While anxiety and depression in pregnant women have already been linked to low birth weight and preterm birth, they may also contribute to higher rates of cesarean deliveries.
Researchers called the study among the largest to document a link between mood and anxiety disorders and first-time C-sections among low-risk pregnant women.
"Our findings reinforce the importance of better identifying and treating perinatal depression and anxiety disorders in pregnant women," said senior study author Dr. Vanessa Dalton, an ob-gyn at University of Michigan Health's Von Voigtlander Women's Hospital. "It's critical to better understand how these mood disorders increase the likelihood of cesarean section deliveries, which we know have both short and long-term health consequences for both expecting moms and their babies."
The research team used national data for more than 360,000 deliveries for women between 2008 and 2017. The women were each insured with commercial insurance and were ages 15 to 44. About 24% had a first-time delivery by cesarean section, which is one of the significant predictors of having a repeat C-section with a future birth.
Women with a prenatal diagnosis of anxiety or depression had a predicted probability of having a cesarean that was about 3.5% higher than women without anxiety or depression, the authors said.
Reasons for the relationship are not clear. It's possible that prenatal anxiety is sometimes focused on the delivery and that providers choose cesarean for their patients to ease the labor process, according to the study.
It may also be that maternal distress affects placental development. If so, this could cause symptoms of fetal distress during labor, which could then lead to a cesarean.
Dalton said further studies are needed.
"We need more research to clarify the relationship between perinatal mood and anxiety disorders and primary cesarean section rates to enhance our understanding of the consequences of these disorders for health outcomes," she said in a hospital news release. "This could potentially inform efforts to develop and evaluate effective treatments and policy interventions."
Perinatal mood and anxiety disorders affect 1 in 5 reproductive-age women in the United States, according to the study. Their prevalence more than doubled between 2006 and 2015 among childbearing women, a time during which thoughts of suicide and self-harm in the year before or after a birth also rose. Suicide is the leading cause of maternal death.
"There's been growing recognition that mental health is really important during the time of pregnancy," Dalton said. "Maternal suicide risk is especially high the year following delivery."
Cesarean sections carry other risks. These include blood clots, hemorrhaging, infection and risks to future pregnancies.
"Cesarean sections are a major contributing factor to maternal morbidity events after a delivery, with many adverse downstream effects," Dalton said. "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 Healthy People 2030 goal endorsed by many public health and professional societies in the United States is to reduce first-time cesareans by 2.3%.
Women with these mental health disorders were more likely to be older, white and reside in a household with income more than 400% of the federal poverty level.
The findings were published in the October issue of the journal Health Affairs.
The American Academy of Pediatrics has more on anxiety and depression during pregnancy and after birth.
SOURCE: Michigan Medicine-University of Michigan, news release, Oct. 20, 2021