Unintended Pregnancy May Increase Risk of Postpartum Depression, Study Finds

The risk of experiencing symptoms of postpartum depression (PPD) may be higher in women who give birth resulting from unintended pregnancies, according to a study published in Social Science & Medicine. While women who conceive via fertility treatments may not be at an increased risk, the type of treatment used to conceive may impact outcomes.

The prevalence of PPD, defined as a major depressive episode during the postpartum period, is an estimated 13% in the United States, and the condition can be debilitating to mothers. PPD also affects their children and entire family system, and lately, it has been more directly addressed by medical organizations via policies and recommendations.

Identifying key risk factors is a priority in PPD research and can help shape initiatives for prevention, treatment strategies, or policies and practices related to PPD. Most factors of interest in PPD research are biological, including hormone changes and a genetic predisposition, or contextual, such as mental health history, pregnancy intention, or stress.

As fertility treatments have been used more often to conceive, determining the risk of PPD with these methods has become important. The study aimed to determine the prevalence in PPD in 4 groups: women who conceived spontaneously and unintentionally, women who conceived spontaneously and were unsure if they wanted to conceive, women who conceived intentionally while using fertility treatments, and women who conceived spontaneously and intentionally.

A secondary aim of the study was to explore the impact of specific fertility treatments— including fertility-enhancing medications prescribed by a doctor only, insemination procedures with use of fertility-enhancing medications, or assisted reproductive technology (ART)—on PPD risk. Research in this context has often focused on the impact of the social experience of infertility and its potential effects on PPD risk.

“Many fertility treatments alter hormones, such as progesterone and estrogen. These alterations are occurring in the preconception period and early in pregnancy,” the authors wrote. “The literature, to our knowledge, has not investigated how these early hormonal manipulations may or may not impact postpartum mental health, and it is unclear whether there are physiological pathways for how they may do so.”

Data from the Pregnancy Risk Assessment Monitoring System (2012-2019), which is a cross-sectional survey given to women throughout the United States who have recently given birth, were used to assess PPD risk across the study cohorts.

A total of 125,702 women in the study sample conceived spontaneously and intentionally; 70,505 had unintended pregnancies; 40,527 were unsure about their pregnancy intention; and 6943 conceived with fertility treatments. Overall, 13.9% of the women in the study sample had symptoms of PPD.

In an adjusted regression analysis, women who conceived unintentionally had higher odds of PPD than those who conceived spontaneously and intentionally (odds ratio [OR], 1.32; 95% CI, 1.26-1.39; P = .01). Those who conceived unintentionally were also more likely to experience PPD vs those who were unsure about their intention to conceive (OR, 1.30; 95% CI, 1.23-1.38; P < .01). However, women who conceived while on fertility treatments were not at higher odds of elevated PPD symptoms (OR, 0.97; 95% CI, 0.84-1.10; P = .61).

The analysis of fertility treatment type and PPD outcomes included 2210 women. Fertility-enhancing drugs were used by 31.4% of the group, 14.9% used medicated insemination, and 53.7% used ART. An adjusted logistic regression model showed that women using fertility-enhancing drugs were at a higher risk of PPD compared with those using ART (OR, 2.0; 95% CI, 1.24-3.24; P < .01). Those using medical insemination had similar odds as the ART group.

The findings suggest that pregnancy intention, rather than fertility treatment use or type of fertility treatment, may have the greatest impact on PPD from among the variables considered in the study. The authors note that US reproductive policies making abortion access more difficult may lead to increased rates of PPD, as there is an increase of unintended children carried to term. Screening for PPD, especially in those with unintended pregnancy, is an important step in identifying those who are at an increased risk.

“While the experience of undergoing fertility treatments can be stressful, based on a nonclinical sample of women who recently gave birth in the US, our results suggest that women who conceived with fertility treatments were not at a higher risk of PPD,” the authors wrote. “Women who had unintended and unsure pregnancies were more likely to have elevated PPD symptoms relative to those who had spontaneous, intended pregnancies.”

Reference

Barber GA, Steinberg JR. The association between pregnancy intention, fertility treatment use, and postpartum depression. Soc Sci Med. Published online October 13, 2022. doi:10.1016/j.socscimed.2022.115439