Is pregnancy intention associated with postpartum depressive symptoms?
ESC Congress Library. Hellerstedt W. May 28, 2014; 50631; A-216 Disclosure(s): None
Dr. Wendy Hellerstedt
Dr. Wendy Hellerstedt
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Abstract
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Objectives: Half of all pregnancies in the United States are unintended, the result of no or ineffective use of contraceptives.  It is not clear how unintended pregnancy is associated with maternal mental health, specifically postpartum depression (PPD).  Both unintended childbearing (30% of all births) and PPD are disproportionately concentrated among socially vulnerable women and have long-lasting negative effects on maternal and offspring well being.  We assessed the nature of the association between PPD presence and severity with maternal and partner intention, as well as couple discordance in pregnancy intention.

Method: Data were from 7,339 adult female respondents to Minnesota’s 2004-2008 Pregnancy Risk Assessment Monitoring System survey.  Respondents were randomly selected from their infants’ birth certificate 2 to 4 months’ postpartum. We assessed three pregnancy intention variables:  maternal and perceived partner satisfaction with the timing of pregnancy (coded “intended,” “mistimed/unwanted”); and couple concordance (coded “both intended,” “partner intended,” “mother intended,” “neither intended”). We assessed PPD symptoms with the Patient Health Questionnaire-2 that asked how often respondents felt “down, depressed, or hopeless” and “had little interest or pleasure in doing things” since their infant’s birth.  We examined PPD presence (responses of  “always” or “often” to either question) and severity (“no,” “occasional,” “intermediate,” “severe” symptoms) relative to pregnancy intention (maternal and partner) and partner concordance with multivariable and polytomous logistic regression models that included covariates for sociodemographics and prenatal health, substance use, and stressors.

Results: In crude analyses, each pregnancy intention variable was associated with a two-fold increase in risk for PPD symptoms.  In adjusted analyses only partner intended/maternal not intended versus both intended was associated with increased risk (adjusted odds ratio (AOR), 1.45; 95% confidence interval (CI), 1.1, 2.0).  Discordance in parental pregnancy intention was also associated with PPD symptom severity.  Compared to parents who both intended this pregnancy, mothers who reported this pregnancy was unintended by them and intended by their partners were more likely to have intermediate PPD symptoms than no depressive symptoms (AOR, 1.68; 95% CI, 1.1,2.8).

Conclusions: The perception that a partner wanted a pregnancy that was not intended by the mother was a risk factor for the presence and severity of PPD symptoms, independent of measures of social vulnerability.  Further research is warranted to (1) understand the contraceptive patterns of couples with discordant pregnancy intentions; and (2) investigate how to encourage partner (assumed to be mostly male in this sample) involvement in family planning.
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