Postpartum depression risk factors: A narrative review

Tobacco smoking and postpartum depression symptoms in the Pregnancy Risk Assessment and Monitoring System (PRAMS) study

BACKGROUND

Although previous studies have documented the association between tobacco smoking and mental health disorders, its association with postpartum depression (PPD) severity remains unclear. This study aims to assess the association between tobacco smoking and the severity of PPD.

METHODS

We conducted a cross-sectional analysis of 218,128 mothers participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) study from 2015 to 2020. We assessed the prevalence OR of PPD symptom levels using multinomial logistic regression models. We used the Marginal effects to quantify the difference in the prevalence of PPD symptoms of new mothers by their recent tobacco use status. We performed a sensitivity analysis for unmeasured confounders.

RESULTS

Tobacco was associated with all levels of PPD severity prevalence in the adjusted model, 1.33 (1.27, 1.39), 1.58(1.50, 1.66), 2.10 (1.95, 2.26), 2.35 (2.04, 2.71) for mild, moderate, high, and severe PPD, respectively. These findings on tobacco smoking corresponded to a lower prevalence of PPD-free by 8.83 (7.97, 9.70) and a higher prevalence of PPD of all levels of severity: 0.84 % (-0.05, 1.72) for mild, 4.24 % (3.46, 5.03) for moderate, 3.03 % (2.57, 3.48) for high, and 0.73 % (0.53, 0.92) for severe PPD, respectively.

CONCLUSION

Tobacco smoking is associated with a higher prevalence of all levels of PPD symptoms. While these findings are not causal, they suggest the need for continual education and tobacco cessation interventions for women of childbearing age during their routine healthcare management and perinatal care.

Low Social Support is Associated With Postpartum Depression Symptoms Among Illinois Postpartum Women

BACKGROUND

Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women.

METHODS

Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression.

RESULTS

Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4).

CONCLUSION

PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.

The moderating impact of personal and collective resilience resources on postpartum depression in conflict-affected environments

BACKGROUND

Women exposed to conflict are at greater risk of experiencing adverse mental health impacts, and women in the postpartum period may face additional distress and heightened risk. Resilience resources, known to mitigate the impacts of stressful events, could offer protection to these new mothers. The current study aimed to assess whether conflict exposure was associated with greater postpartum depression symptoms, and whether three distinct resilience resources - personal resilience, community resilience, and social support - would moderate this association among women highly exposed to an ongoing conflict.

METHODS

This comparative cross-sectional study included 110 women from regions with high conflict exposure near the Israel-Gaza border and 210 women from areas with lower conflict exposure of Israel. Depression symptoms were evaluated six months postpartum, alongside measures of conflict exposure and personal and collective resilience resources. Multiple linear regression analyses tested the hypotheses.

RESULTS

Higher conflict exposure was not associated with increased postpartum depression symptoms. Instead, all resilience resources showed a negative association with depression symptoms. Notably, community resilience significantly moderated the effect of conflict exposure on postpartum depression among highly exposed women, after adjusting for personal characteristics.

LIMITATIONS

The study's cross-sectional design and reliance on online data collection may have introduced a selection bias.

CONCLUSIONS

These findings underscore the critical protective role of community resilience for new mothers in conflict-laden regions. They indicate the importance of mental health interventions that bolster not just individual resilience but also community support, and suggest a shift toward more integrative, community-focused approaches in addressing mental health challenges in such settings.

Postpartum Depression in Patients with Chronic Migraine: A Retrospective, Observational Analysis

