TABLE 3.
Adjusted direct, indirect, and total effect on the effects of PCOS (diagnosis by healthcare provider and symptomology) on postpartum depressed mood and anhedonia mediated through clinical and psychological factors (n = 3906a)
| Mediating factors | NDE, aPR (95% CI) | NIE, aPR (95% CI) | TE, aPR (95% CI) | Proportion mediatedb |
|---|---|---|---|---|
| PCOS diagnosisc | ||||
| Prenatal depression and anxiety | 1.66 (1.10–2.50) | 1.10 (1.05–1.13) | 1.81 (1.19–2.73) | 20 |
| Delivery modalityd | 1.73 (1.15–2.62) | 1.00 (0.83–1.22) | 1.74 (1.11–2.74) | 0 |
| GDM | 1.77 (1.17–2.68) | 0.99 (0.97–1.02) | 1.76 (1.17–2.66) | 2 |
| HDP | 1.74 (1.15–2.63) | 1.01 (0.97–1.05) | 1.76 (1.67–2.66) | 2 |
| Preterm births (<37 wk) for index pregnancy | 1.68 (1.11–2.54) | 1.03 (0.97–1.10) | 1.74 (1.15–2.63) | 7 |
| Small for gestational age | 1.72 (1.14–2.60) | 1.01 (0.98–1.05) | 1.74 (1.15–2.63) | 2 |
| PCOS symptomology (2+ symptoms)c,e | ||||
| Prenatal depression and anxiety | 1.30 (0.96–1.76) | 1.11 (1.07–1.15) | 1.44 (1.07–1.95) | 32 |
| Delivery modality | 1.44 (1.06–1.94) | 1.00 (0.88–1.14) | 1.44 (1.04–2.00) | 0 |
| GDM | 1.43 (1.05–1.93) | 1.00 (0.98–1.02) | 1.43 (1.05–1.93) | 0 |
| HDP | 1.44 (1.07–1.94) | 1.01 (0.98–1.04) | 1.45 (1.07–1.96) | 3 |
| Preterm births (<37 wk) for index pregnancy | 1.44 (1.06–1.94) | 1.01 (0.97–1.05) | 1.45 (1.07–1.96) | 3 |
| Small for gestational age | 1.44 (1.07–1.94) | 1.00 (0.98–1.03) | 1.44 (1.07–1.95) | 0 |
aPR, adjusted prevalence ratio; BMI, body mass index; CI, confidence interval; GDM, gestational diabetes mellitus; HDP, hypertensive diseases of pregnancy; NDE, natural direct effect; NIE, natural indirect effect; OR, odds ratio; PCOS, polycystic ovary syndrome; TE, total effect.
Reflecting an estimated population size of 142,963 women;
Proportion mediated=(NDE/[NIE-1])/(NDE×NIE-1);
Models adjusted for age, prepregnancy BMI, ethnicity, race, education, and marital status;
Cesarean delivery is used as a reference;
Defined as having a and b, a and c, or a, b, and c; 4 common PCOS symptoms include (1) skin conditions that cause pimples (acne); (2) irregular periods (menstruation); (3) increased hair growth on the face, chest, or other parts of the body; and (4) being overweight or obese.