Delivery mode and the course of pre- and postpartum depression

To compare depressiveness scores, both during and after pregnancy, with the delivery mode (DM).

In a longitudinal, prospective study, standardized questionnaires for the Edinburgh Postnatal Depression Scale were presented to 1,100 women and used to assess the presence and severity of depressiveness at three time points: prenatal, from the 30th gestational week (Q1); 48-72 h postnatal (Q2); and 6-8 months postnatal (Q3). The patients were divided into four groups relative to DM: spontaneous delivery, primary cesarean section (CS), secondary CS, and assisted vaginal delivery. The final number of participating women with both delivery mode and depression information for all three time points was 753.

There was a significant difference of the mean EPDS values between the spontaneous delivery and primary CS groups (P=0.04) at Q1 (5.1 vs. 6.3). None of the other comparisons was significant. Significant differences relative to DM were seen at Q2 (P<0.0001), but there were no significant differences between the patient groups at Q3 (P=0.54).

DM only showed coherence with the extent of depression briefly during the peripartal period. A relationship was found between depressiveness during pregnancy and DM, with higher depressiveness scores in the group of patients undergoing primary CS. This should be taken into account when patients requesting an elective cesarean section are being counseled.