Purpose: To evaluate how migraine impacts the risk for postpartum depression (PPD) in women of reproductive age as well as the effect of comorbidities on this risk. Methods: This is a retrospective observational study in a tertiary neurology center involving 6248 women with migraine and 4154 women without migraine between the ages of 18 and 45 seen from January 1, 2017, to January 30, 2024. The primary outcome was the odds ratio (OR) for PPD in migraine relative to women without migraine. Secondary outcomes included the OR for PPD in women with chronic migraine who also had comorbidities. Results: After adjusting for demographic factors and comorbid conditions, only chronic migraine, with and without aura, was associated with higher OR for PPD; chronic migraine without aura had the highest risk for PPD (OR: 2.13; 95% CI: 1.29 to 3.53, p = 0.003). In patients with chronic migraine, preeclampsia was associated with the largest OR for PPD, followed by depression, gestational diabetes, and premenstrual dysphoric disorder. Anxiety, advanced maternal age, endometriosis, and post-traumatic stress disorder were not associated with a statistically significant increase in OR for PPD. Conclusions: Chronic migraine, with and without aura, is associated with a higher OR for PPD relative to non-migraine controls. Patients with chronic migraine, preeclampsia, depression, gestational diabetes, and premenstrual dysphoric disorder were also associated with increased risk of PPD. These data support screening patients with both chronic migraine and these comorbidities for PPD with validated screening tools to connect them with optimal resources best.

Joint effects of traffic-related air pollution and hypertensive disorders of pregnancy on maternal postpartum depressive and anxiety symptoms

BACKGROUND

Ambient air pollution has been linked to postpartum depression. However, few studies have investigated the effects of traffic-related NOx on postpartum depression and whether any pregnancy-related factors might increase susceptibility.

OBJECTIVES

To evaluate the association between traffic-related NOx and postpartum depressive and anxiety symptoms, and effect modification by pregnancy-related hypertension.

METHODS

This study included 453 predominantly low-income Hispanic/Latina women in the MADRES cohort. Daily traffic-related NOx concentrations by road class were estimated using the California LINE-source dispersion model (CALINE4) at participants' residential locations and averaged across pregnancy. Postpartum depressive and anxiety symptoms were evaluated by a validated questionnaire (Postpartum Distress Measure, PDM) at 1, 3, 6 and 12 months postpartum. Multivariate linear regressions were performed to estimate the associations at each timepoint. Interaction terms were added to the linear models to assess effect modification by hypertensive disorders of pregnancy (HDPs). Repeated measurement analyses were conducted by using mixed effect models.

RESULTS

We found prenatal traffic-related NOx was associated with increased PDM scores. Specifically, mothers exposed to an IQR (0.22 ppb) increase in NOx from major roads had 3.78% (95% CI: 0.53-7.14%) and 5.27% (95% CI: 0.33-10.45%) significantly higher 3-month and 12-month PDM scores, respectively. Similarly, in repeated measurement analyses, higher NOx from major roads was associated with 3.06% (95% CI: 0.43-5.76%) significantly higher PDM scores across the first year postpartum. Effect modification by HDPs was observed: higher freeway/highway and total NOx among mothers with HDPs were associated with significantly higher PDM scores at 12 months postpartum compared to those without HDPs.

IMPACT

This study shows that prenatal traffic-related air pollution was associated with postpartum depressive and anxiety symptoms. The study also found novel evidence of greater susceptibility among women with HDPs, which advances the understanding of the relationships between air pollution, maternal cardiometabolic health during pregnancy and postpartum mental health. Our study has potential implications for clinical intervention to mitigate the effects of traffic-related pollution on postpartum mental health disorders. The findings can also offer valuable insights into urban planning strategies concerning the implementation of emission control measures and the creation of green spaces.

Association Between Antibiotic Exposure During Pregnancy and Postpartum Depressive Symptoms: The Japan Environment and Children's Study

Postpartum depressive symptoms (PDS) are a common mental health condition among women after delivery. Although various causative factors have been reported, PDS remains a challenging condition to predict and prevent. The disruption of the gut microbiota due to antibiotic exposure has been reported to affect psychiatric conditions. Similarly, previous research suggests that antibiotic exposure during pregnancy could be related to PDS. Therefore, this prospective study examines the association between antibiotic exposure during pregnancy and PDS for 6 months after delivery. Data were obtained from 65,272 mothers from the Japan environment and children's study, a prospective birth cohort study. The ratios of maternal PDS at 1 and 6 months after delivery were 12.3% and 10.1%, respectively. During pregnancy, 10.7% of women took antibiotics orally. Antibiotic exposure during pregnancy was associated with an increased risk of PDS only at 6 months after delivery (OR = 1.13, 95% CI [1.00, 1.26]), adjusted for potential confounding factors. An increase in Edinburgh Postnatal Depression Scale scores in relation to antibiotic exposure during pregnancy was primarily observed via psychological distress during pregnancy. Although a causal link was not established, antibiotic exposure during pregnancy may be a contributing risk factor for PDS. Therefore, when antibiotic administration is required, clinical practitioners and perinatal care providers should consider the potential risk for PDS.

