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TOPLINE:

Cesarean deliveries, whether planned or unplanned, were associated with more than a 15% increased risk for new postpartum psychiatric conditions compared with spontaneous vaginal births. Successful operative vaginal delivery (OVD) showed no increased psychiatric risk, whereas cesarean delivery after failed OVD had a 26% higher risk.

METHODOLOGY:

• Researchers conducted an observational cohort study of 934,524 individuals with singleton live births at ≥ 37 weeks of gestation in the US between 2008 and 2022, using data from the Merative MarketScan Commercial Database.
• Participants were categorized into five mutually exclusive delivery mode groups: spontaneous vaginal delivery, successful OVD, planned cesarean delivery, unplanned cesarean delivery without an OVD attempt, and unplanned cesarean delivery after failed a OVD attempt.
• The primary outcome was a new diagnosis of depression, anxiety, posttraumatic stress disorder, or other serious psychiatric conditions, or a new antidepressant prescription within 6 months postpartum, identified using the International Classification of Diseases, 9th and 10th Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes.
• Individuals with psychiatric diagnoses or antidepressant prescriptions between the last menstrual period and delivery were excluded to focus on new-onset postpartum psychiatric conditions.
• Multivariable Poisson regression models with robust standard errors estimated associations between mode of delivery and postpartum psychiatric conditions, adjusting for maternal age, region, delivery year, class III obesity (BMI ≥ 40), substance use during pregnancy, gestational age at delivery, chronic hypertension, pregestational diabetes mellitus, and severe unexpected newborn complications.

TAKEAWAY:

• Compared with mothers with spontaneous vaginal births (9.2%), those with planned cesarean deliveries showed an 11.4% incidence of postpartum psychiatric conditions (adjusted risk ratio [aRR], 1.19; 95% CI, 1.17-1.21), those with unplanned cesarean deliveries without an OVD attempt showed a 10.8% incidence (aRR, 1.16; 95% CI, 1.14-1.18), and those with unplanned cesarean deliveries after failed a OVD attempt showed a 10.9% incidence (aRR, 1.26; 95% CI, 1.18-1.35).
• Those with successful OVD showed no increased risk for postpartum psychiatric conditions compared with those with spontaneous vaginal delivery (9.2% vs 9.2%, aRR, 1.00; 95% CI, 0.97-1.03).
• All individual psychiatric diagnoses including depression, anxiety, and posttraumatic stress were higher among individuals with planned cesarean deliveries or unplanned cesarean deliveries without an OVD attempt than among those with spontaneous vaginal deliveries.
• The majority of diagnoses of depression, anxiety, and other serious psychiatric conditions occurred within 0-90 days after delivery, whereas posttraumatic stress emerged at similar rates between 0-90 and 91-180 days postpartum.

IN PRACTICE:

“Postpartum psychiatric conditions were increased after cesarean deliveries, planned or unplanned, but not after successful OVDs. Results suggest that cesarean delivery may be associated with an increased risk of psychiatric conditions and warrants closer surveillance postpartum,” wrote the authors of the study.

SOURCE:

The study was led by Samantha L. Kruger, MD, MA, and Danielle M. Panelli, MD, MS, Department of Obstetrics & Gynecology, Stanford University, Stanford, California. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

The study population consisted only of individuals with commercial insurance who received healthcare for psychiatric symptoms, which could underestimate the effects of traumatic delivery mode on postpartum mental health. The use of ICD codes is subject to misclassification, underascertainment, and temporal changes in screening, referral, and diagnostic practices over the study period. Assessment of unplanned, intrapartum cesarean births is challenging due to the lack of well-defined corresponding codes to distinguish planned from unplanned cesarean deliveries, despite attempts to develop an algorithm to exclude conditions for which cesarean deliveries typically are planned. The study included only patients with continuous healthcare encounters through 6 months postpartum, representing an idealized level of prenatal and postnatal care, which may limit generalizability. Results may not be generalizable to individuals with preexisting psychiatric conditions because these individuals were excluded from the analysis.

DISCLOSURES:

Funding for the study was provided in part by the National Heart, Lung, and Blood Institute; the Dunlevie Maternal-Fetal Medicine Center at Stanford University; and the National Center for Advancing Translational Sciences Clinical and Translational Science Awards to the Stanford Center for Population Health Sciences Data Core. Panelli disclosed receiving partial funding through grant 1K23HD113845. Pervez Sultan disclosed receiving partial funding through grant 5RO1HL166253-02. Stephanie A. Leonard disclosed receiving funding from the National Heart, Lung, and Blood Institute through grant KO1HL171699. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.