) had <10,000 participants, while the remaining seven studies ( 21 – 23 , 25 , 31 , 33 , 34 ) had >10,000 participants. Furthermore, ten studies ( 21 , 23 , 26 , 28 – 31 , 34 , 36 , 37 ) were conducted in Asia, whereas seven studies ( 22 , 24 , 25 , 27 , 32 , 33 , 35 ) were carried out in Europe, one studies ( 11 ) were conducted in North America. Additionally, ten studies ( 11 , 23 , 24 , 27 – 30 , 34 , 35 , 37 ) utilized the Edinburgh Postnatal Depression Scale (EPDS) to measure PPD levels, two studies ( 22 , 25 ) deployed the SCL-90, two studies ( 21 , 31 ) adopted the 2010 LNHID, one study ( 26 ) used the CES-D, one study ( 36 ) employed the NHIS-NSC, one study ( 32 ) utilized the BDI, and one study ( 33 ) incorporated the HDR.…”

“…Furthermore, ten studies ( 21 , 23 , 26 , 28 – 31 , 34 , 36 , 37 ) were conducted in Asia, whereas seven studies ( 22 , 24 , 25 , 27 , 32 , 33 , 35 ) were carried out in Europe, one studies ( 11 ) were conducted in North America. Additionally, ten studies ( 11 , 23 , 24 , 27 – 30 , 34 , 35 , 37 ) utilized the Edinburgh Postnatal Depression Scale (EPDS) to measure PPD levels, two studies ( 22 , 25 ) deployed the SCL-90, two studies ( 21 , 31 ) adopted the 2010 LNHID, one study ( 26 ) used the CES-D, one study ( 36 ) employed the NHIS-NSC, one study ( 32 ) utilized the BDI, and one study ( 33 ) incorporated the HDR. The interventions varied in duration and length across the trials, and the assessment of PPD was conducted between 3 days and 12 months after delivery.…”

Association Between Mode of Delivery and Postpartum Depression: A Cross-Sectional Study in Saudi Arabia

“…Similarly, in a study conducted in Japan on 89,954 women, those who underwent CS delivery were considered a target for PPD monitoring [ 17 ]; the same conclusion was also suggested by Heba Kamal Meky in their cross-sectional study [ 15 ]. A previous study conducted in Taiwan reported that CS was linked to an increased risk of PPD regardless of whether the women had a history of depression [ 18 ].…”