Obstetric and psychosocial risk factors associated with maternity blues

Postpartum blues: a predictor of postpartum depression, from the IGEDEPP Cohort

BACKGROUND

To identify the different factors associated with postpartum blues and its association with postpartum depression, from a large French cohort.

METHODS

We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter cohort including 3310 women. Their personal (according to the Diagnostic and Statistical Manual, fifth edition [DSM-5]) and family psychiatric history, stressful life events during childhood, pregnancy, and delivery were collected. Likewise, the French version of the Maternity Blues Scale questionnaire was administered at the maternity department. Finally, these women were assessed at 8 weeks and 1 year postpartum by a clinician for postpartum depression according to DSM-5 criteria.

RESULTS

The prevalence of postpartum blues in this population was 33%, and significant factors associated with postpartum blues were found as personal (aOR = 1.2) and family psychiatric history (aOR = 1.2), childhood trauma (aOR = 1.3), obstetrical factors, or events related to the newborn, as well as an experience of stressful life events during pregnancy (aOR = 1.5). These factors had a cumulative effect, with each additional factor increasing the risk of postpartum blues by 31%. Furthermore, adjustment for sociodemographic measures and history of major depressive episode revealed a significant association between postpartum blues and postpartum depression, mainly at early onset, within 8 weeks after delivery (aOR = 2.1; 95% CI = 1.6-2.7), but also at late onset (aOR = 1.4; 95% CI = 1.1-1.9), and mainly if the postpartum blues is severe.

CONCLUSION

These results justify raising awareness among women with postpartum blues, including reassurance and information about postpartum depression, its symptomatology, and the need for management in case of worsening or prolongation of postpartum blues.

Postpartum Blues in Fathers: Prevalence, Associated Factors, and Impact on Father-to-Infant Bond

In this study we explored, in men, one of the most common postpartum syndromes in women: the postpartum blues. The aims of the study were (a) to evaluate the prevalence of postpartum blues in fathers, (b) to explore the sociodemographic and perinatal factors that may be associated with its intensity, and (c) to investigate the relationship between the intensity of blues symptoms and the quality of father-to-infant bonding. Three hundred and three French-speaking fathers living in France completed a sociodemographic and obstetrical questionnaire, the Maternity Blues Questionnaire, and the Postpartum Bonding Questionnaire. The fathers were recruited from two maternity hospitals and a Child and Maternal Health Centre within 10 days of their infant's birth, or from online forums devoted to parenting. At least 17.5% of fathers experienced postpartum blues. A high level of education was associated with a higher level of postpartum blues symptoms. Dissatisfaction with the maternity care and significant father involvement during pregnancy and delivery predicted more severe postpartum blues symptoms. Symptoms of postpartum blues were positively correlated with impairment in the father-to-infant bond. This study lends support to the existence of postpartum blues among fathers and highlights its possible consequences on early father-infant relationships.

Oxytocin changes in women with emergency cesarean section: Association with maternal blues by delivery mode

Introduction

Women with emergency cesarean section (CS) have presumed effects of an unscheduled surgery on their salivary oxytocin (OXT) level and psychological state. This study aimed to measure changes in the salivary OXT levels of women with emergency CS and change in the OXT levels by delivery mode, and to investigate the association between changes in OXT levels and maternity blues.

Methods

We used a longitudinal observational study. The eligibility criteria were primipara pregnant women who were planning to have vaginal delivery. The salivary OXT levels of women were measured at 36 weeks gestation, 38 weeks gestation, 1 day postpartum, and 5 days after childbirth. Maternity blues was diagnosed using the Maternity Blues Scale (13 items), 'Fatigue after Childbirth' was diagnosed using the Visual Analogue Scale (0-100), and the subjective symptoms of fatigue was diagnosed using the Jikaku-sho shirabe. The three groups ("Without EA", "With EA", and "Emergency CS") were analyzed separately. The changes in the oxytocin levels of women with emergency CS at four time points were analyzed by using a repeated measure analysis of variance.

Results

The mean OXT levels of women with emergency CS (n = 6) were significantly lower at 5 days after childbirth than at 36 weeks gestation, 38 weeks gestation, and 1 day postpartum. There was a significant middle correlation between changes in the mean maternity blues scores between 1 day and 5 days, and the mean changes in OXT levels from 38 weeks gestation to 5 days after childbirth.

