Post Partum Hormonal Contraception Use Linked with Heightened Depression Risk
The initiation of hormonal contraception post partum was associated with an immediate increase in depression risk in first-time mothers in Denmark, according to a study published in JAMA Network Open.
“The associated risk was higher the earlier it was initiated post partum, at least for COC [combined oral contraceptives],” reported corresponding author Vibe Gedsø Frokjaer, PhD, of Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark, and study coauthors.
The population-based cohort study included 610,038 first-time mothers in the nationwide Danish register who gave birth between 1997 and 2022. Researchers investigated whether a known association between hormonal contraceptive use and depression in women in general was also true in the postpartum period, when the risk of depression is elevated. The study did not include any women with depression in the 2 years before delivery.
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Among the first-time mothers in the study, 40.7% initiated hormonal contraceptives within 12 months of giving birth. Compared with women who did not use hormonal contraceptives, those who initiated use had a 1.49 adjusted hazard ratio for depression within 12 months postpartum, which was defined as filling an antidepressant prescription or having a hospital diagnosis of depression.
The initiation of hormonal contraception increased the 12-month average absolute risk of depression from 1.36% to 1.54%, according to the study.
By hormonal contraceptive type, adjusted hazard ratios for depression were 1.97 for combined nonoral contraceptives, 1.72 for combined oral contraceptives, and 1.40 for progestogen-only nonoral contraceptives. Meanwhile, progestogen-only pills were linked with an instantaneously reduced risk of depression in the early postpartum period, which increased substantially from about 8 months post partum through late post partum.
Early postpartum initiation of combined oral contraceptives was associated with a higher rate of depression. Although adjusted hazard ratios for depression with combined oral contraceptive use gradually eased over the first 7 months, they stayed above 1 all 12 months.
“These findings raise the issue of whether the incidence of depression post partum may be inflated by routine HC [hormonal contraceptive] initiation,” researchers wrote, “which is important information to convey at postpartum contraceptive counseling.”
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