• Maki Yokoyama, Keiko Tanaka, Takashi Sugiyama, Masashi Arakawa, and Yoshihiro Miyake.
• Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Ehime, Japan. Electronic address: yokoyama.maki.jg@ehime-u.ac.jp.
• J Affect Disord. 2021 Jan 1; 278: 497-501.

BackgroundThe association between cesarean section and the risk of postpartum depressive symptoms remains controversial. The present prebirth cohort study examined this issue in Japan.MethodsStudy subjects were 1310 women. Information under study was obtained using a self-administered questionnaire. Postpartum depressive symptoms were defined as a total Edinburgh Postnatal Depression Scale score of nine or higher between three and four months postpartum. Multivariate logistic regression analysis was used to adjust for age, body mass index, gestational weeks at baseline, gestational weeks at delivery, number of children at baseline, previous miscarriage or stillbirth, previous abortion, history of depression, family history of depression, region of residence, employment status, educational level, household income, family structure, breastfeeding status, smoking during pregnancy, infant's birthweight, and infant's sex.ResultsPostpartum depressive symptoms were identified in 8.2%. After adjustment for the confounding factors, compared with vaginal delivery, cesarean section was independently associated with an increased risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 1.95 (95% confidence interval [CI]: 1.16-3.23). This positive association was more apparent among those who had no other children at baseline than among those who already had one or more children: the adjusted ORs were 2.94 (95% CI: 1.35-6.26) and 1.45 (95% CI: 0.68-2.92), respectively; however, this interaction was not significant.LimitationsInformation on whether each cesarean section was emergency or elective and other obstetric complications was not available.ConclusionsCesarean section may be associated with an increased risk of postpartum depressive symptoms, especially among women without children at baseline.Copyright © 2020. Published by Elsevier B.V.

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