Multiple births and maternal mental health from pregnancy to 5 years after birth: A longitudinal population-based cohort study

Abstract

Background: There is a lack of population-based studies on multiple births and maternal mental health. Having a high-risk pregnancy by bearing two or more children is a stressful life event, and the challenges of parenting two or more children probably also lead to a high level of parental stress. There are a few results on multiple births and maternal mental health from studies on in vitro fertilization samples. The only previous cohort study on multiple birth and maternal mental health included a single measure of depressive symptoms at 9 months postpartum. We aim to estimate the relative risk for depression and anxiety after multiple birth in a population-based prospective cohort study while adjusting for factors prior and subsequent to fertilization. Methods: We used data from 87,807 pregnancies included in the Norwegian Mother and Child Cohort study. Information on multiple birth was retrieved from the Norwegian Medical Birth Registry, and maternal mental health was assessed at 17 th and 30 th week of gestation and 0.5, 1.5, 3, and 5 years postpartum. There were 1,842 plural births included in the study (i.e. 1,821 twin births and 21 higher order births). We predicted maternal mental health at each time point, subsequently adjusting for 1) factors prior to fertilization (e.g. maternal age and in vitro fertilization); 2) factors during pregnancy (e.g. hypertensive states); 3) factors at delivery (e.g. cesarean section); 4) child-related postnatal complications (e.g. intracranial hemorrhage); and 5) concurrent depression or anxiety after pregnancy. Results: Adjusted for antecedents of plural birth, mothers expecting a plural birth had a normal risk for anxiety (RR=1.05; 95% CI 0.92-1.20) and depression (RR=1.02; 95% CI 0.89-1.16) at 17 th week of gestation. However, plural birth was associated with maternal depression at 1.5, 3, and 5 years postpartum and maternal anxiety at 3 years postpartum. The trend was for the association to increase across time, and mothers of multiplets had a significant higher risk for depression at 5 years (RR=1.77; 95% CI 1.33-2.35). Fully adjusted the RR for depression was 1.51 (95% CI 1.10-2.08). By adjusting depression for concurrent anxiety, and vice versa we found the effect of multiple pregnancy to be specific to depression and not anxiety. Conclusions: Mothers expecting multiplets have normal mental health during pregnancy. After birth there is an increasing risk for depression up to 5 years of age. Our findings indicate that more is simply more, and mothers of multiplets have need for additional support several years postpartum.

Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial

“…For example, in the Term Breech Trial, 10.1% of women in the planned CS group and 10.8% of women in the planned VB group scored >12 on the EPDS at 3 months post partum . The increase in elevated depression scores observed here might be attributed to the fact that almost 50% of births in our sample occurred preterm, and depression has been found to be more prevalent among mothers of preterm infants, or that a moderate proportion of women in both groups used assisted conception methods, which has also been associated with increased emotional stress . However, it is possible that giving birth to and caring for twins independently predisposes women to postpartum depression, and this finding deserves further investigation.…”

Sleep problems in preschoolers and maternal depressive symptoms: An evaluation of mother- and child-driven effects.

“…Mothers’ depression has repeatedly been shown to be associated with sleep problems in their offspring (Martin, Hiscock, Hardy, Davey, & Wake, 2007; Zuckerman, Stevenson, & Bailey, 1987). From pregnancy and throughout the preschool years, the peak level of maternal depressive symptoms is when the child is between 1.5 and 3 years of age (Ystrom et al, 2014). Maternal depression is related to parental behavior, and research has suggested that maternal depression may affect child development on several domains, including cognitive and language development (Grace, Evindar, & Stewart, 2003; Sohr-Preston & Scaramella, 2006); mental health problems (Goodman et al, 2011; Lieb, Isensee, Höfler, Pfister, & Wittchen, 2002); suboptimal diet (Ystrom, 2012; Ystrom, Barker, & Vollrath, 2012); and a number of different social, emotional, and behavior problems (Goodman et al, 2011; Grace et al, 2003; Nilsen, Gustavson, Røysamb, Kjeldsen, & Karevold, 2013).…”

Is the twin‐singleton difference in BMI related to the difference in birth weight? A register‐based birth cohort study of Norwegian males

“…An epigenetic control of growth‐factor genes in the twin‐fetuses might have such effects. One should also keep in mind that mothers of twins are more likely to be affected by psychological distress (Ystrom et al, ), and that families with twins may perhaps be more likely to experience economic strain. Such psychosocial and economic factors might influence the postnatal weight gain of the children.…”