The Association Between Pregnancy Intention, Fertility Treatment Use, and Postpartum Depression: A Study by Gabriela Barber & Julia R.Steinberg

by | Jan 5, 2023

In a recently published study, researchers aimed to understand whether postpartum depressive (PPD) symptoms vary by pregnancy intention and if the use of fertility treatments has implications for reproductive health policies and practices. Below are Gabriela Barber’s answers about her work on this study. 

What were your research questions for this study?

The journey to parenthood can look different for everyone, and I was interested in learning more about how several different pathways to parenthood may impact risk of developing postpartum depression. Therefore, I examined how unintended pregnancy impacts risk of later postpartum depression and how the use of fertility treatments impacts later risk of postpartum depression. While these are two very different experiences, and are almost the converse of one another, many individuals in the U.S. either experience an unintended pregnancy or need fertility treatments in order to conceive, and both of these paths to parenthood are often laced with many stressors. Our second research question looked at whether the specific type of fertility treatment that was used to conceive differentially impacted the risk of postpartum depression.

How did you go about answering your research questions?

To answer our research questions, we used data from the CDC. The CDC annually administers a survey called the Pregnancy Risk Assessment Monitoring System which asks women who have recently given birth a variety of questions about their pregnancy and postpartum experience. Using this data, we were able to determine whether each woman who had participated in the survey had given birth to a pregnancy that was unexpected (either because they were not planning the pregnancy or they were unsure whether they had wanted to conceive at that time or not), was conceived spontaneously and planned, or was conceived with the help of fertility treatments. We also had information from each woman about the postpartum depressive symptoms she had experienced since giving birth. Lastly, for a small subsample of the women who reported that they had conceived with fertility treatments, we had information about what fertility treatment they used to conceive.

What were the findings of your study? 

We had 243,677 women from 42 states in our sample. Overall, we found that women whose pregnancies were unexpected were more likely to experience postpartum depression in comparison to those who conceived spontaneously and intentionally and those who conceived with fertility treatments. For our second analysis we looked specifically at whether there was differential risk of postpartum depression based on what fertility treatment was used, we found that women who conceived using fertility enhancing drugs, which are often considered the least invasive and intensive of the fertility treatments, were much more likely to experience postpartum depression than those who conceived with insemination or ART procedures, like IVF.

What implications do these findings have? What do you hope people will take away from this work?

There are several takeaways from this study. First, we need to continue to provide support for women during the postpartum period in terms of mental health. Overall, 13% of our sample experienced elevated postpartum depressive symptoms. Second, the context surrounding pregnancy and conception is important when looking at risk for postpartum depression, and it is important that medical providers are aware and cognizant of this. Lastly, up until this point, most research on fertility treatments and mental health outcomes lumps all fertility treatments together. However, if anyone has gone through fertility treatments themselves, they would recognize that there are many differences between the common fertility treatments we have available in the U.S., including cost, degree of invasiveness to one’s body, chances of success, and reasons why one might be using that treatment. Our study is unique in that for our second analysis we look at whether there is differential risk of postpartum depression based on which treatment is used, and we found that there was differential risk. This means that in future research, we need to begin to look at why different treatments might confer differential risk and be mindful of this when designing studies.

​If you or someone you know struggling with postpartum depression, there is help. Reach out to Gaby today to start getting support. 

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