The association of delivering during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding

Purpose : Examine the impact of war conditions on maternal mental health postpartum outcomes pertaining to depression and anxiety, as well as on maternal-infant bonding (MIB). Methods : A prospective cohort study was performed in 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, 230 delivered during the War and 272 delivered before. Rates of symptoms of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p <0.001), while multivariable regression revealed two times higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p =0.017). Rate of postpartum anxiety risk was also higher (34.3% vs 17.0%, p <0.001), and reached a trend towards significance accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p =0.058). Finally, delivery during the war was related to specific factors of impaired MIB. However, did not increase the overall impaired score (PBQ>=26) (10.2 ± 14.1 vs 8.3 ± 6.9, p=0.075). Conclusion : The study revealed increased risk of PPD, marginal significance risk for PPA and some aspects of impairments in MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impact on the whole family. Therefore, comprehensive screening and adequate resources should be placed in women delivering in war-conflict zones.