The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study

Kuuri-Riutta Sanni,Ekholm Eeva,Karlsson Hasse,Korhonen S Laura,Scheinin M Noora,Karlsson Linnea

doi:10.1007/s00737-022-01212-0

Kuuri-Riutta Sanni, Ekholm Eeva + Show 4 more

Open Access

https://doi.org/10.1007/s00737-022-01212-0

Copy DOI

Abstract

Antepartum depression, general anxiety symptoms, and pregnancy-related anxiety have been recognized to affect pregnancy outcomes. Systematic reviews on these associations lack consistent findings, which is why further research is required. We examined the associations between psychological distress, mode of birth, epidural analgesia, and duration of labor. Data from 3619 women with singleton pregnancies, from the population-based FinnBrain Birth Cohort Study were analyzed. Maternal psychological distress was measured during pregnancy at 24 and 34 weeks, using the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) and its subscale “Fear of Giving Birth” (FOC), the anxiety subscale of the Symptom Checklist-90 (SCL-90) and the Edinburgh Postnatal Depression Scale (EPDS). Mode of birth, epidural analgesia, and labor duration were obtained from the Finnish Medical Birth Register. Maternal psychological distress, when captured with PRAQ-R2, FOC, and SCL-90, increased the likelihood of women having an elective cesarean section (OR: 1.04, 95% CI 1.01–1.06, p = .003; OR: 1.13, 95% CI 1.07–1.20, p < .001; OR: 1.06, 95% CI 1.03–1.10, p = .001), but no association was detected for instrumental delivery or emergency cesarean section. A rise in both the PRAQ-R2, and FOC measurements increased the likelihood of an epidural analgesia (OR: 1.02, 95% CI 1.01–1.03, p = .003; OR: 1.09, 95% CI 1.05–1.12, p < .001) and predicted longer second stage of labor (OR: 1.01, 95% CI 1.00–1.01, p = .023; OR: 1.03, 95% CI 1.02–1.05, p < .001). EPDS did not predict any of the analyzed outcomes. The results indicate that maternal anxiety symptoms (measured using PRAQ-R2, FOC, and SCL-90) are associated with elective cesarean section. Psychological distress increases the use of epidural analgesia, but is not associated with complicated vaginal birth.

Highlights

Psychiatric disorders are the leading cause of disease burden in women from 15 to 44 years (“WHO | The Global Burden of Disease: 2004 Update,” 2014)
Symptoms of anxiety or depression in pregnancy have been associated with a higher fear of childbirth (FOC) and a lower pain threshold, which further associate with higher rates of cesarean deliveries and increased use of epidural analgesia during labor
Psychological distress as measured by our parameters was not associated with a higher risk for instrumental delivery or acute cesarean section (ACs); pregnancyrelated anxiety did increase the odds for elective cesarean section (ElCs)

Summary

Introduction

Psychiatric disorders are the leading cause of disease burden in women from 15 to 44 years (“WHO | The Global Burden of Disease: 2004 Update,” 2014). Some studies have found that antenatal depression and FOC, in contrast to antenatal general anxiety, increase the risk of cesarean section (Bayrampour et al 2015; Laursen et al 2009; Räisänen et al 2014; Ryding et al 2015). Systematic reviews on these associations lack consistent findings (Dencker et al 2019; Grigoriadis et al 2018). The rates of cesarean sections have increased over the past decades in developed countries, partly due to FOC (Ryding et al 2015; Saisto and Halmesmäki 2003)

Objectives

Methods

Results

Discussion

Conclusion