title: Impact of a multiple, IVF birth on post-partum mental health: a composite analysis.
abstract: BACKGROUND
  This study explored the impact of a multiple IVF birth on maternal mental health in the early post-partum period.
  
  
  METHODS
  A prospective study of 207 women who had conceived following IVF treatment and followed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled and Irregular Behaviour scale. Mothers' emotional well-being was explored using theme analysis of semi-structured telephone interviews.
  
  
  RESULTS
  Of the 175 (84.5%) followed up post-partum, 56 (32%) had a multiple birth (7 triplets, 49 twins). Nearly 16% of mothers in the multiple group scored>12 on the EPDS indicating clinically significant symptoms, which represented a 3-fold increased risk compared to mothers of singletons (Odds ratio=3.4, Confidence Interval=1.011-11.618, P=0.048). Unsettled and irregular infant behaviour was another independent risk factor. Qualitative analysis of interviews identified 12 themes. Mothers of multiples were more likely to express negative themes including 'tiredness' (P<0.01), 'feelings of stress/depression' (P<0.05) and 'questioning parenthood' (P<0.05). Mothers of singletons were more likely to be 'feeling wonderful', reflecting their delight in parenthood (P<0.05).
  
  
  CONCLUSIONS
  Mothers of multiples are at increased risk of poorer emotional well-being. Clinicians should focus on the psychological benefits of a singleton birth.
authors.affiliation: Division of Psychiatry, Queen's Medical Centre, Nottingham NG7 2UH, UK. charlotte.sheard@nottingham.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Sheard
authors.forename: S
authors.initials: S
authors.lastname: Cox
authors.forename: M
authors.initials: M
authors.lastname: Oates
authors.forename: G
authors.initials: G
authors.lastname: Ndukwe
authors.forename: C
authors.initials: C
authors.lastname: Glazebrook
mesh_terms: D004644:Emotions; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D008603:Mental Health; D016017:Odds Ratio; D016487:Parenting / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D013689:Telephone; D014310:Triplets; D014427:Twins