title: Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions.
abstract: OBJECTIVE
  The effect of prenatal mental health on the risk of obstetric interventions is unclear. The present study examined the associations between depressive and anxiety symptoms in the second and third trimesters and mode of delivery, epidural use and labor induction in a large community-based pregnancy cohort, in Alberta, Canada.
  
  
  METHODS
  Women who had singleton pregnancies, delivered in hospital, and had medical data were selected (n = 2825). Obstetric intervention data were obtained from the medical records, and depressive and anxiety symptoms were measured by the Edinburgh Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Data were evaluated with multivariate multinomial and logistic regression analyses using a hierarchical modeling.
  
  
  RESULTS
  After accounting for factors known to increase the risk of each intervention, including demographic variables, smoking, hospital site, gestational age, previous history of cesarean delivery, prepregnancy body mass index, assisted conception, and antepartum risk score, the only mental health variable associated with obstetric interventions was depressive symptoms in the third trimester, which increased the risk of emergency cesarean delivery (adjusted odds ratio, 2.04; 95% confidence interval, 1.26-3.29). No associations were found between antenatal depressive and anxiety symptoms and other obstetric interventions.
  
  
  CONCLUSIONS
  The present findings support an association between depressive symptoms and adverse obstetric outcomes and suggest that anxiety and depression may have different effects on obstetric outcomes. Understanding the mechanism in which depression increases the risk of emergency cesarean birth needs further research.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Hamideh
authors.initials: H
authors.lastname: Bayrampour
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Charleen
authors.initials: C
authors.lastname: Salmon
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Vinturache
authors.affiliation: Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Tough
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D001007:Anxiety / Q000150:complications* / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D055815:Young Adult
keywords: cesarean delivery; obstetric interventions; prenatal mental health; risk factors