Association between nighttime snacking during pregnancy and postpartum depression among community-dwelling pregnant women: a prospective cohort study

BACKGROUND/OBJECTIVES

The effect of the frequency of nighttime snacking during pregnancy on postpartum depression (PPD) remains unclear. This prospective cohort study aimed to explore the association between the frequency of nighttime snacking during pregnancy and the incidence of PPD.

METHODS

This study included 609 community-dwelling pregnant women who were recruited between July 2019 and July 2022. Data on the frequency of nighttime snacking and sociodemographic, economic, and lifestyle factors were obtained using self-administered questionnaires. Data on dietary intake were obtained using a validated brief self-administered diet history questionnaire. PPD was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The incidence of PPD (EPDS score of ≥9) based on the frequency of nighttime snacking was analyzed using multiple logistic regression analysis.

RESULTS

After adjusting for potential confounding factors, the odds ratio (OR) of PPD in participants who had a frequency of nighttime snacking 3 times/week or more compared with those who had a frequency of nighttime snacking less than 1 time/week was 2.59 (95% confidence interval, 1.14-5.86). Sensitivity analysis was repeated for the excluded participants with depressive symptoms during pregnancy, yielding similar results. The OR of PPD in those who indulged in nighttime snacking ≥3 times/week was the highest (2.81; 95% confidence interval, 1.13-6.96).

CONCLUSIONS

The present study clarified the association between the frequency of nighttime snacking and PPD. Further studies with large and diverse samples are needed to overcome any potential selection bias.

Prevalence of suicidal ideation and associated factors among perinatal women living with HIV: a systematic review and meta-analysis

Perinatal women living with HIV face increased susceptibility to mental health challenges, including suicidal ideation (SI). This study aimed to determine the prevalence of SI among perinatal women with HIV and identify associated factors. A systematic search was done across PubMed, Embase, Scopus, ScienceDirect, and Google Scholar. Data analysis was executed using R software. Publication bias was assessed via funnel plot and Egger's test, while heterogeneity was investigated using the I2 statistic. A total of 11 studies involving 4329 participants were included. The pooled prevalence of SI was 23.4% (95% CI: 16.3-32.4). Subgroup analysis showed higher prevalence in postnatal women (36.4%) than antenatal women (27.8%), although this difference was not statistically significant. Studies employing the Edinburgh Postnatal Depression Scale reported a higher prevalence (38.9%). Studies published between 2013-2017 showed a higher prevalence (37.6%) compared to those published between 2018-2022 (18.2%). Factors associated with SI included depression during pregnancy or postpartum, unplanned pregnancy, intimate partner violence, undisclosed HIV status, lack of social support, and recent diagnosis of sexually transmitted infections other than HIV. The high prevalence of SI emphasizes the need for mental health screening and interventions. Mental health assessments should be integrated into routine antenatal and postnatal care.

Impact of Affirmation Relaxation and Back Massage on Depression, Anxiety, and Stress in Mothers Who Have Undergone Caesarean Section

