Risk of Mood and Anxiety Disorders in the Postpartum Period Following Assisted Reproduction: A Retrospective Cohort Study

Background and Aims: To assess the risk of developing postpartum mood and anxiety disorders (PMAD) in patients who conceive via assisted reproductive technology (ART) versus naturally and to evaluate differences stratified by race and ethnicity. Methods: This retrospective cohort study was conducted using the TriNetX research network (> 100 million patients from 68 United States health care organizations). The ART group was defined using ICD-10 code O09.81 ("supervision of pregnancy resulting from assisted reproductive technology") and was compared against non-ART pregnant, age, race, ethnicity, and history of mental health condition-matched, non-ART, controls, all of whom reached term gestation. The relative risk of developing PMAD within 12 months of delivery was investigated. Results: There were 43,103 patients in the ART group and 1,296,725 patients in the non-ART group. Patients who conceived with ART were at a small but statistically increased risk for developing a depressive mood composite: postpartum depression, major depressive disorder, and depressive episode (5.9% vs 4.6%, RR 1.28 [95% CI (1.23,1.34)]), postpartum depression on its own (3.9% vs 3.4%, RR 1.13 (1.07,1.18)), and anxiety in the postpartum period (1.8% vs 1.2%, RR 1.56 [1.45,1.67]). These differences persisted when matching for both female infertility and obstetric complications. Within the ART group, Asian patients were significantly less likely than White patients to be diagnosed with all three outcomes. Conclusions: While patients who conceive via ART are at a slightly increased risk for PMAD, the difference is small and arguably not clinically significant. This may be related to the psychological burden and stress of an infertility diagnosis and infertility treatment. Mental health services should be offered to patients being seen in ART practice.