Mood disturbance in pregnancy and the mode of delivery

In prior studies, mood disturbance has been associated with poor obstetric outcomes. The purpose of this study was to determine whether depression during pregnancy is associated with a higher frequency of cesarean or assisted vaginal delivery.

A mood disorders questionnaire, which included the standardized Center for Epidemiologic Studies Depression Scale (CES-D), was offered to all antenatal patients in their early third trimester from January 1996 to December 1999 at the Massachusetts General Hospital. Maternal demographics and pregnancy outcome data were collected from a computerized database on 1697 patients who completed the surveys. A CES-D score of 16 or higher was considered to indicate significant depressive symptoms. Rates of cesarean section and assisted vaginal delivery in women with and without scores of 16 or higher were compared by using the chi(2) test.

Of the study population, 264 women (15.6%) had CES-D scores of 16 or higher. Among all subjects, the cesarean section rate was 24.0%, and the assisted vaginal delivery rate was 10.0%. There was no statistically significant difference between the rate of cesarean section (26.5% vs 23.6%) or assisted vaginal delivery (8.0% vs 10.4%) in women with and without elevated CES-D scores (P =.34). These findings did not change when nulliparous and multiparous patients were analyzed separately, when the definition of patients at risk for depression was expanded to include women who indicated current or past use of antidepressants or when the cutoff CES-D score criteria was increased to 19 or 25. With our sample size, an alpha =.05 and a beta =.2, we had the power to detect a 7.5% difference between our two groups.

Data from this study did not support a relationship between depressive symptoms during pregnancy and mode of delivery.