Introduction The postpartum psychological well-being and quality of life of mothers after caesarean section are poor when compared to mothers following vaginal delivery. Therefore, the study aimed to evaluate the impact of a combination of back massage and affirmation relaxation technique on depression, anxiety, and stress experienced by mothers who had undergone caesarean section. Methodology This interventional study used a pretest-posttest control group design and was quantitative in nature. Twenty-four caesarean section mothers, with 12 in the experimental group and 12 in the control group, were chosen by a purposive sampling technique at Fatima Hospital, Mau, Uttar Pradesh, India, from July 1, 2022, to August 14, 2022. A structured questionnaire on sociodemographic data and a standardised tool, DASS-21 (Depression, Anxiety and Stress Scale, 21 items), were used to gather the data. Data collection was done from the experimental and control groups on the 3rd and 6th post-operative days. The experimental group was given a back massage and affirmation relaxation four times a day for 10 minutes each on the 4th, 5th, and 6th post-operative days. The control group mothers received routine health assessment and health education on postnatal care and breastfeeding. Descriptive and inferential statistics were used to analyse the data using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). The analysis of categorical data was done using frequency and percentage distribution, whereas the analysis of continuous variables was done using mean and standard deviation. The Wilcoxon signed rank test and the Mann-Whitney U test were employed to evaluate the intervention's efficacy. The significance level was set at p < 0.05. Results A total of 24 mothers who have undergone caesarean section participated in the study. Baseline characteristics such as age, type of family, education, parity, type of LSCS, gender of the newborn, birthweight of the newborn, and timing of initiation of breastfeeding were homogeneously distributed in both experimental and control groups. Before intervention, the mean depression score of both the experimental group (8 ± 2.09) and the control group (8.50 ± 2.28), the mean anxiety score of the experimental group (11.67 ± 3.06) and the control group (11.50 ± 2.97), and the mean stress score of the experimental group (10.33 ± 3.17) and the control group (11.00 ± 2.63) were comparable. After intervention, there was a significant reduction in the maternal stress score in the experimental group (6 ± 2.83) compared to the control group (8.67 ± 2.31), which was statistically significant at p < 0.05. The anxiety score was also reduced after intervention in the experimental group (6.50 ± 3.53) compared to the control group (9.17 ± 1.99), which was nearly significant (p = 0.052). The mean depression score between the experimental group (6.50 ± 1.93) and the control group (7 ± 2.49) was not statistically significant (p > 0.05). Conclusion The study findings highlight the potential benefits of affirmation relaxation and back massage for improving the psychological well-being of postpartum women who have had caesarean sections. The advantages of this mother-friendly, cost-effective method should prompt hospitals and health centres to incorporate it into standard postpartum care. Nursing students should also be taught about it as part of their midwifery education.

Perinatal mental health and the justice delivery system in India

On 20 April 2022 the Sessions Court of Greater Mumbai sentenced a postpartum depressed woman to lifetime imprisonment for abandoning and murdering her twin girl child (In re: The State of Maharashtra). In the absence of a diagnosis or treatment for postpartum depression at the time when the crime was committed, a plea of insanity was denied. This article considers how the absence of services for perinatal mental health in India may challenge the delivery of criminal justice in cases of infanticide.

The prevalence of postpartum depression among women with physical disabilities: a systematic review and meta-analysis

PURPOSE

Pregnant and postpartum mothers with physical disabilities face discrimination in healthcare settings and high rates of maternal and obstetric complications, as well as having higher rates of lifetime depression prior to pregnancy, potentially increasing their likelihood of experiencing postpartum depression (PPD). Some studies have found higher rates of PPD in mothers with physical disabilities than in mothers without physical disabilities, with more disabling symptoms associated with worse PPD systems; however, the literature is sparse and heterogenous. This systematic review and meta-analysis advanced this area of study by evaluating the strength of the association between PPD and physical disability.

METHODS

We searched PubMed and PsycInfo, with the primary inclusion criteria being that the studies had an established measure of depression in women during the postpartum period and either a cohort identified as having physical disability or an established measure of physical disability in a general population sample. We aggregated the prevalence of PPD in women with physical disabilities and tested the robustness of our findings to moderators, including region, sample population, and measure type.

RESULTS

Findings from our quantitative meta-analysis (n=14) demonstrated a strong (d=.76, p<.0001) association between PPD and physical disabilities, such that individuals with physical disabilities reported more depression symptoms than individuals without physical disabilities. Moderator analyses were null, revealing that the association between PPD and physical disabilities was robust to several variables. Qualitative results support our conclusion that individuals with physical disabilities are at increased risk of PPD symptoms.

CONCLUSION

Our findings of a strong association between physical disability and PPD support the need for more research. Additional studies would 1) augment a nuanced understanding of how best to conceptualize PPD in women with physical disabilities and 2) facilitate testing the robustness of the association between PPD and physical disabilities to additional important moderators.

The Perinatal Microbiota-Gut-Brain Axis: Implications for Postpartum Depression

BACKGROUND

Pregnancy and childbirth are accompanied by widespread maternal physiological adaptations and hormonal shifts that have been suggested to result in a period of vulnerability for the development of mood disorders such as postpartum depression (PPD). There is also evidence of peripartum changes in the composition of the gut microbiota, but the potential contribution of intestinal microbes to the adaptations, or subsequent vulnerabilities, during this period are unknown.