Conclusion

It could be assumed that women with emergency cesarean section may be affected psychologically by the unplanned method of delivery. In the present study, it was not possible to analyze this association because of the small sample size; however, it is possible to clarify predictors as the sample size accumulates in the future.

Maternity Blues: A Narrative Review

Puerperium is a period of great vulnerability for the woman, associated with intense physical and emotional changes. Maternity blues (MB), also known as baby blues, postnatal blues, or post-partum blues, include low mood and mild, transient, self-limited depressive symptoms, which can be developed in the first days after delivery. However, the correct identification of this condition is difficult because a shared definition and well-established diagnostic tools are not still available. A great heterogenicity has been reported worldwide regarding MB prevalence. Studies described an overall prevalence of 39%, ranging from 13.7% to 76%, according to the cultural and geographical contexts. MB is a well-established risk factor for shifting to more severe post-partum mood disorders, such as post-partum depression and postpartum psychosis. Several risk factors and pathophysiological mechanisms which could provide the foundation of MB have been the object of investigations, but only poor evidence and speculations are available until now. Taking into account its non-negligible prevalence after childbirth, making an early diagnosis of MB is important to provide adequate and prompt support to the mother, which may contribute to avoiding evolutions toward more serious post-partum disorders. In this paper, we aimed to offer an overview of the knowledge available of MB in terms of definitions, diagnosis tools, pathophysiological mechanisms, and all major clinical aspects. Clinicians should know MB and be aware of its potential evolutions in order to offer the most timely and effective evidence-based care.

Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling

BACKGROUND

Postnatal depression (PND) is the second most common cause of disability and the most common complication after childbirth. Understanding the potential mechanisms by which the stress process can lead to PND is an important step for planning preventive interventions for PND. This study employed a stress process model to explore the possible pathways leading to PND in Gondar Town, Ethiopia.

METHODS

A community-based cohort study was conducted in 916 pregnant women, who were assessed for depression in their second or third trimester of pregnancy and re-assessed two to eight weeks after birth. Women with an Edinburgh Postnatal Depression Scale (EPDS) ≥6 were considered to be depressed. Modified Poisson regression was used to identify the independent predictors of PND. A Generalized Structural Equation Modeling (GSEM) was then used to explore the direct and indirect effects of stressors and their mediators on PND.

RESULTS

The prevalence and incidence proportion of PND were 9.27% (95%CI: 7.45, 11.36) and 7.77% (95%CI: 6.04, 9.79), respectively and 2.1% of the women demonstrated symptoms of depression within the study period. PND was independently predicted by having limited postnatal care services, Antenatal Depression (AND) and a Common Mental Disorders (CMD) before pregnancy, (IRR = 1.8; 95%CI: 1.0, 3.2), 1.6(95%CI: 1.4, 1.7), and 2.4 (95%CI: 1.4, 4.3) respectively). In SEM, AND (standardized total effect = 0.36) and a CMD before pregnancy (standardized total effect = 0.11) had both a direct and an indirect positive effect on PND scores. Low birth weight (standardized β = 0.32) and self-reported labor complications (standardized β = 0.09) had direct effects only on PND scores.

CONCLUSION

The observed incidence and prevalence of PND in Ethiopia were lower than in previous studies. A CMD before pregnancy and low birth weight (LBW) increased PND scores, and these effects were in part mediated via antenatal depression and labor complications. Early detection and treatment of depression before or during pregnancy could either directly or indirectly reduce the risk of labor complications and PND. Interventions that reduce LBW or improve the uptake of postnatal care might reduce PND incidence.

Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period

OBJECTIVE

To determine the prevalence of maternity blues among women in the postpartum period.

DATA SOURCES

We conducted our systematic review and meta-analysis by searching the literature for relevant articles published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through December 11, 2019, using the keywords prevalence, incidence, maternity blues, and baby blues.

STUDY SELECTION

From 336 articles initially screened, we included 26 articles in the systematic review and meta-analysis.

DATA EXTRACTION

Two independent reviewers used a standardized form to extract data from eligible articles. We evaluated the quality of individual studies and the overall evidence according to Hoy et al.'s risk of bias tool.

DATA SYNTHESIS

The prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence interval [32.3, 45.6]; I² = 96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.

CONCLUSION

Considering the great prevalence of maternity blues in women after childbirth, paying attention to the key symptoms of maternity blues and implementing educational programs for health care providers and mothers after childbirth are essential.