Association between infertility treatment and perinatal depressive symptoms: A meta-analysis of observational studies

Investigating cultural conflicts in everyday self-care among Chinese first-time pregnant migrants in Australia

BACKGROUND

Given the fast-growing migration and globalisation trends in the last decades, women increasingly experienced pregnancy as migrants and often faced complex and unique challenges related to both migration and pregnancy in a foreign land, affecting their psychological wellbeing during pregnancy. Cultural conflicts between pregnant migrants' home and host cultures could play a critical role affecting their pregnancy experiences and psychological wellbeing.

AIMS

This study aimed to explore cultural conflicts that challenge Chinese first-time expectant mothers living in Australia regarding their pregnancy self-care and their psychological wellbeing.

METHOD

A qualitative methodology was adopted utilising interpretative phenomenological analysis. Participants were 18 Chinese-born first-time pregnant migrants in Australia. A semi-structured interview schedule focused on their pregnancy self-care and psychological wellbeing and any effects of Chinese-Western/Australian cultural conflicts.

FINDINGS

Two psychosocial approaches were identified to explain how all the participants were psychologically challenged by self-care cultural conflicts to some extent: 1) challenging decision-making processes about self-care cultural conflicts and 2) interpersonal tension if the decisions conflicted with someone's advice/beliefs/opinions.

CONCLUSION

Emotional, cognitive, and social factors were relevant in shaping the participants' engagement with and their experiences of various pregnancy self-care activities.

Antenatal and postpartum depression in women who conceived after infertility treatment: a longitudinal study

BACKGROUND

Although the association between a history of infertility treatment and perinatal depression has been investigated, most research has been cross-sectional and has not used diagnostic assessment tools.

AIMS

This study investigates longitudinally the association between a history of infertility treatment and perinatal depression using WHO-Composite International Diagnostic Interview 3.0 (WHO-CIDI 3.0) and the Edinburgh Postnatal Depression Scale (EPDS).

METHODS

This study used data (N = 2,435) from the control group of a randomised controlled trial on a sample of pregnant women. Survival analysis was used to examine the influence of infertility treatment on perinatal depressive disorder evaluated by WHO-CIDI 3.0. The EPDS scores at four time points (T1 [baseline]: 14 ± 2 weeks gestation, T2: 32 weeks gestation, T3: 1 week postpartum, T4: 3 months postpartum) were analysed using generalised mixed model analysis.

RESULTS

The risk of experiencing a major depressive episode evaluated by WHO-CIDI 3.0 did not significantly differ between women conceiving through infertility treatment and those conceiving spontaneously (adjusted hazard ratio = 1.64, p = 0.109). The longitudinal analysis demonstrated that EPDS scores significantly increased at T3 and T4 among women conceiving through infertility treatment compared with those conceiving spontaneously (adjusted estimates of fixed effect from T1 to T3: 1.17, p < 0.01; from T1 to T4: 0.71, p = 0.022).

CONCLUSION

Women conceiving through infertility treatment were not found to have a higher risk of diagnosable perinatal depressive disorder than those conceiving naturally. However, a history of infertility treatment can marginally increase sub-clinical postpartum depressive symptoms.

Assisted reproductive technologies and postpartum depressive symptoms: A meta-analysis

BACKGROUND

Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established.

METHODS

PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group.

RESULTS

A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I2 = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I2 = 24.3 % vs. I2 = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression.

LIMITATIONS

Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results.

CONCLUSION

The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association.

The association between pregnancy intention, fertility treatment use, and postpartum depression

RATIONALE

Understanding whether postpartum depressive (PPD) symptoms vary by pregnancy intention and use of fertility treatments has implications for reproductive health policies and practices.

OBJECTIVE

The first aim of this study was to determine whether PPD symptoms differ between women who had unintended pregnancies, women who conceived spontaneously and were unsure about their pregnancy intention, women who used fertility treatments to conceive, and women who conceived spontaneously and intentionally. The second aim was to determine whether PPD symptoms differed based on the fertility treatment used to conceive (fertility drugs only, medicated insemination, or assisted reproductive technology [ART]).

METHODS

Data from the Pregnancy Risk Assessment Monitoring System (2012-2019), a cross-sectional survey administered to women throughout the U.S. who have recently given birth, was used to carry out our aims.

RESULTS

For the first aim (unweighted N = 243,677), compared to women who had spontaneous, intended pregnancies, women who had unintended pregnancies (OR: 1.32, 95% CI: 1.26-1.39, p < 0.01) and those with spontaneous pregnancies who were unsure about their intention (OR: 1.30, 95% CI: 1.23-1.38, p < 0.01) had higher odds of elevated PPD symptoms, adjusting for a range of covariates. Women who conceived with fertility treatments did not have higher odds of elevated PPD symptoms (OR: 0.97, 95% CI: 0.84-1.10, p = 0.61). For the second aim (unweighted N = 2,210), compared to those in the ART group, those who conceived using only fertility enhancing drugs had greater odds of developing elevated PPD symptoms (OR: 2.00, 95% CI: 1.24-3.24, p < 0.01).

