Perinatal mood and anxiety disorders have already been associated with adverse pregnancy outcomes like low birth weight and preterm birth. And now, a new Michigan Medicine study finds that they may also be linked to significantly higher rates of first-time cesarean deliveries among women who were otherwise at low risk of having one.
"Our findings reinforce the importance of better identifying and treating perinatal depression and anxiety disorders in pregnant women," said senior author Vanessa Dalton, MD, MPH, obstetrician-gynecologist at University of Michigan Health Von Voigtlander Women's Hospital.
"It's critical to better understand how these mood disorders increase the likelihood of cesarean section deliveries, which we know have both short and long-term health consequences for both expecting moms and their babies."
Researchers analyzed national data for 360,225 delivery hospitalizations among commercially insured women ages 15-44 during the decade between 2008 and 2017, with 24 percent including the first-time delivery by cesarean section.
The study is among the largest to document a link between predated mood and anxiety disorders and first-time c-sections among low-risk pregnant women. Previous research on this relationship is limited, often including patients who had previous cesarean deliveries - one of the most significant predictors of a repeat c-section - or who may not have already been diagnosed with a perinatal mood disorder.
Perinatal mood and anxiety disorders affect as many as one in five reproductive-age women in the United States, and the prevalence of these disorders more than doubled between 2006 and 2015 among childbearing women in the US The prevalence of suicidal ideation and intentional self-harm in the year before or after birth also rose during that time period, with suicide being a leading cause of maternal mortality.
"There's been growing recognition that mental health is really important during the time of pregnancy," Dalton said. "Maternal suicide risk is especially high the year following delivery." Anxiety and depression have numerous other negative consequences for women and their children, Dalton said, including adverse birth outcomes, higher rates of maternal morbidity, and lost earnings.
Estimated costs of untreated perinatal mood and anxiety disorders also exceed USD 14 billion in the US from conception through the first five years of a child's life and may affect the long-term use of health care resources for both women and their children, authors note.