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Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study
Author(s) -
Asif S,
MulicLutvica A,
Axfors C,
Eckerdal P,
Iliadis SI,
Fransson E,
Skalkidou A
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16271
Subject(s) - medicine , edinburgh postnatal depression scale , obstetrics , postpartum depression , odds ratio , depression (economics) , cohort study , pregnancy , postpartum period , confounding , cohort , mood , perineum , psychiatry , anxiety , depressive symptoms , surgery , macroeconomics , biology , economics , genetics
Objective Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even thoughts of self‐harm. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience. Design Nested cohort study. Setting Uppsala, Sweden. Sample Vaginally delivered women with singleton pregnancies ( n = 2990). Methods The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale. A digital acyclic graph was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A sub‐analysis was run after excluding women with normal or high resilience. Main outcome measures Postpartum depression, assessed with the Depression Self‐Reporting Scale, completed at 6 weeks postpartum. Results There was no significant association between severe obstetric perineal lacerations and PPD at 6 weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR = 4.8, 95% CI 1.2–20), persisting even after adjusting for confounding factors. Conclusion Healthcare professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration. Tweetable abstract Severe perineal lacerations associated with postpartum depression in women with low resilience in a Swedish cohort.