SUMMARY

Here, we outline key pathways involved in peripartum adaptations including GABAergic signaling, oxytocin, and immunomodulation that are also associated with susceptibility to mood disorders and present evidence that these pathways are modulated by gut microbes. We also discuss the therapeutic potential of the microbiota-gut-brain axis in PPD and identify future directions for research to help realize this potential.

KEY MESSAGES

Peripartum adaptations are associated with shifts in gut microbial composition. Disruption of GABAergic, oxytocin, and immunomodulatory pathways may contribute to vulnerability of mood disorders including PPD. These key adaptive pathways are modulated by intestinal microbes suggesting a role for the gut microbiota in determining susceptibility to PPD. More research is needed to confirm relationship between gut microbes and PPD and to gain the mechanistic understanding required to realize the therapeutic potential of microbiota-gut-brain axis in this mood disorder.

Prevalence and correlates of postpartum PTSD following emergency cesarean sections: implications for perinatal mental health care: a systematic review and meta-analysis

BACKGROUND

The increasing awareness of the emotional consequences of emergency cesarean deliveries (C-sections) highlights their substantial role in fostering postpartum post-traumatic stress disorder (PTSD). This systematic review and meta-analysis aim to evaluate the prevalence and determinants of PTSD following emergency C-sections, as well as the implications of these events on maternal mental health and welfare.

METHODS

Undertaking extensive searches of Scopus, PubMed, PsycINFO, and Google Scholar, we have incorporated studies published from 2013 onwards that examined the occurrence of PTSD following emergency C-sections. Our primary focus was on the prevalence of PTSD at 6 weeks and up to 12 months postpartum. To evaluate the quality of these studies, we employed the Newcastle-Ottawa Scale (NOS) and the CEBM Critical Appraisal Tools.

FINDINGS

We included a total of 10 studies with 4,995 participants. The prevalence of PTSD following emergency C-sections ranged from 2.2 to 41.2%, compared to 0-20% in elective cesarean sections. A meta-analysis revealed a significant rise in the number of people with PTSD in the emergency C-section group compared to the elective C-section group six weeks after giving birth (OR = 2.74; 95% CI = 1.13 to 6.64; p = 0.03) and six weeks to 12 months later (OR = 3.68; 95% CI = 2.63 to 5.15; p < 0.00001). The emergency C-section group also had a higher PTSD prevalence compared to vaginal birth six weeks to 12 months after birth (OR 3.16; 95% CI 1.51 to 6.60; p = 0.02). Risk factors included poor social support, maternal and neonatal complications, and prior psychiatric history.

CONCLUSIONS

Emergency C-sections are significantly associated with an increased risk of postpartum PTSD, necessitating targeted psychological support and interventions. Future research should aim for standardized diagnostic criteria and explore the long-term psychological outcomes of emergency C-sections.

Risk and protective factors for postpartum depression among Polish women - a prospective study

This prospective study conducted at a single center in 2022 aims to identify risk and protective factors for postpartum depression (PPD) in Polish women and to assess the impact of pregnancy, delivery, the postpartum period, and psychosocial factors on PPD. After delivery and 4 weeks later, 311 women filled out two questionnaires of our design related to risk factors for PPD. Immune Power Personality Questionnaire, Walsh Family Resilience Questionnaire, and Edinburg Postnatal Depression Scale were also applied. The predictors of PPD identified at two time points included: use of antidepressants, previous depressive episodes, family history of depression, risk of preterm delivery, anxiety about child's health, and breastfeeding and sleep problems. Risk factors for PPD found only after delivery were: suicidal ideation before pregnancy, stressful life events, premature rupture of the membranes, and cesarean section. Inhalation analgesia during labor reduced the PPD frequency. At 4 weeks' postpartum, regular physical activity was also predictive of PPD, while breastfeeding, financial satisfaction, and sufficient sleep duration were protective factors. PPD after delivery was negatively correlated with capacity to confide, hardiness, assertiveness, self-complexity, and communication. PPD at 4 weeks postpartum decreased belief systems, organization patterns, and communication. Two proposed self-designed questionnaires can be useful for effectively screening PPD in the Polish population.

