The association between caesarean and postnatal psychological distress: Effect modification by mental health history

Pregnancy and birth complications and long-term maternal mental health outcomes: A systematic review and meta-analysis

BACKGROUND

Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes.

OBJECTIVES

To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes.

SEARCH STRATEGY

Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022.

SELECTION CRITERIA

Three reviewers independently reviewed titles, abstracts and full texts.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017).

MAIN RESULTS

Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20-1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20-1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38-2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11-1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32-1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41-2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52-5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75-8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses.

CONCLUSIONS

Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.

Presence of the partner in the operating room during emergency caesarean section: A scoping review

BACKGROUND

Emergency caesarean sections are often very urgent, with limited time for informing and guiding parents. Is it preferable to leave the partner outside of the operating room, or let the partner accompany the mother?

OBJECTIVE

This review aimed to provide an overview of the available evidence regarding the presence of the partner in the operating room during emergency caesarean sections.

DESIGN

Scoping review.

DATA SOURCES

A systematic literature search was performed in PubMed, Embase, Cinahl and the Cochrane Library.

ELIGIBILITY CRITERIA

All published literature reporting on emergency caesarean sections in regional or general anaesthesia with the partner present in the operating room were eligible, no matter the design.

RESULTS

Twenty-four titles, published between 1984 and 2020, were included; 15 contained original clinical findings and 9 were letters/debates. Quality of evidence was assessed using the Mixed Methods Appraisal Tool and found to be very low/low (17 studies), moderate (6) or good (1). Studies originated from Europe (16 studies), USA/Canada (4), South America (2), Asia (1) and Africa (1). Content data were thematically summarised and were overall either in favour or against having the partner present. Staff seemed reluctant to let partners be present for caesarean sections under general anaesthesia; mothers and partners preferred the partners' presence. Under regional anaesthesia, parents also wished for the partners' presence and described the caesarean section under regional anaesthesia as a predominantly positive experience. Most staff had a favourable attitude towards letting the partner be present for caesarean sections under regional anaesthesia.

CONCLUSION

Limited evidence exists regarding the presence of the partner during emergency caesarean sections, but is of low quality. Most parents prefer having their partner present. Staff can be reluctant, especially when general anaesthesia is used.

Mode of Delivery Is Associated with Postpartum Depression: Do Women with and without Depression History Exhibit a Difference?

Whether the mode of birth delivery correlates with the incidence of postpartum depression (PPD) is still under debate. This study seeks to clarify such a correlation and to further investigate if there are any differences in the likelihood of PPD medical care use among women with and without a history of depression. A logistic regression at two assessment points (6-month and 12-month postpartum) on the National Health Insurance Database in Taiwan is performed. In total, 32,729 women were included who gave first birth from 2007 to 2011 via cesarean section (CS), elective CS, and vaginal delivery, of whom 3580 (10.9%) were diagnosed with a history of depression. Findings show that CS was associated with a higher likelihood of PPD doctor visits regardless of whether the women have a history of depression or not, but elective CS tended to have different impacts for these two groups of women. Mentally healthy women who experienced elective CS had 1.36- and 1.64-times higher risk of PDD medical care use than those who delivered vaginally, whereas previous depressive women undertaking an elective cesarean birth had no significant difference observed in incidences. A notably higher risk of elective CS delivery versus vaginal delivery for mentally healthy women suggests that elective CS is not clinically appropriate, yet it might be an alternative to vaginal delivery with careful counseling for pregnant women who experience a history of depression.