National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Psychol Med. 2022 Oct;52(14):3210-3221. doi: 10.1017/S0033291720005322. Epub 2021 Jan 28.
Policy in many high-income settings supports giving pregnant women with previous caesarean section a choice between an elective repeat caesarean section (ERCS) or planning a vaginal birth after previous caesarean (VBAC), provided they have no contraindications to VBAC. Despite the potential for this choice to influence women's mental health, evidence about the associated effect to counsel women and identify potential targets for intervention is limited. This study investigated the association between planned mode of birth after previous caesarean and women's subsequent use of psychotropic medications.
A population-based cohort study of 31 131 women with one or more previous caesarean sections who gave birth to a term singleton in Scotland between 2010 and 2015 with no prior psychotropic medications in the year before birth was conducted using linked Scottish national datasets. Cox regression was used to investigate the association between planned mode of birth and being dispensed psychotropic medications in the first year postpartum adjusted for socio-demographic, medical, pregnancy-related factors and breastfeeding.
Planned VBAC ( = 10 220) compared to ERCS ( = 20 911) was associated with a reduced risk of the mother being dispensed any psychotropic medication [adjusted hazard ratio (aHR) 0.85, 95% confidence interval (CI) 0.78-0.92], an antidepressant (aHR 0.83, 95% CI 0.76-0.90), and at least two consecutive antidepressants (aHR 0.83, 95% CI 0.75-0.91) in the first year postpartum.
Women giving birth by ERCS were more likely than those having a planned VBAC to be dispensed psychotropic medication including antidepressants in the first year postpartum. Further research is needed to establish the reasons behind this new finding.
许多高收入国家的政策支持为有过剖宫产史的孕妇提供选择，可选择择期再次剖宫产（ERCS）或计划经阴道分娩（VBAC），前提是她们没有 VBAC 的禁忌症。尽管这种选择可能会影响妇女的心理健康，但关于为妇女提供咨询和确定潜在干预目标的相关证据有限。本研究调查了既往剖宫产术后计划分娩方式与妇女随后使用精神药物之间的关系。
采用苏格兰国家数据集进行了一项基于人群的队列研究，共纳入 31131 名在苏格兰 2010 年至 2015 年间有一次或多次剖宫产史且在分娩前一年无精神药物使用史的足月单胎产妇。使用 Cox 回归分析了计划分娩方式与产后第一年使用精神药物之间的关系，并对社会人口统计学、医疗、妊娠相关因素和母乳喂养进行了调整。
与 ERCS（n=20911）相比，计划 VBAC（n=10220）与母亲使用任何精神药物的风险降低相关（调整后的危险比[aHR]0.85，95%置信区间[CI]0.78-0.92）、抗抑郁药（aHR 0.83，95% CI 0.76-0.90）和至少连续两种抗抑郁药（aHR 0.83，95% CI 0.75-0.91）。
与计划 VBAC 相比，行 ERCS 的妇女在产后第一年更有可能被开处精神药物，包括抗抑郁药。需要进一步研究以确定这一新发现的原因。
