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

BJOG. 2021 Feb;128(3):594-602. doi: 10.1111/1471-0528.16499. Epub 2020 Oct 8.


Objective: To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks.

Design: Prospective national population-based EPIPAGE-2 cohort study.

Setting: 268 neonatology departments in France, March to December 2011.

Population: Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge.

Methods: The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model.

Main outcome measures: Severe symptoms of depression and anxiety in mothers of preterm infants.

Results: Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety.

Conclusions: Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care.

Tweetable abstract: Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.

Keywords: Anxiety; caesarean; depression; extreme prematurity; patient involvement; prematurity.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / epidemiology*
  • Anxiety / surgery
  • Cesarean Section / psychology
  • Cesarean Section / statistics & numerical data*
  • Depression / epidemiology*
  • Depression / surgery
  • Female
  • France / epidemiology
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Mothers / psychology
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / psychology
  • Pregnancy Complications / surgery
  • Premature Birth / epidemiology*
  • Premature Birth / psychology
  • Premature Birth / surgery
  • Prospective Studies