Pregnant women who suffer with depression or anxiety are more likely to need a caesarean section delivery, according to new research.

Mood and anxiety disorders in pregnant women have previously been linked to adverse pregnancy outcomes, such as preterm birth. New research suggests that women with these disorders may also be more likely to have first-time c-sections when compared to other women with a low caesarean risk.

Senior author of the study, Dr Vanessa Dalton, obstetrician gynaecologist at the University of Michigan Health Von Voigtlander Women’s Hospital, said: “Our findings reinforce the importance of better identifying and treating perinatal depression and anxiety disorders in pregnant women.”

She continued: “It’s critical to better understand how these mood disorders increase the likelihood of caesarean section deliveries, which we know have both short and long-term health consequences for both expecting moms and their babies.”

This study is one of the largest to investigate the relation between perinatal (during and up to one year after pregnancy) mood and anxiety disorders and caesarean sections among low-risk women. It involved examining 360,225 delivery hospitalisations of women aged from 15 to 44 years, during the period from 2008 to 2017. Almost a quarter of these women had a first-time caesarean section.

Past studies have included women who had previously given birth by caesarean section, one of the greatest predictors of having another caesarean amongst women with and without perinatal mood and anxiety disorders.

In the US, around 20 per cent of reproductive-age women are affected by these perinatal mood and anxiety disorders, which more than doubled during the period 2006 to 2015 among pregnant women. The idea of suicide and deliberate self-harm in the year before and after birth also increased during this time. Suicide is the most prevalent cause of maternal mortality.

Dr Dalton said: “There’s been growing recognition that mental health is really important during the time of pregnancy. Maternal suicide risk is especially high the year following delivery.”

According to Dr Dalton, anxiety and depression create other issues, such as adverse birth outcomes, increased number of maternal morbidities, lost earnings, and an estimated cost of $14b in the United States.

Caesarean sections come with risks, just like any other surgery, such as haemorrhaging, infection, blood clots, and threats to later pregnancies. Many women who have a first-time caesarean will deliver by caesarean during future births.

Dr Dalton said: “Caesarean sections are a major contributing factor to maternal morbidity events after a delivery with many adverse downstream effects. We need to understand all factors that may increase a woman’s chance of a c-section delivery so we can avoid any unnecessary risks.”

The study found that women diagnosed with prenatal depression or anxiety are around 3.5 per cent more likely to need a caesarean section.

There are numerous ideas of why this link exists, such as the idea that prenatal anxiety surrounds only the delivery and so women opt for a c-section, and that maternal distress disturbs placental development which effects foetal distress in labour and often leads to c-section.

Nevertheless, none of these theories are proven so Dr Dalton suggests further investigation into the area to develop understanding of the link.

She said: “We need more research to clarify the relationship between perinatal mood and anxiety disorders and primary caesarean section rates to enhance our understanding of the consequences of these disorders for health outcomes. This could potentially inform efforts to develop and evaluate effective treatments and policy interventions.”

The study was published in the journal Health Affairs.

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