Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada.
Alberta Children's Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada.
Int J Environ Res Public Health. 2022 Apr 18;19(8):4900. doi: 10.3390/ijerph19084900.
Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7-9% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers' perceptions of more negative childbirth experiences, such as unplanned/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (β = 0.17 ( = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms.
剖宫产术（C -section）分娩占每年分娩的近 30%，其中紧急剖宫产术占所有分娩的 7-9%。研究表明剖宫产术与产后抑郁症（PPD）有关。PPD 与亲子互动质量下降以及母婴健康的不良影响有关。新妈妈对分娩经历的更多负面看法，如计划外/紧急剖宫产术，与创伤后应激障碍（PTSD）有关，而 PTSD 又与 PPD 有关。我们的目标是确定：（1）剖宫产术类型（计划外/紧急与计划）与 PPD 症状之间的关联，以及（2）如果产后 PTSD 症状是否会影响这种关联。本研究采用 2009 年至 2013 年期间来自艾伯塔省妊娠结局和营养（APrON）研究的 354 对母婴对的前瞻性收集数据进行二次分析，采用条件过程模型。产后三个月时，采用爱丁堡产后抑郁量表（EPDS）和精神科诊断筛查问卷（PDSQ）评估产后抑郁和创伤后应激症状。调整后和未调整模型中，紧急剖宫产术对 PPD 症状的直接影响均不显著；然而，在控制产前抑郁症状、社会支持和 SES 后，紧急剖宫产术通过 PTSD 症状对 PPD 症状的间接影响具有统计学意义（β=0.17（=0.11），95%CI [0.03, 0.42]）。这表明，与经历计划性剖宫产术的母亲相比，经历紧急或非计划性剖宫产术的母亲 PTSD 评分增加了近半分（0.47），即使经过调整。总体而言，紧急剖宫产术通过 PTSD 症状与 PPD 症状间接相关。研究结果表明，PTSD 症状可能是紧急剖宫产术与 PPD 症状发展相关的机制之一。
