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Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study.
MedLine Citation:
PMID:  21489126     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Please cite this paper as: Sword W, Kurtz Landy C, Thabane L, Watt S, Krueger P, Farine D, Foster G. Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02950.x. Objective  To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge. Design  A prospective cohort study. Setting  Eleven hospitals in Ontario, Canada. Sample  A total of 2560 women ≥16 years of age who delivered singleton, live infants at term. Methods  Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression. Main outcome measure  Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression. Results  Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73-10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46-6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99-4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19-2.80); urinary incontinence (OR 1.79; 95% CI 1.06-3.03); multiparity (OR 1.59; 95% CI 1.22-2.08); low mental health functioning (OR 1.20; 95% CI 1.15-1.25); low subjective social status (OR 1.16; 95% CI 1.02-1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03-1.22); low social support (OR 1.06; 95% CI 1.03-1.09); and low physical health functioning (OR 1.03; 95% CI 1.003-1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed. Conclusions  Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.
Authors:
W Sword; C Kurtz Landy; L Thabane; S Watt; P Krueger; D Farine; G Foster
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-13
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  -     ISSN:  1471-0528     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
Affiliation:
 School of Nursing, McMaster University, Hamilton, ON, Canada  School of Nursing, York University, Toronto, ON, Canada  Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada  Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada  School of Social Work, McMaster University, Hamilton, ON, Canada  Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada  Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
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