Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants and Data Collection
2.2. Postpartum Depression (PPD) and Follow-Up
2.3. Urinary Incontinence (UI)
2.4. Covariates
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- O’Hara, M.W.; McCabe, J.E. Postpartum depression: Current status and future directions. Annu. Rev. Clin. Psychol. 2013, 9, 379–407. [Google Scholar] [CrossRef] [PubMed]
- Parsons, C.E.; Young, K.S.; Rochat, T.J.; Kringelbach, M.L.; Stein, A. Postnatal depression and its effects on child development: A review of evidence from low-and middle-income countries. Br. Med. Bull. 2012, 101, 57–79. [Google Scholar] [CrossRef]
- Youn, H.; Lee, S.; Han, S.W.; Kim, L.Y.; Lee, T.-S.; Oh, M.-J.; Jeong, H.-G.; Cho, G.J. Obstetric risk factors for depression during the postpartum period in South Korea: A nationwide study. J. Psychosom. Res. 2017, 102, 15–20. [Google Scholar] [CrossRef] [PubMed]
- Rahman, A.; Fisher, J.; Bower, P.; Luchters, S.; Tran, T.; Yasamy, M.T.; Saxena, S.; Waheed, W. Interventions for common perinatal mental disorders in women in low-and middle-income countries: A systematic review and meta-analysis. Bull. World Health Organ. 2013, 91, 593–601. [Google Scholar] [CrossRef] [Green Version]
- Sword, W.; Kurtz Landy, C.; Thabane, L.; Watt, S.; Krueger, P.; Farine, D.; Foster, G. Is mode of delivery associated with postpartum depression at 6 weeks: A prospective cohort study. BJOG 2011, 118, 966–977. [Google Scholar] [CrossRef] [PubMed]
- Nam, J.Y.; Choi, Y.; Kim, J.; Cho, K.H.; Park, E.-C. The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea. J. Affect. Disord. 2017, 218, 53–58. [Google Scholar] [CrossRef] [PubMed]
- Abdul Raheem, R.; Chih, H.J.; Binns, C.W. Maternal Depression and Breastfeeding Practices in the Maldives. Asia Pac. J. Public Health 2019, 31, 113–120. [Google Scholar] [CrossRef]
- Jones, I.; Chandra, P.S.; Dazzan, P.; Howard, L.M. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 2014, 384, 1789–1799. [Google Scholar] [CrossRef]
- Hullfish, K.L.; Fenner, D.E.; Sorser, S.A.; Visger, J.; Clayton, A.; Steers, W.D. Postpartum depression, urge urinary incontinence, and overactive bladder syndrome: Is there an association? Int. Urogynecol. J. 2007, 18, 1121–1126. [Google Scholar] [CrossRef]
- Qi, X.; Shan, J.; Peng, L.; Zhang, C.; Xu, F. The effect of a comprehensive care and rehabilitation program on enhancing pelvic floor muscle functions and preventing postpartum stress urinary incontinence. Medicine 2019, 98, e16907. [Google Scholar] [CrossRef]
- Lin, Y.-H.; Chang, S.-D.; Hsieh, W.-C.; Chang, Y.-C.; Chueh, H.-Y.; Chao, A.-S.; Liang, C.-C. Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J. Obstet. Gynecol. 2018, 57, 340–345. [Google Scholar] [CrossRef] [PubMed]
- Tähtinen, R.M.; Cartwright, R.; Vernooij, R.W.; Rortveit, G.; Hunskaar, S.; Guyatt, G.H.; Tikkinen, K.A.O. Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes. Am. J. Obstet. Gynecol. 2019, 220, 181.e1–181.e8. [Google Scholar]
- Tähtinen, R.M.; Cartwright, R.; Tsui, J.F.; Aaltonen, R.L.; Aoki, Y.; Cárdenas, J.L.; El Dib, R.; Joronen, K.M.; Al Juaid, S.; Kalantan, S.; et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: A systematic review and meta-analysis. Eur. Urol. 2016, 70, 148–158. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Van de Pol, G.; Van Brummen, H.; Bruinse, H.; Heintz, A.; Van Der Vaart, C. Is there an association between depressive and urinary symptoms during and after pregnancy? Int. Urogynecol. J. 2007, 18, 1409–1415. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Howell, E.A.; Mora, P.A.; Chassin, M.R.; Leventhal, H. Lack of preparation, physical health after childbirth, and early postpartum depressive symptoms. J. Womens Health 2010, 19, 703–708. [Google Scholar] [CrossRef]
