Urinary incontinence linked to postpartum depression risk

Urinary incontinence linked to postpartum depression risk | Image Credit: © tiagozr - © tiagozr - stock.adobe.com.

The risk of postpartum depression (PPD) is increased among women with urinary incontinence (UI), according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

A depression episode has been estimated in 10% to 25% of women during their lifetime, making it one of the most common psychiatric conditions. Additionally, 14% of women are impacted by PPD after delivery, with symptoms most common from 6 to 8 weeks after delivery.

PPD can lead to decreased quality of life, anxiety, depressed mood, hopelessness, fatigue, sleep deprivation, guilt, and irritability, making it a serious mental health condition. Cleveland Clinic recommends patients contact their health care provider if they experience symptoms such as thoughts of suicide and difficulty thinking.²

Offspring may also be impacted by PPD, as parents with PPD may fail to establish a connection with their baby. Children of mothers with PPD may experience behavior or learning problems, feeding and sleeping issues, impaired social skills, and increased obesity risk. Child care may also be neglected when they are ill.

UI has been linked to pregnancy and childbearing factors, with a postpartum mean prevalence of 31%.¹ As UI may contribute to depressive symptom onset, it may be associated with PPD.

To determine the association between UI and PPD, investigators conducted a systematic review and meta-analysis. Articles were identified through searches of the MEDLINE, Embase, Cochrane, Web of Science, and PsycINFO databases by 2 independent reviewers.

Inclusion criteria included cohort and cross-sectional study, having postpartum women as participants, UI as the exposure, and a PPD outcome determined through validated questionnaires. The association between UI and PPD was reported as the main outcome.

Extracted data included first author name and publication year, type of study, country, cohort name, sample characteristics, PPD outcomes, purpose of the study, and adjustment variables. This data was extracted by 2 independent authors, with a third appraising the accuracy of the information.

There were 7 cohort studies and 4 cross-sectional studies published between 2000 and 2023 included in the final analysis. Patients were aged 15 to 40 years, and the time from delivery ranged from 25 days to 1 year.

Additionally, 4.5% to 16.4% of women were single, divorced, or widowed, and 18.6% to 97.5% had a university of professional school education. The type of UI was reported in only 1 study, which reported stress UI.

The Edinburgh Postnatal Depression Scale was used to measure PPD in all but 1 study. When evaluating the association between UI and PPD in the 7 cohort studies, a pooled odds ratio (OR) of 1.63 was reported.

In the 4 cross-sectional studies, the pooled OR was 1.05, leading to an overall OR of 1.45. In a subgroup analysis evaluating the association based on the time after delivery, the pooled OR was 1.44 for time after delivery under 6 months vs 1.53 for 6 months or longer.

These results indicated an association between UI and increased PPD risk. Investigators concluded health care providers should be aware of this association and provide support and treatment options to women experiencing these disorders during the postpartum period.

Reference

1. Gallego-Gómez C, Rodríguez-Gutiérrez E, Torres-Costoso A, et al. Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;231(3):296-307.E11. doi:10.1016/j.ajog.2024.02.307
2. Postpartum depression. Cleveland Clinic. Accessed September 9, 2024. https://my.clevelandclinic.org/health/diseases/9312-postpartum-depression