Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort

Abstract

Objective: To assess the relationship between unintended pregnancy and postpartum depression.

Design: Secondary analysis of data from a prospective pregnancy cohort.

Setting: The study was performed at the University of North Carolina prenatal care clinics.

Population/sample: Pregnant women enrolled for prenatal care at the University of North Carolina Hospital Center.

Methods: Participants were questioned about pregnancy intention at 15-19 weeks of gestation, and classified as having an intended, mistimed or unwanted pregnancy. They were evaluated for postpartum depression at 3 and 12 months postpartum. Log binomial regression was used to assess the relationship between unintended pregnancy and depression, controlling for confounding by demographic factors and reproductive history.

Main outcome measures: Depression at 3 and 12 months postpartum, defined as Edinburgh Postpartum Depression Scale score >13.

Results: Data were analysed for 688 women at 3 months and 550 women at 12 months. Depression was more likely in women with unintended pregnancies at both 3 months (risk ratio [RR] 2.1, 95% confidence interval [95% CI] 1.2-3.6) and 12 months (RR 3.6, 95% CI 1.8-7.1). Using multivariable analysis adjusting for confounding by age, poverty and education level, women with unintended pregnancies were twice as likely to have postpartum depression at 12 months (RR 2.0, 95% CI 0.96-4.0).

Conclusion: While many elements may contribute to postpartum depression, unintended pregnancy could also be a contributing factor. Women with unintended pregnancy may have an increased risk of depression up to 1 year postpartum.

Keywords: Depression; pregnancy intention; unwanted pregnancy.

FIGURE 1

Assessment of Pregnancy Intention * Lack of additivity represents non-respondents to individual questions

FIGURE 2

Prevalence of depression by pregnancy intention