Data still hazy for immediate postpartum hormonal contraception and postpartum depression

A recent study investigated the association between immediate postpartum hormonal contraceptives and postpartum depression, according to an abstract presented at the 2022 American College of Obstetricians & Gynecologists' Annual Clinical & Scientific Meeting held in San Diego, California from May 6-8.¹

“Immediate postpartum contraception, including long-acting reversible contraception (LARC) placement, is convenient, effective, and becoming more accessible given ongoing reimbursement changes,” wrote the authors.

While some hormonal contraceptives have been linked to mood changes outside of the peripartum period, these contraceptives have not been fully studied in the postpartum period, according to the authors

Shailly Prasad, MD, a resident physician at Mount Sinai Health System in New York, New York, along with fellow Icahn School of Medicine at Mount Sinai researchers Gabriela Frid, BS, an MD candidate; Jacqueline Roig, an MD candidate; Britt Lunde, MD, MPH, assistant professor; and Nina M. Molenaar, MD, PhD, conducted a retrospective cohort study on patients at their postpartum visit from January 1, 2016 to June 30, 2019, at a hospital-based outpatient clinic.

Study participants were separated into 3 arms: hormonal contraceptives, nonhormonal contraceptives, and no contraceptives.

The primary outcome of the study was measured by Edinburgh Postnatal Depression Scale (EPDS) score, which uses a cut-off score of 13 to determine depressed from nondepressed women.

Data were collected at the postpartum visit (typically 4-10 weeks following delivery). Additionally, a multivariate analysis was conducted to control for confounders such as the history of mood disorders and psychiatric medications, multiparity, and neonatal outcomes.

Results of the study found that of 1,041 patients analyzed, the immediate postpartum hormonal contraceptive use rate was 14.6%. Researchers also discovered that across the 3 study arms, there was no difference in the mean or median EPDS score.

Ultimately, the authors concluded there was neither a decreased nor increased risk for postpartum depression in patients who received hormonal contraception as there was insufficient evidence to determine that the rate of EPDS.12 or EPDS as a continuous variable was significantly different between the study arms.

Reference

1. Prasad S, Frid G, Roig J, Lunde B, Molenaar NM. Immediate postpartum hormonal contraceptives and their association with postpartum depression [A12]. Presented at: 2022 American College of Obstetrics and Gynecology Annual Clinical & Scientific Meeting. May 6 to May 8, 2022.