Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study

Objective To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. Design Prospective national population-based EPIPAGE-2 cohort study. Setting 268 neonatology departments in France, March to December 2011. Population Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. Methods The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D >= 16) and anxiety (STAI >= 45) was assessed by weighted and design-based log-linear regression model. Main outcome measures Severe symptoms of depression and anxiety in mothers of preterm infants. Results Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. Conclusions Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. Tweetable abstract Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.

Automated summary

The study found that mothers who underwent cesarean delivery before 26 weeks of gestation were more likely to experience severe symptoms of depression, with no significant association observed between delivery mode and anxiety. After adjusting for factors such as birthweight and severe neonatal morbidity, cesarean delivery before 26 weeks was significantly associated with maternal depression symptoms.