Neighborhood socioeconomic status and postpartum depression among commercial health insurance enrollees: a retrospective cohort study

BACKGROUND

Postpartum depression (PPD) is a prevalent psychological condition. Although the effect of obstetrical and maternal complications on PPD are well described, the impact of neighborhood socioeconomic status (SES) on PPD is relatively unexplored.

OBJECTIVES

This study examined the relationship between neighborhood SES score and PPD.

METHODS

A summary SES measure for each U.S. zip code was constructed using income, education, and occupational 2021 Census data and linked to national commercial claims for 2017-2023. PPD status using diagnosis codes at outpatient and inpatient visits, and prescription drug use 3, 6, 9, and 12 months postpartum, were determined. Multivariate analysis controlled for potential confounders.

RESULTS

PPD prevalence in commercial claims was 11.48%. Patients with PPD had higher rates of obstetrical (OR: 1.555, p < .0001) and maternal complications (OR: 1.145, p < .0001), and more lifestyle risk factors (OR: 1.113, p < .0001). Comorbidity scores were higher for patients with PPD. Controlling for age and clinical factors, living in a disadvantaged neighborhood was associated with an increased incidence of PPD (OR: 1.137, p < .0001).

LIMITATIONS

Claims data may include potential inaccurate coding of diagnoses/procedures. Clinical information is limited to conditions and treatments defined by ICD-10-CM codes. Area-based SES measures inevitably misclassify people on both ends of the socioeconomic spectrum (this misclassification is random; direction of bias is known).

CONCLUSIONS

The inverse and significant effect of area-based high SES on PPD rates demonstrates that preventive efforts may require interventions focusing on both the patient and the lived environment.

A pooled analysis of the efficacy of sertraline in women, with a focus on those of childbearing age

INTRODUCTION

Gender- and age-specific research on medications is essential for personalizing treatment plans, optimizing dosing, minimizing adverse effects and improving outcomes. Women are twice as likely to be diagnosed with major depressive disorder (MDD), and it is commonly reported during their reproductive years. This post-hoc pooled analysis evaluated the efficacy of sertraline (one of the most studied medications in women) in women of reproductive age (18-44 years).

METHODS

Data was pooled from nine clinical trials of sertraline that included 1832 subjects with MDD. The analysis set included 1097 women, 651 of those were of reproductive age. Sertraline was compared with placebo for changes in total HAM-D17 and CGI scores measured over time through MMRM analysis. The change from baseline to the end of study (-week 8) was assessed using ANCOVA.

RESULTS

The changes from baseline in total HAM-D17 and CGI scores were significantly higher for sertraline than for placebo at the end of 8 weeks for all women (LS Mean difference, 95% CI: -1.81(-3.01,-0.62), P = 0.0029; -0.38(-0.55,-0.20), P < 0.0001, respectively). For women of reproductive age these changes (LS Mean difference, 95% CI: -2.08(-3.52,-0.64), P = 0.0047; -0.44(-0.66,-0.22), P < 0.0001, respectively), were significant from week 2 (HAM-D17) and week 1 (CGI) till the end of study.

LIMITATIONS

Only sertraline and placebo arms were included in the analysis. The dosing varied between studies, and the effect of dose was not addressed.

CONCLUSIONS

Sertraline is an effective option for treatment of MDD in women, including those in the childbearing age.

