Association Between Mode of Delivery and Abnormal Scores on Psychometric Scales After Stillbirth [ID: 1379988

Abstract

INTRODUCTION: Those who deliver a stillborn infant are at increased risk of postpartum depression (PPD), postpartum anxiety (PPA), and lower post-trauma recovery. We aimed to explore whether PPD, PPA, or post-traumatic growth (PTGI) scores differed among women who had stillborn infants via vaginal delivery (VD) versus cesarean delivery (CD). METHODS: This is a secondary analysis of case–control study from the Stillbirth Collaborative Research Network. Longitudinal pregnancy, delivery, and postpartum data were collected between people who had stillbirth and live birth between 2006 and 2009. Those with stillborn infants who completed psychological assessments for PPD (Edinburg Postpartum Depression Scale), PPA (State-Trait Anxiety Inventory), and PTGI were included. The primary outcome was screening positive for PPD (score >10 on the Edinburgh Postnatal Depression Scale). Secondary outcomes were screening positive for PPA (score >40 on the State-Trait Anxiety Inventory), and PTGI score, measured continuously. Outcomes were compared between those who had VD versus CD. Multivariable analysis controlling for demographic or obstetric differences between groups was conducted. RESULTS: Of 982 stillbirths, 269 patients (27.4%) completed postpartum psychological assessments and were included. Of these, 41 (15.2%) had CD. Those who had CD were more likely to be Hispanic (48.8% versus 27.2%, P=.006) and have older gestational age (34.4±4.3 weeks versus 26.9±6.5 weeks, P<.001). Mode of delivery (MOD) was not associated with differences in screening positive for PPD (CD odds ratio [OR] 1.62 [95% CI 0.79–3.27]) or PPA (CD OR 1.52 [95% CI 0.75–3.05]). However, MOD was associated with lower PTGI score. This difference persisted after controlling for confounders (beta coefficient −0.17 [standard error 0.07, P=.0141]). CONCLUSION: After stillbirth, MOD is not associated with differences in screen-positive rates for PPD or PPA. However, delivering a stillborn infant via CD was associated with lower PTGI score, which suggests additional support resources may be needed in this population to promote positive psychological growth.