The association of delivery during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding, a prospective cohort study.

Objective: To examine the impact of war conditions on maternal mental health postpartum outcomes, specifically depression and anxiety, as well as on maternal-infant bonding (MIB).

Study design: A prospective cohort study was performed on women who gave birth in a tertiary medical center during (October-November 2023) and before (March-May 2020) the Israel-Hamas War. All participants completed validated self-reported questionnaires: The Edinburgh Postnatal Depression Scale (EPDS ≥ 10), State-Trait Anxiety Inventory (STAI > 39) and the Postpartum Bonding Questionnaire (PBQ ≥ 26).

Results: A total of 502 women were included in the study, with 230 delivering during the war and 272 delivered before. The rates of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p < 0.001), while multivariable regression revealing a two-fold higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p = 0.017). The rate of postpartum anxiety (PPA) risk was also higher (34.3% vs 17.0%, p < 0.001), reaching a trend towards significance when accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p = 0.058). Additionally, delivery during the war was associated with specific factors of impaired maternal-infant bonding (MIB), although it did not increase the overall impaired MIB (PBQ ≥ 26) (10.2 ± 14.1 vs 8.3 ± 6.9, p = 0.075).

Conclusion: The study revealed an increased risk of PPD, a marginally risk for PPA, and some aspects of impaired MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impacts on the entire family. Therefore, comprehensive screening and adequate resources should be provided for women delivering in war-conflict zones.