1022: Association between extremely preterm cesarean delivery and maternal depressive symptoms: a national population-based cohort study

The aim of this study was to evaluate whether cesarean delivery before 26 weeks was associated with depressive and anxiety symptoms of mothers of preterm infants in comparison with cesarean deliveries between 26 and 34 weeks. The Etude Epidémiologique sur les petits ages gestationnels (EPIPAGE) 2 is a national prospective population-based cohort study of preterm birth in 2011. We included mothers who delivered between 22 and 34 weeks and whom mothers' self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (State-Trait Anxiety Inventory: STAI) symptoms were assessed at the moment of neonatal discharge. To assess the association of cesarean delivery before 26 weeks with depression (CES-D ≥ 16) and anxiety symptoms (STAI ≥ 45), we used univariate and cluster (to take into account a potential center effect) multivariate logistic regression analysis. Among 2270 women completing CES-D and STAI questionnaires at the moment of neonatal discharge, 38 (0.6%) had cesarean delivery and 61 (0.9%) had vaginal delivery before 26 weeks whereas 1415 (62.7%) women had cesarean delivery after 26 weeks and 744 (40.1%) had vaginal delivery after 26 weeks. Depression symptoms occurred in 25 (65.8%) women having cesarean delivery before 26 weeks versus in 748 (50.6%) women having cesarean delivery after 26 weeks (p=0.03). Cluster multivariate logistic regression showed significant association of cesarean delivery before 26 weeks and depression symptoms compared with cesarean delivery after 26 weeks (adjusted odd ratio [aOR], 2.61 ; 95% confidence interval [CI], 1.13-6.02) whatever neonatal birth weight and severe neonatal morbidity. Univariate and cluster multivariate analysis did not show significant association between preterm mode of delivery and anxiety symptoms. Cesarean delivery before 26 weeks is an independent factor of depressive symptoms in mothers of preterm infants. Perinatal professionals should be aware of maternal psychological morbidity and take special preventive care to these women.