Puducherry: A recent cohort study by Papa Dasari, JIPMER, Puducherry, India, and colleagues sheds light on the association between mode of delivery and postpartum depression (PPD). The researchers found twice higher risk of postpartum depression among women in the cesarean section (CS) group than in the normal delivery (ND) group.
The study, published online in the Journal of Obstetrics and Gynecology of India, also found a very high significant association between domestic abuse or violence and postpartum depression.

There are several established risk factors for postpartum depression. Whether the mode of delivery is associated with PPD is controversial. Therefore, the research team aimed to assess the prevalence of PPD among women who delivered normally versus cesarean section. They also assessed the association between sociodemographic factors and clinical factors with PPD.
The prospective cohort study was conducted in the Department of Obstetrics and Gynecology in JIPMER Hospital Puducherry from 2019 to 2020. It included women without high-risk factors for postpartum depression. 121 women were included in the normal delivery group and 121 in the cesarean section group.
Screening for postpartum depression was conducted within one week of delivery and again after six weeks of delivery using a validated English or Tamil version of the EPDS (Edinburgh Postnatal Depression Scale). An EPDS score ≥ 13 was considered positive for PPD. To determine the association univariate and multivariable analysis was done.
The researchers reported the following findings:
The overall prevalence of postpartum depression was 27.27%.
The prevalence of PPD was higher in the CS (34.71%) than in the ND group (19.83%).
PPD was found 2.1 times (OR-2.1) in the CS group within one week and 2.5 times (RR-2.5) at six weeks of delivery, respectively.
Among the social factors, a history of domestic abuse or violence was found to be significantly associated with PPD by both univariate and multivariable analysis.

"Our findings revealed that postpartum depression was twice higher among women in the cesarean section than in the normal delivery group," the researchers wrote. "Domestic abuse or violence was very highly significantly associated with PPD."
Reference:
Agarwal, P., Dasari, P. & Sarkar, S. Mode of Delivery and Postpartum Depression: A Cohort Study. J Obstet Gynecol India (2023). https://doi.org/10.1007/s13224-023-01810-7