BACKGROUND Infertility treatment (IFT) increases the likelihood of multiple gestations, which are associated with postpartum depressive symptoms (PDS). There has been little study of the association between successful IFT and risk of PDS, accounting for multiple gestations.

METHODS Using representative data from the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) 2007-2010, we evaluated the association between self-reported IFT use and PDS. We categorized IFT as: fertility-enhancing drugs (FD), donor insemination/intrauterine insemination (DI/IUI), or assisted reproductive technology (ART) including in-vitro fertilization. We defined PDS as the report of ‘always’ or ‘often’ to any depressive symptoms. Modified Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs), controlling for socioeconomic status, mode of delivery, multiple gestation, neonatal risk factors and prior mental health care use.

RESULTS Among 3,600 participants, 11.4% reported IFT (FD=5.9%, DI/ IUI=2.5%, ART=4.8%). Compared with non-users of IFT who delivered singletons, RRs for PDS were 1.32 (95% CI: 0.97-1.80) for IFT users who delivered singletons, 2.61 (95% CI: 1.58-4.01) for non-users of IFT who delivered multiples, and 1.06 (95% CI: 0.45-2.47) for IFT users who delivered multiples. Among mothers of singletons with Caesarean deliveries, IFT use was associated with an increased risk of PDS, RR=1.56 (95% CI: 1.03-2.38).

CONCLUSIONS Non-users of IFT who delivered multiples had a greater than two-fold increased risk of PDS compared with all other groups of mothers, including IFT users who delivered singletons or multiples. IFT use was positively associated with PDS risk only among mothers with Caesarean singleton deliveries.

Summary of Abstract Mothers of multiples who did not use Infertility Treatments (IFT) had more than twice the risk of PDS compared with all other groups of mothers, controlling for mode of delivery.

The authors have declared no competing interest.

This study was supported by the Boston University Reproductive, Perinatal, and Pediatric Epidemiology Training Grant from the Eunice Kennedy Shriver National institute for Child Health and Human Development (T32HD052458).

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PRAMS is a multi-state, population-based surveillance system funded by the Centers for Disease Control and Prevention (CDC) in collaboration with state health departments. The study was approved by the Institutional Review Board of the Massachusetts Department of Public Health.

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