To assess the feasibility of comparing the rates of positive depression screens at 6 weeks and 3 months postpartum in women using immediate postpartum etonogestrel implant (ENG-implant) and women using non-hormonal contraception or sterilisation.
This was a pilot prospective cohort study performed to test the design adequacy of comparing the rates of positive postpartum PHQ-9 screens (≥10) in women using immediate postpartum ENG-implant and women using non-hormonal contraception or sterilisation. Participants were recruited during the third trimester of pregnancy or during delivery hospitalisation. They self-allocated to one of the two comparison groups. PHQ-9 surveys were administered during the third trimester of pregnancy, immediately postpartum, and at 6 weeks and 3 months postpartum.
Between June 2017 and March 2018, 91 patients were recruited. Of these patients, 11 were excluded and the remaining 80 were split evenly into each cohort. The women in the ENG-implant group were younger, less educated, and more often publicly insured. The percentage of participants with positive PHQ-9 screens were: 3% during the postpartum hospitalisation, 6.2% at 6 weeks postpartum, and 10.2% at 3 months postpartum. PHQ-9 scores were similar between groups at both postpartum time points.
The rates of positive PHQ-9 screens at 6 weeks postpartum were similar between groups. These preliminary data suggest that immediate postpartum placement of the ENG-implant does not negatively impact the risk for a positive depression screen. Larger-scale, adequately powered studies are warranted to further investigate this finding.
目的：评价比较产后即刻植入依托孕烯(ENG-PLANT)与使用非激素避孕或绝育的妇女产后6周和3个月抑郁筛查阳性率的可行性。方法：这是一项初步前瞻性队列研究, 目的是测试比较产后立即植入ENG的妇女和使用非激素避孕或绝育的妇女产后PHQ-9筛查(≥10)阳性率的研究设计充分性。参与者是在怀孕后期或分娩住院期间招募的。他们自愿进入两个研究组之一。PHQ-9调查在妊娠晚期、产后即刻、产后6周和3个月进行。结果：2017年6月至2018年3月, 共招募91例患者。在这些患者中, 11名被排除在外, 其余80名被平均分配到每个队列中。ENG植入组的女性更年轻, 受教育程度较低, 而且更多的时候是公共保险。PHQ-9筛查阳性的参与者比例为：产后住院期间为3%, 产后6周为6.2%, 产后3个月为10.2%。两组在产后两个时间点的PHQ-9得分相似。结论：产后6周PHQ-9筛查阳性率组间相似。这些初步数据表明, 产后立即放置ENG植入物并不会对阳性抑郁筛查的风险产生负面影响。有必要进行更大规模、支持充足的研究来进一步探究这一发现。
We would like to thank Emily S. Miller, MD, MPH for her expert guidance with this research.
Carolyn M. Ross, Jessika A. Ralph, Lauren C. Balmert, and Katherine L. Wisner have no conflicts of interest to disclose. Jessica Kiley serves as a consultant for CVS Caremark. Cassing Hammond is a consultant for UpToDate and serves on the Independent Data Monitoring Committee for Medicines360.