The impact of pregnancy and birth complications on long-term maternal mental health

Background and aims Pregnancy and birth complications, including hypertensive disorders of pregnancy (HDP), preterm birth, haemorrhage in pregnancy, gestational diabetes mellitus (GDM), and pregnancy losses, have been linked to an increased risk of maternal mental health disorders, particularly postpartum depression. However, less is known about the long-term mental health impacts of complications of pregnancy and birth. This thesis aimed to investigate the impacts of pregnancy and birth complications on long-term maternal mental health. Structure and methods This thesis used a multi-method approach. In Chapter 1, a description of the background and rationale, as well as the aims and objectives of the thesis, is provided. A detailed description of the methodology and study designs used in this thesis is provided in Chapter 2. Chapters 3 and 4 described the association between pregnancy and birth complications and long-term maternal mental health disorders, synthesised using a systematic review and meta-analysis. Data from the Millennium Cohort Study (MCS) were analysed to examine the association between pregnancy complications and depressive/anxiety disorders up to 14 years postpartum in Chapter 5, and the association between mode of birth and depressive/anxiety disorders up to 14 years postpartum in Chapter 6. In both studies, univariable and multivariable logistic regression models were conducted, adjusting for several sociodemographic and perinatal factors. In Chapter 7, semi-structured qualitative interviews were conducted with purposively sampled women to explore their experiences, including mental health, following pregnancy and birth complications. Finally, the systematic review and meta-analysis were updated and included studies in this thesis (Chapter 8), along with a discussion of findings, strengths, and limitations of the thesis, and recommendations for future research (Chapter 9). Results Updated systematic review and meta-analyses Overall, the published literature on this topic was sparse, and most meta-analyses were based on small numbers (<10) of original studies. Termination of pregnancy was associated with 30% increased odds of depression and 36% increased odds of anxiety disorders. Miscarriage was associated with increased odds of depression [adjusted odds ratio (aOR 1.73, 95% CI, 1.20 - 2.50) and anxiety disorders (aOR 1.16, 95% CI, 1.05 - 1.29). The associations between stillbirth and depression (aOR 1.80, 95% CI, 0.79 - 4.10), anxiety disorders were increased, although not statistically significantly. There were few studies on other mental health disorders, and therefore, it was not possible to perform meta-analyses. Original population-based cohort studies The overall findings from the study in Chapter 5 suggested that the odds of depressive/anxiety disorders are higher in women with preeclampsia, threatened miscarriage, and bleeding in later pregnancy compared to women without pregnancy complications. No statistically significant association was found between gestational diabetes mellitus and depressive/anxiety disorders. The dose-response association between the total number of pregnancy complications and depressive/anxiety disorders persisted independent of parity, maternal age, and body mass index, among other potential confounders. The findings in Chapter 6 suggested 13% increased odds of developing depressive/anxiety disorders across 14 years postpartum in women who had induced vaginal birth compared with spontaneous vaginal birth. No other mode of birth was associated with depressive/anxiety disorders across the study period. Semi-structured interviews Following semi-structured interviews with women, four main themes were developed: Expectation versus reality, unresolved consequences, perception of healthcare experiences, support networks, and systems. Conclusion This thesis demonstrates that pregnancy and birth complications can have longer effects on maternal mental health, specifically, depressive and anxiety disorders. Prioritising early detection and targeted interventions during pregnancy for women at risk of mental health disorders may reduce substantial psychiatric morbidity in the longer term. Further research on longer-term maternal mental health disorders should include diverse and underrepresented populations and employ robust designs to minimise bias and better capture long-term trajectories of maternal mental health disorders.

Grantor dc:publisher

University College Cork

Year dc:date.issued

2025

Author dc:creator

• Bodunde, Elizabeth O.

Advisors dc:contributor.advisor

• Khashan, Ali
• McCarthy, Fergus
• O'Connor, Karen
• Matvienko-Sikar, Karen

• Pregnancy complications
• Birth experiences
• Maternal health
• Long-term mental health disorders
• Multl-methods design

Statement dc:rights

• © 2025, Elizabeth O. Bodunde.

Licence dc:rights.uri

• https://creativecommons.org/licenses/by/4.0/

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10468/18933

OAI identifier oai:identifier

oai:cora.ucc.ie:10468/18933