Failed trial of labor after cesarean section associated with postpartum antidepressant use
Patients with a previous cesarean delivery who failed a trial of labor were more likely to be using antidepressants 6 weeks postpartum compared with those who had a successful trial of labor.
However, the study also found that there was no significant difference in postpartum depression rates among these two groups of patients.
“The surgical and physiologic risks of trials of labor after cesarean section (TOLAC) are well documented, but this specific subset of patients has not been examined for incidences or risk of affective disorders like postpartum depression,” Emily O’Brien, an MD/MBA candidate at Penn State College of Medicine in Hershey, Pennsylvania, told Healio. “Current studies have shown that rates of postpartum affective disorders are higher in patients whose birth experience differed from their birth plans (ie, those requiring emergency cesarean section but desiring a vaginal birth), and we wanted to see if that pattern continued in patients who intended to deliver via vaginal birth after cesarean section (VBAC) but required repeat cesarean section at the time of their delivery.”
O’Brien and colleagues retrospectively reviewed the charts of patients who underwent TOLAC from Jan. 1, 2008, to Jan. 1, 2018, and who had Edinburgh Postnatal Depression Scale (EPDS) scores available from their 6-week postpartum visit.
The findings, presented at the Society for Reproductive Investigation Annual Meeting, showed there was no significant difference in EPDS scores between patients who had a successful VBAC and those who failed TOLAC (average EPDS, 4.9 vs. 5.4, respectively).
However, patients who failed TOLAC were significantly more likely to be using antidepressants compared with patients who had a successful VBAC (10% vs. 4.3%; P = .046).
“We feel that this antidepressant use can be seen as a proxy for a diagnosis of postpartum depression; this suggests that patients who failed a TOLAC should be closely monitored for postpartum affective disorders, regardless of previous psychological history,” O’Brien said.
Moving forward, the researchers plan to continue studying this cohort.
“First, the data used in this study spanned from 2008 to 2018, and postpartum documentation varied widely over this period; currently, we have a more standardized documentation system that would improve our rate of follow-up,” O’Brien said. “Secondly, we would like to examine EPDS longitudinally, and characterize any patterns that may exist over time from an immediate postpartum score (prior to discharge home), at a 2-week postpartum check-in and at the 6-week postpartum visit.
“Finally, though our existing data do represent the population we serve in central Pennsylvania, it is not very diverse or generalizable to other populations,” O’Brien said. “As our population changes over time, we hope to include a more diverse group of patients. We would also love to collaborate with other institutions who regularly see patients of other socioeconomic backgrounds in order to improve the generalizability of our findings.”