Long-term maternal depression after expectant management of early preterm birth

This study was undertaken to determine factors that affect depression after delivery of infants at the limits of viability. We hypothesized that expectantly managed mothers would have lower risk of depression several years after delivery.

Charts were reviewed for deliveries in the calendar years 2003 through 2005 with a diagnosis of preterm labor, premature rupture of membranes or cervical insufficiency admitted at a gestation between 20 and 25(6/7) weeks. Surveys were sent that included the Edinburgh Postnatal Depression Scale and questions regarding care around the time of delivery.

A total of 176 patients met inclusion criteria. Of those, 36 consented and returned surveys. Of patients who were expectantly managed, none (0%) screened positive for depression, while 11 (38%) patients who were not expectantly management screened positive (p=0.08). Between 36 and 72 returned surveys would be needed for this to be significant, using p<0.05. Survey results indicated that 75% of respondents agreed hospitalization was traumatic, 78% would still attempt to delay birth, 97% would accept tocolysis, 89% agreed their child functioned similar to other children, and 77% were happy with how physicians handled their care.

Expectant management may be associated with lower risk of depression. Larger studies evaluating psychosocial effects of interventions are justified.