Postnatal depression scores and maternal characteristics during COVID-19 pandemic

Abstract

Objective To evaluate Edinburgh Postnatal Depression Scores (EPDS) during COVID-19 pandemic. Design Alert of COVID-19 was first announced in Hong Kong on 4 January 2020. Childbirth companion and hospital visiting were suspended since 25 January 2020. While childbirth companion was periodically resumed, no visiting was allowed in the postnatal ward. Women were assessed using EPDS a day after delivery and EPDS of 10 or more was considered high. Method This was a retrospective review of EPDS of all women delivered from 1 January 2020 to 31 December 2020 at Queen Mary Hospital in Hong Kong. The scores were analyzed with maternal characteristics and delivery information retrieved from obstetric database. Results Among 2707 deliveries, EPDS was available in 2627 pregnancies. 365 (13.9%) women had EPDS score 10 or more. A significant higher proportion of them (15.0% versus 11.7%, P = 0.02) had high EPDS score. The mean EPDS score was significant higher in women without childbirth companion (5.09 versus 4.60, P < 0.01). Univariate analysis showed that nulliparity (P < 0.001), underlying mental problem (P < 0.001), preterm delivery (P = 0.034), Caesarean section (P = 0.039), birth companion (P = 0.02), use of epidural analgesia (P = 0.002), pethidine (0.009) and transcutaneous electrical nerve stimulation (TENS) (P = 0.012) were associated with high EPDS. On multivariate analysis, women in first labour (OR 1.62;95% CI 1.26-2.09), having underlying mental problem (OR 5.36;95% CI 3.54-8.10), preterm delivery (OR 1.57;95% CI 1.04-2.37) or requiring pethidine for pain relief (OR 1.57;95% CI 1.01-2.44) were associated with higher EPDS. On contrary, women having childbirth companion had lower odds (OR 0.74;95% CI 0.57-0.95) of high EPDS. Conclusion Alternation in obstetric service during COVID-19 pandemic has adverse impact on EPDS. Women with mental problem were particularly vulnerable while childbirth companion was associated with higher EPDS. The demand for pain relief by pethidine was greater. Childbirth companion was the key modifiable relieving factor and should be maintained even during COVID-19. Every effort should also be taken in facilitating the visiting arrangement for mothers and babies.