Depression, Anxiety Among Pregnant Women Linked to Higher Risk of C-Section


The study is one of the largest to document a link between predated mood and anxiety disorders and first-time cesarean sections among low-risk pregnant women.

Perinatal mood and anxiety disorders may be linked with significantly higher rates of first-time cesarean deliveries (C-section) among women who are otherwise at a low risk of having one, according to a study from researchers at Michigan Medicine.

Earlier research had linked perinatal mood and anxiety disorders with adverse pregnancy outcomes such as low birth weight and preterm birth, but the new findings suggest they may be connected with the type of delivery a woman has. The findings were published in Health Affairs.

“Our findings reinforce the importance of better identifying and treating perinatal depression and anxiety disorders in pregnant women,” said senior author Vanessa Dalton, MD, MPH, an obstetrician gynecologist at University of Michigan Health Von Voigtlander Women’s Hospital, in the press release. “It’s critical to better understand how these mood disorders increase the likelihood of cesarean section deliveries, which we know have both short and long-term health consequences for both expecting moms and their babies.”

The study is one of the largest to document a link between predated mood and anxiety disorders and first-time C-sections among low-risk pregnant women. Previous research on this topic is limited and often includes patients who had prior C-sections, which is one of the more significant predictors of a repeat C-section.

C-sections have numerous risks, including blood clots, hemorrhaging, infection, and risks to future pregnancies. Most women who undergo a C-section for their first birth will have a repeat C-section as well.

“Cesarean sections are a major contributing factor to maternal morbidity events after a delivery with many adverse downstream effects,” Dalton said in the press release. “We need to understand all factors that may increase a woman’s chance of a C-section delivery so we can avoid any unnecessary risks.”

Perinatal mood and anxiety disorders affect as many as 20% of reproductive-aged women in the United States, and the prevalence of these disorders more than doubled between 2006 and 2015 among childbearing women in the United States. Significantly, the prevalence of suicidal ideation and intentional self-harm in the year before or after birth also rose during that time period, and suicide was a leading cause of maternal mortality.

“There’s been growing recognition that mental health is really important during the time of pregnancy,” Dalton said in the press release. “Maternal suicide risk is especially high the year following delivery.”

In the study, investigators analyzed national data for 360,225 delivery hospitalizations among commercially insured women between the ages of 15 and 44 between 2008 and 2017. Among those, 24% were a first-time delivery by C-section. Reducing the rate of first-time C-sections by 2.3% is a Health People 2030 goal in the United States, and the authors noted that women with a prenatal diagnosis of anxiety or depression had a predicted probability of having a C-section that was about 3.5% higher than women without those conditions.

Women with anxiety or depression were more likely to be older, white, and reside in a household with income more than 400% over the poverty line compared with those without perinatal mood and anxiety disorders. Although reasons for the link between mental health and C-sections are speculative, some unproven theories include the idea that prenatal anxiety is sometimes focused on the delivery itself—which may prompt providers to turn to C-sections to reduce the labor process. Other researchers have posited that maternal distress may impact placental development, which could lead to symptoms of fetal distress during labor.

“We need more research to clarify the relationship between perinatal mood and anxiety disorders and primary cesarean section rates to enhance our understanding of the consequences of these disorders for health outcomes,” Dalton said in the press release. “This could potentially inform efforts to develop and evaluate effective treatments and policy interventions.”


Depression, anxiety may be linked to c-section risk among pregnant women. News release. Michigan Health Lab; October 19, 2012. Accessed November 17, 2021.

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