Perinatal depressive symptoms and subsequent fertility intention: a multicenter cohort study in Japan

Declining fertility rates represent a critical demographic challenge worldwide. While socioeconomic determinants of reproductive decision-making have been studied, the influence of maternal mental health on subsequent fertility intention remains unclear. In this multicenter prospective cohort study in Japan, 689 pregnant women were followed up to one month postpartum to examine whether postpartum depressive symptoms were associated with subsequent fertility intention, after adjustment for prespecified covariates (maternal age, partner age, parity, and maternal individual income). The Edinburgh Postnatal Depression Scale (EPDS) total score at one month postpartum was the main exposure. Logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for a dichotomized outcome (Yes vs Considering/No). Higher EPDS scores were significantly associated with reduced subsequent fertility intention (OR = 0.931, 95% CI 0.898-0.965, p < 0.001). Higher parity and older partner age were also negatively associated with intention, whereas higher maternal individual income was positively associated. In exploratory models, a significant interaction between depressive symptoms and higher maternal individual income (OR = 3.512, 95% CI 1.144-10.782, p = 0.028) suggested possible income-based moderation within this cohort. Postpartum depressive symptoms were associated with reduced fertility intention after adjustment for prespecified covariates, while economic resources may buffer this effect. Integrated mental-health screening combined with socioeconomic support during the postpartum period may support reproductive decision-making.