605: Is route of delivery a risk factor for postpartum depression?

Abstract

Depression is one of the most common complications of pregnancy. Route of delivery has been implicated as a risk factor for postpartum depression (PPD) in the months following delivery. Previous studies have rarely focused on the immediate postpartum period (0-4 days in the hospital). Our objective was to determine whether women who had Cesarean section were more likely to screen positive for PPD risk in the immediate postpartum period. This cohort study was conducted at a community medical center in New Jersey using delivery and demographic data for deliveries between 8/2015-1/2016. Women were screened in the hospital for PPD risk using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression, adjusting for maternal age and religion, was performed to evaluate the association between delivery type and PPD. A total of 1858 women (56% Jewish) had complete data for present analyses. Overall 83 women (4.5%) screened positive for mild PPD risk (EPDS ≥ 8) and 37 women (2.0%) screened positive for moderate PPD risk (EPDS ≥ 10). Logistic regression results showed that Cesarean delivery was significantly associated with mild PPD risk (OR=3.04, 95% CI 2.00–4.60), which remained significant after adjusting for age and religion (OR 1.75, 95% CI 1.207–2.87, p=0.03). Delivering by Cesarean section may be an independent risk factor for mild PPD symptoms in the immediate postpartum period. This cohort had low rates of PPD risk compared to epidemiological rates (10%), particularly in the Jewish women. Ethnic, racial and religious minorities encounter more stigma and may not readily report symptoms, therefore, cut-points are often lowered from the standard EPDS ≥ 10. Indeed, in our sample CS was significantly associated with EPDS ≥ 10 in the univariate model. Mild PPD risk in the immediate post partum period is also predictive of subsequent development of PPD. Obstetric providers may consider immediate PPD screening, education, and referral to treatment for patients, particularly for those who deliver via Cesarean section.