Risk factors associated to a positive screening for Postpartum Depression in Mexican women with elective cesarean delivery: an analytical cross-sectional study during the early postoperative stage

Abstract

Background. It has been reported that the Postpartum Depression (PPD)’s symptomatology increases during the first 72 hours after delivery. Although PPD’s screening is recommended during this period, there is few evidence about the associated Risk Factors (RF) that determine this disorder in women who exclusively underwent an Elective Cesarean Delivery (ECD). Hence, our objective was to determine the RF for PPD’s positive screening in the early postoperative stage after an ECD. Methods. An analytical cross-sectional study was conducted in 123 women, rooming-in at Guadalajara’s Civil Hospital Fray Antonio Alcalde, during the average hospital length of stay after an ECD (2.1±1.02 days). To screen the PPD’s symptomatology, we applied the Edinburgh Postpartum Depression Scale (EPDS). To identify possible RF, we checked the women’s sociodemographic characteristics, obstetric/pregnancy complications, and neonatal comorbidities in their Medical Records. Subsequently, we carried out Odds Ratio (OR) analysis, followed by logistic regression that determined adjusted OR (aOR) and 95% Confidence Intervals (95% CI). Results. By applying the EPDS, we identified 32.5% of PPD’s positive screening, significantly associated with miscarriages (OR 2.6, 95% CI: 1.06-6.30), multiparity (OR 2.6, 95% CI: 1.08-6.43) and age ≥30 years (OR 2.3, 95% CI: 1.04-5.20). Other associations were found with less than four prenatal visits (OR 2.4, 95% CI: 1.10-5.35), unplanned pregnancy (OR 2.7, 95%CI: 1.29-5.98), newborn comorbidities (OR 2.7, 95% CI: 1.18-6.03), and obstetric complications (OR 3.1, 95% CI: 1.37-7.07). Nevertheless, the logistic regression determined that previous history of depression (aOR 8.8, 95% CI: 1.62-13.8), obstetric complications (aOR 8.8, 95% CI: 1.58-9-43), and newborn comorbidities (aOR 9.9, 95% CI: 1.86-14.7) were RF for PPD. Conclusions. Newborn and obstetric complications, along with previous depression, were main causes for the presence of depressive symptoms in women with an ECD. By considering not only the latter, but also that the prevalence for PPD’s positive screening that we found was higher than the results from national reports, we suggest that clinical and surgical professionals seek these RF during this early postoperative period, in order to treat and prevent any negative long-term effects on the mother’s mental well-being.