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

OBJECTIVE To evaluate whether caesarean delivery before 26 weeks of gestation was associated with depressive and anxious symptoms of 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 depressive (Center for Epidemiologic Studies Depression Scale: CES-D) and anxious (State-Trait Anxiety Inventory: STAI) symptoms were assessed at the moment of neonatal discharge. METHODS The association of caesarean delivery before 26 weeks with high depressive (CES-D ≥ 16) and anxious symptoms (STAI ≥ 45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES High depressive and anxious symptoms of mothers of preterm infants. RESULTS Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, high depressive symptoms occurred in 25 (65.8%) women having caesarean before 26 weeks versus in 748 (50.6%) women having caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with high depressive symptoms compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR], 1.42; 95% confidence interval [CI], 1.12-1.81) adjusted on neonatal birth weight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and anxious symptoms. CONCLUSIONS Mothers having caesarean delivery before 26 weeks' gestation are at high risk of depressive symptoms and may benefit from specific preventive care.