- Brown, S.; Lumley, J. Physical health problems after childbirth and maternal depression at six to seven months postpartum. BJOG 2000, 107, 1194–1201. [Google Scholar] [CrossRef] [PubMed]
- Melville, J.L.; Fan, M.Y.; Rau, H.; Nygaard, I.E.; Katon, W.J. Major depression and urinary incontinence in women: Temporal associations in an epidemiologic sample. Am. J. Obstet. Gynecol. 2009, 201, e491–e497. [Google Scholar] [CrossRef]
- Eckerdal, P.; Georgakis, M.K.; Kollia, N.; Wikström, A.K.; Högberg, U.; Skalkidou, A. Delineating the association between mode of delivery and postpartum depression symptoms: A longitudinal study. Acta Obstet. Gynecol. Scand. 2018, 97, 301–311. [Google Scholar] [CrossRef]
- Xu, H.; Ding, Y.; Ma, Y.; Xin, X.; Zhang, D. Cesarean section and risk of postpartum depression: A meta-analysis. J. Psychosom. Res. 2017, 97, 118–126. [Google Scholar] [CrossRef]
- Woolhouse, H.; Gartland, D.; Perlen, S.; Donath, S.; Brown, S.J. Physical health after childbirth and maternal depression in the first 12 months postpartum: Results of an Australian nulliparous pregnancy cohort study. Midwifery 2014, 30, 378–384. [Google Scholar] [CrossRef]
- Sangsawang, B.; Sangsawang, N. Stress urinary incontinence in pregnant women: A review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. 2013, 24, 901–912. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kjerulff, K.H.; Brubaker, L.H. New mothers’ feelings of disappointment and failure after cesarean delivery. Birth 2018, 45, 19–27. [Google Scholar] [CrossRef] [PubMed]
- National Institute for Health and Care Excellence. Caesarean Section (CG132) Clinical Guideline. 2011. Available online: https://www.nice.org.uk/guidance/cg132/ (accessed on 25 July 2020).
- Shorey, S.; Chee, C.Y.I.; Ng, E.D.; Chan, Y.H.; San Tam, W.W.; Chong, Y.S. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J. Psychiatr. Res. 2018, 104, 235–248. [Google Scholar] [CrossRef] [PubMed]
- Dong Woo Lee, J.W.B. Research for Management System of Postpartum Depression (Korean); Korea Mental Health Foundation: Seoul, Korea, 2015. [Google Scholar]
- Park, K.T. Is the Moderating Effect of Social Support on New Korean Mothers’ Psychological Distress Contingent on Levels of Marital Quality? Asia Pac. J. Public Health 2018, 30, 167–177. [Google Scholar] [CrossRef]
Urinary Incontinence | ||||||
---|---|---|---|---|---|---|
No | Yes | Total | ||||
n | (%) | n | (%) | n | (%) | |
Postpartum Depression | ||||||
No | 77,068 | (99.22) | 5307 | (98.41) | 82,375 | (99.17) |
Yes | 605 | (0.78) | 86 | (1.59) | 691 | (0.83) |
Maternal Age (Year) | ||||||
15–24 | 3625 | (4.67) | 256 | (4.75) | 3881 | (4.67) |
25–29 | 23,428 | (30.16) | 1610 | (29.85) | 25,038 | (30.14) |
30–34 | 37,030 | (47.67) | 2592 | (48.06) | 39,622 | (47.70) |
35–39 | 11,950 | (15.39) | 837 | (15.52) | 12,787 | (15.39) |
≥40 | 1640 | (2.11) | 98 | (1.82) | 1738 | (2.09) |
Income Level | ||||||
1Q | 7474 | (9.62) | 511 | (9.48) | 7985 | (9.61) |
2Q | 11,177 | (14.39) | 820 | (15.20) | 11,997 | (14.44) |
3Q | 20,151 | (25.94) | 1416 | (26.26) | 21,567 | (25.96) |
4Q | 25,416 | (32.72) | 1703 | (31.58) | 27,119 | (32.65) |
5Q | 13,455 | (17.32) | 943 | (17.49) | 14,398 | (17.33) |
Type of Insurance | ||||||
Self-employed insured | 21,716 | (27.96) | 1628 | (30.19) | 23,344 | (28.10) |
Employee insured | 55,693 | (71.70) | 3747 | (69.48) | 59,440 | (71.56) |