CONCLUSIONS

These findings suggest that giving birth to an unintended pregnancy in the U.S. increases risk of elevated PPD symptoms. While overall women who conceive with the use of fertility treatments are not at increased risk of experiencing elevated PPD symptoms, there may be variability in risk based on the specific fertility treatments used.

The association between conception history and subsequent postpartum depression and/or anxiety: Evidence from the Clinical Practice Research Datalink 1991-2013

BACKGROUND

Infertility, and fertility treatment, are associated with psychological distress that may influence subsequent mental health including postpartum depression and anxiety.

METHODS

Data for women who had a livebirth between 1991 and 2013 were drawn from the Clinical Practice Research Datalink. Conception history prior to their first recorded birth was categorised as 'no fertility problems', 'untreated subfertility', ovulation induction (OI), and assisted reproductive technologies (ART). Depression and/or anxiety in the 12 months postpartum were identified using records of diagnoses, symptoms, and prescriptions. Prevalence was compared, and odds ratios estimated using multivariable logistic regression.

RESULTS

Of 235,127 mothers, 31,947 (13.6%) had evidence of postpartum depression and/or anxiety. Mothers in the ART group had 22% lower odds of postnatal depression and/or anxiety compared to mothers in the fertile group (OR 0.78; 95% CI [0.70-0.86]; p < 0.0001). Accounting for prior mental health, lifestyle, sociodemographic and pregnancy-related factors reduced the strength of the association (aOR 0.87; 95% CI [0.78-0.97]; p = 0.01). There were no significant associations observed in the untreated subfertility or OI groups.

LIMITATIONS

As in any analysis of routine data, the quality of recording is important and some information was unavailable (e.g. education, social support).

CONCLUSIONS

Women with a history of subfertility, OI or ART treatment were not at increased risk of postpartum depression and/or anxiety compared to those with no fertility problems. It is important to explore whether women who underwent ART are less likely to experience depression/anxiety or do not seek help when needed, with implications for their health and care.

Pregnancy or Psychological Outcomes of Psychotherapy Interventions for Infertility: A Meta-Analysis

Background: The pregnancy and psychological status of infertile couples has always been a concern, but there is no clear evidence for the efficacy of psychotherapy for infertile couples. This study aimed to summarize the current evidence of the effects of psychotherapy on psychological and pregnancy outcomes for infertile couples.

Method: We searched Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science (ISI) for articles published from 1946 to June 26, 2020. The pregnancy outcomes, psychological outcomes, and acceptability were involved in the study.

Results: Overall, 29 studies with a combined total of 3,522 adult participants were included in the meta-analysis. Compared with a placebo, psychotherapy was associated with the pregnancy rate [risk ratio (RR) = 1.43, 95% CI [1.07, 1.93]], total psychological scales associated with infertility [standardized mean difference (SMD) = −0.33 95% CI [−0.63, −0.02]], subsymptoms of psychological scores using the 28-item version of GHQ (including social function [MD = −3.10, 95% CI [−4.30, −1.90]] and depression [MD = −3.90, 95% CI [−5.36, −2.44]], and depression [MD = 3.60, 95% CI [2.25, 4.95]] using the 14-item version of Hospital Anxiety and Depression Scale, but it had no statistically significant association with the other outcomes. In the stratified analyses, the pregnancy rate using assisted reproduction, cognitive behavioral therapy (CBT), and the integrative body–mind–spirit (BMS); total psychological scales associated with infertility using other treatments and more than a month; and anxiety using BMS had significant statistical significance. The funnel plots of all outcomes were approximately symmetrical, and no significant publication bias was found.

Conclusions: The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, were applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility.

Trajectories of Maternal Postpartum Depressive Symptoms

OBJECTIVES

To identify homogenous depressive symptom trajectories over the postpartum period and the demographic and perinatal factors linked to different trajectories.

METHODS

Mothers (N = 4866) were recruited for Upstate KIDS, a population-based birth cohort study, and provided assessments of depressive symptoms at 4, 12, 24, and 36 months postpartum. Maternal demographic and perinatal conditions were obtained from vital records and/or maternal report.

RESULTS

Four depression trajectories were identified: low-stable (74.7%), characterized by low symptoms at all waves; low-increasing (8.2%), characterized by initially low but increasing symptoms; medium-decreasing (12.6%), characterized by initially moderate but remitting symptoms; and high-persistent (4.5%), characterized by high symptoms at all waves. Compared with the high-persistent group, older mothers (maximum odds ratio [OR] of the 3 comparisons: 1.10; 95% confidence interval [CI]: 1.05 to 1.15) or those with college education (maximum OR: 2.52; 95% CI: 1.36 to 4.68) were more likely to be in all other symptom groups, and mothers who had a history of mood disorder (minimum OR: 0.07; 95% CI: 0.04 to 0.10) or gestational diabetes mellitus diagnosis (minimum OR: 0.23; 95% CI: 0.08 to 0.68) were less likely to be in other symptom groups. Infertility treatment, multiple births, prepregnancy BMI, gestational hypertension, and infant sex were not differentially associated with depressive symptom trajectories.

CONCLUSIONS

One-quarter of mothers in a population-based birth cohort had elevated depressive symptoms in 3 years postpartum. Screening for maternal depression beyond the postpartum period may be warranted, particularly after mood and diabetic disorders.