Associations of Infertility With Depressive Symptom Change Across Specific Life Stages (Pregnancy, Postpartum, and Midlife) Among Parous Women.

BACKGROUND

Limited longitudinal data exist on the associations of infertility with depressive symptoms across the lifecourse.

OBJECTIVES

To investigate how depressive symptoms change across specific life stages (pregnancy, postpartum, and midlife), with a focus on the differences between women with and without a history of infertility before index pregnancy.

METHODS

Women enrolled in Project Viva (1999-2002) during early pregnancy (mean [SD] age 32.5 [4.7] years) completed the Edinburgh Postnatal Depression Scale (EPDS) in mid-pregnancy (median 27.9 weeks gestation) and at 6 months postpartum, and completed the Patient Health Questionnaire (PHQ-9) in midlife (2017-2021, 50.9 [5.1] years). We converted EPDS and PHQ-9 scores to externally standardised T-scores (mean = 50, SD = 10). 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 or prescriptions abstracted from medical records. We performed adjusted linear regression models to examine associations of infertility with depressive symptoms across the three-time spans (pregnancy-postpartum, postpartum-midlife, and pregnancy-midlife).

RESULTS

Among 1368 participants, 281 (21%) experienced infertility at index pregnancy. Infertility was associated with a 1.83- point increase in depressive symptoms (T-score) between the postpartum period and midlife (adjusted β $$ \beta $$ 1.83, 95% confidence interval [CI] 0.00, 3.66). Infertility was unrelated to change in depressive symptoms between pregnancy and postpartum (adjusted β $$ \beta $$ 0.02, 95% CI -1.24, 1.28) or pregnancy and midlife (adjusted β $$ \beta $$ 1.30, -0.64, 3.23).

CONCLUSIONS

The experience of infertility among parous women is associated with a greater increase in depressive symptoms between the post-partum period and midlife.