Association between placenta accreta spectrum and postpartum depression: a retrospective case-control study

To better evaluate the relationship between placenta accreta spectrum (PAS) and postpartum depression, and to examine rates of re-admission after delivery for patients with PAS.

This retrospective case-control study utilized deliveries from a single hospital system between April 2012-November 2024. PAS cases were identified by ICD-10 codes and verified by manual review of operative and pathology reports by two clinicians. Patients without PAS were selected using propensity score matching 2:1 for age, parity, and mode of delivery. The primary outcome was postpartum depressive symptoms defined as an ICD-10 code and/or an Edinburgh Postnatal Depression Scale ≥10 between delivery and 6 months postpartum. Bivariate and stepwise multivariate logistic regression analyses were performed. Rates of postpartum ER visits and inpatient re-admissions for any reason, and separately for mental health, were compared between PAS and non-PAS patients. Sub-analyses among PAS patients explored the association of timing of the diagnosis, FIGO grade, and hysterectomy during delivery.

A total of 232 PAS and 464 matched non-PAS patients were included. In the multivariate analysis, PAS remained an independent risk factor for postpartum depressive symptoms (aOR 3.1 [95% CI 1.67 - 5.75]). In bivariate tests, patients with PAS demonstrated higher rates of ER visits, re-admissions postpartum for any reason and for a mental health diagnosis. Among PAS patients, neither timing of PAS diagnosis, hysterectomy, nor FIGO grade was associated with postpartum depressive symptoms.

In this cohort, 1 in 5 patients with PAS had postpartum depressive symptoms, a 3.1-fold higher odds after adjustment for confounders.