Abstract | Revitalizing Women's Healthcare Together

September 29-30, 2023 

Correspondence to: perezmz@bc.edu
Melissa Pérez Capotosto, PhD, RN, WHNP1, Erin Corcoran1, Ann Wolbert Burgess, DNSc, APRN1, Sheryl L. Rifas-Shiman, MPH2, Jorge E. Chavarro, MD, ScD3,4, Emily Oken, MD, MPH4,5,

1William F. Connell School of Nursing, Boston College
2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
3Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
4Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
5Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Author Affiliations

Title: Associations of infertility with symptoms of pregnancy-related anxiety and depression during pregnancy and 6-months postpartum in Project Viva

Background: Women experiencing infertility have a higher prevalence of anxiety and depression compared with other women of reproductive age. Symptoms of anxiety and depression are common in the peripartum period, but little is known about the effects of infertility on mental health outcomes once pregnancy has been achieved.

Purpose: To examine associations of infertility with pregnancy-related anxiety and depressive symptoms during mid-pregnancy and at 6-months postpartum.

Methods: Women enrolled in the Project Viva cohort 1999-2002 during early pregnancy completed a pregnancy-related anxiety scale in early pregnancy (median 9.9 weeks’ gestation), the Edinburgh Postnatal Depression Scale (EPDS) in mid-pregnancy (median 27.9 weeks’ gestation), and the EPDS again at 6-months postpartum. We classified high anxiety if participants chose “very much” to three or more questions on the 7-item pregnancy-related anxiety scale and an EPDS ≥13 (0-30 scale) to indicate prenatal or postpartum depressive symptoms. We performed unadjusted and multivariable adjusted logistic regression models, adjusting for socio-demographics, reproductive characteristics, and early life hardships, to examine associations of infertility with symptoms of pregnancy-related anxiety and pregnancy and postpartum probable depression. We defined infertility before index pregnancy as ≥6 cycles to achieve pregnancy if ≥35 years of age or ≥12 cycles to achieve pregnancy if <35 years of age or claims for infertility treatments/prescriptions abstracted from medical records.

Results: Among the 2039, 386 (19%) experienced infertility before index pregnancy. Among those with infertility, 11.9% had high pregnancy-related anxiety and 8.2% and 9.1% had prenatal/postpartum depressive symptoms (vs. 10.8%, 9.3%, and 8.6%, respectively among those without infertility). In both unadjusted and adjusted models, infertility at index pregnancy was not associated with pregnancy anxiety (adjusted odds ratio [aOR] 1.03, 95% CI 0.69,1.53), mid-pregnancy depression (aOR 0.93, 95% CI 0.57,1.51), or postpartum depression (aOR 1.01, 95% CI 0.60,1.60).

Conclusion: Among women who achieved a pregnancy, we observed no associations of infertility with anxiety and depressive symptoms during pregnancy or postpartum.

Impact Statement: The results reinforce the importance of screening all women in pregnancy and postpartum for perinatal mood disorders, as these conditions are common and adversely affect the health and well-being of new mothers, their infants, and their families.