Impact of Perinatal Depression on Contraceptive Planning [4N

Abstract

INTRODUCTION: Contraceptive choice may be influenced by disturbances in perinatal mood disorders, but studies have shown mixed results. We wished to assess the postpartum contraceptive choices of women at risk for perinatal depression, specifically in regard to hormonal contraception, long-acting reversible methods, and surgical sterilization. METHODS: This retrospective cohort study evaluated a population of women (n= 419) who participated in a calibration pilot for depression screening while pregnant and after delivery using a novel computerized adaptive diagnostic screener (CAT-MH). Maternal age, race and gestational age at delivery were used to match cases (n=64) to controls (1:2). Chart review was used to screen for choice of contraception and potential confounders including pre-pregnancy mental health disorders and/or current mental health treatments. Bivariate analyses and multiple logistic regressions were used to study the impact of depressive symptoms on contraceptive planning. RESULTS: No significant differences in contraceptive choice were observed between depressed and control groups. However, worsening postpartum mood was associated with the choice of non-hormonal methods when compared to stable mood after delivery (24.1% vs. 48.3%, p=0.016). This association persisted in a multivariate logistic regression which included age, race, insurance status, obstetric history, mode of delivery, and NICU admission. Women who were treated with psychiatric medications while pregnant were more likely to choose surgical sterilization (11.3% vs. 33.9%, p=.02). CONCLUSION: A relationship between depressed maternal mood and contraceptive planning may be mediated by preexisting mental illness and use of psychiatric medications, influencing both hormonal contraception and surgical sterilization choices.