Medical aid | 264 | (0.34) | 18 | (0.33) | 282 | (0.34) |
Residential Area | ||||||
Rural | 22,883 | (29.46) | 1712 | (31.74) | 24,595 | (29.61) |
Urban | 54,790 | (70.54) | 3681 | (68.26) | 58,471 | (70.39) |
Mode of Delivery | ||||||
Spontaneous vaginal delivery | 43,947 | (56.58) | 3008 | (55.78) | 46,955 | (56.53) |
Instrumental delivery | 4975 | (6.41) | 282 | (5.23) | 5257 | (6.33) |
Cesarean section delivery | 28,751 | (37.02) | 2103 | (38.99) | 30,854 | (37.14) |
Parity | ||||||
1 (Nulliparous) | 50,014 | (64.39) | 2949 | (54.68) | 52,963 | (63.76) |
2 | 24,458 | (31.49) | 2185 | (40.52) | 26,643 | (32.07) |
3+ | 3201 | (4.12) | 259 | (4.80) | 3460 | (4.17) |
Twin Birth Status | ||||||
Singleton | 76,574 | (98.59) | 5314 | (98.54) | 81,888 | (98.58) |
Twin | 1099 | (1.41) | 79 | (1.46) | 1178 | (1.42) |
Maternal Comorbidities | ||||||
0 | 50,164 | (64.58) | 3409 | (63.21) | 53,573 | (64.49) |
1+ | 27,509 | (35.42) | 1984 | (36.79) | 29,493 | (35.51) |
Obstetrical Complications | ||||||
0 | 65,904 | (84.85) | 4591 | (85.13) | 70,495 | (84.87) |
1+ | 11,769 | (15.15) | 802 | (14.87) | 12,571 | (15.13) |
77,673 | (93.51) | 5393 | (6.49) | 83,066 | (100.00) |
Postpartum Depression | ||||
---|---|---|---|---|
Person-Days | n | HR | 95% CI | |
Urinary Incontinence | ||||
No | 13,928,597 | 605 | 1.00 | |
Yes | 963,536 | 86 | 2.04 | (1.63–2.57) |
Age (Year) | ||||
15–24 | 694,617 | 46 | 1.48 | (1.07–2.05) |
25–29 | 4,490,245 | 203 | 1.06 | (0.88–1.27) |
30–34 | 7,105,892 | 300 | 1.00 | |
35–39 | 2,290,843 | 115 | 1.13 | (0.91–1.41) |
≥40 | 310,536 | 27 | 1.81 | (1.21–2.71) |
Income Level | ||||
1Q | 1,429,083 | 94 | 1.34 | (1.02–1.77) |
2Q | 2,149,874 | 102 | 0.99 | (0.76–1.29) |
3Q | 3,867,094 | 161 | 0.90 | (0.71–1.14) |
4Q | 4,864,234 | 215 | 0.98 | (0.78–1.22) |
5Q | 2,581,848 | 119 | 1.00 | |
Type of Insurance | ||||
Self-employed insured | 4,184,131 | 208 | 1.06 | (0.90–1.25) |
Employee insured | 10,657,715 | 477 | 1.00 | |
Medical aid | 50,287 | 6 | 1.72 | (0.75–3.94) |
Residential Area | ||||
Rural | 4,407,834 | 210 | 1.00 | (0.85–1.18) |
Urban | 10,484,299 | 481 | 1.00 | |
Mode of Delivery | ||||
Spontaneous vaginal delivery | 8,425,082 | 337 | 1.00 | |
Instrumental delivery | 942,528 | 44 | 1.14 | (0.83–1.57) |
Cesarean section delivery | 5,524,523 | 310 | 1.39 | (1.19–1.63) |
Parity | ||||
1 (Nulliparous) | 9,491,220 | 459 | 1.16 | (0.98–1.39) |
2 | 4,780,780 | 201 | 1.00 | |
3+ | 620,133 | 31 | 1.18 | (0.80–1.74) |
Twin Birth Status | ||||
Singleton | 14,680,583 | 685 | 1.99 | (0.89–4.47) |
Twin | 211,550 | 6 | 1.00 | |
Comorbidities During Pregnancy | ||||
0 | 9,605,024 | 435 | 1.00 | |
1+ | 5,287,109 | 256 | 1.08 | (0.93–1.27) |
Obstetrical Complications | ||||
0 | 12,638,226 | 586 | 1.00 | |
1+ | 2,253,907 | 105 | 1.04 | (0.85–1.28) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nam, J.Y.; Park, E.-C.; Cho, E. Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea. Int. J. Environ. Res. Public Health 2021, 18, 437. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020437
Nam JY, Park E-C, Cho E. Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea. International Journal of Environmental Research and Public Health. 2021; 18(2):437. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020437
Chicago/Turabian StyleNam, Jin Young, Eun-Cheol Park, and Eun Cho. 2021. "Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea" International Journal of Environmental Research and Public Health 18, no. 2: 437. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020437