Postpartum Depression and Its Determinants: A Cross-Sectional Study

Background Postpartum depression (PPD) is the most prevalent psychological disorder after childbirth associated with a negative impact on the daily functioning of mothers and the cognitive development of infants. Inequitable primary mental health access in lower-middle-income countries (LMICs) further aggravates this major public health problem. Objective The objective of this study is to estimate the prevalence and determinants of PPD among women reporting to secondary care facilities in Delhi, India. Methods A cross-sectional study was conducted in the outpatient settings of two secondary care (one government and one private) hospitals in the Delhi-National Capital Region among mothers of infants aged below six months. The study was conducted from January to June 2023. Data were collected by a single trained investigator using a self-designed interview schedule, while PPD was measured by administering the Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed with Stata statistical software, version 15.1 (StataCorp LLC, College Station, TX). P < 0.05 was considered statistically significant. Results The mean age of the study participants was 28.49 ± 3.77 years with 53 (18.28%) detected as having possible postpartum depression on screening with the EPDS. On adjustment for covariates, the participants with husbands consuming alcohol (adjusted odds ratio, 6.97; 95% confidence interval {CI}, 2.73-17.8), those who underwent C-section (adjusted odds ratio, 4.39; 95% CI, 1.02-18.85), and those giving birth in private hospitals (adjusted odds ratio, 5.48; 95% CI, 1.53-19.55) had significantly higher odds of having PPD. In contrast, mothers staying at home (not employed) (adjusted odds ratio, 0.08; 95% CI, 0.02-0.41), without specific preference for the newborn's gender (adjusted odds ratio, 0.07; 95% CI, 0.01-0.78), and those living in nuclear families (adjusted odds ratio, 0.03; 95% CI, 0.005-0.19) had significantly lower odds of PPD. Conclusion Nearly one in five mothers were screened for having possible PPD. Prioritizing birth preparedness during the antenatal period and strengthening health system screening protocols may prevent and mitigate the effects of PPD.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BACKGROUND

Postpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.

METHOD

A descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.

RESULTS

The prevalence of PPD was 21.8%, 95% CI (18.7-25.3). Factors associated with PPD were maternal age: 25-34 years [AOR = 0.52; 95% CI (0.29-0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20-0.96)], being married [AOR = 0.43; 95% CI (0.21-0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50-19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65-263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43-7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04-4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28-0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07-1.67)].

CONCLUSION

The prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study

BACKGROUND

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

METHODS

The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

RESULTS

Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

CONCLUSIONS

Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Prevalence and Risk Factors of Postpartum Depression Among Women in Low-Income Developing Rural Areas: A Cross-Sectional Study in China

Background: Postpartum depression (PPD) significantly affects the welfare of mothers, infants, families, and communities. Mothers in rural areas often face low incomes, poor social security, low education levels, and inadequate medical services. These specific cultural, social, and economic aspects have led to a worsening of PPD in rural areas. However, the current situation of PPD among women in rural areas of China is still insufficiently explored. Aim: This study aims to explore the prevalence and risk factors of PPD among women in low-income developing rural areas of China. Methods: A cross-sectional design was used in this study. Edinburgh Postnatal Depression Scale (EPDS) was applied to evaluate PPD symptoms. General demographic questionnaire, obstetrics-/pediatrics-related questionnaire, and psychosocial-related questionnaire were adopted. Abuse Assessment Screen (AAS) was utilized to assess experienced intimate partner violence during pregnancy and postpartum. Social Support Rating Scale (SSRS) was utilized to measure their levels of social support. Results: Of the 467 participants, the overall prevalence of PPD among women in rural areas of China was 16.5%, and the average EPDS score was 8.35 (SD = 4.50). PPD occurred most frequently at 7-9 months postpartum (33.8%). Six factors associated with PPD were whether the sex of the baby was in line with the family's expectations, monthly income of partners, social support, IPV during pregnancy and childbirth, and negative life events in the last 1 year, as well as physical and mental exhaustion from caring for a baby. Conclusions: This study sheds light on the prevalence and various risk factors associated with PPD among women residing in low-income developing rural areas of China. The findings highlighted the need for targeted interventions and support systems designed to address the specific socioeconomic and cultural difficulties encountered by rural mothers.

Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales

PURPOSE

To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms.

METHODS

Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15.

RESULTS

The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p =  < 0.001) compared to the EPDS-3 (R2 = 0.46, p =  < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035).

CONCLUSIONS

Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

Hair cortisol concentrations across pregnancy and maternal postpartum depressive symptoms - The ELFE cohort

Postpartum depression and depressive symptoms have a major impact on maternal and infant health and well-being, yet to date their aetiology remains unclear. One hypothesis suggests a link between these symptoms and variations in prenatal cortisol levels, but existing evidence is limited and inconclusive. This study aims to provide additional evidence to disentangle the relationship between prenatal cortisol concentrations and subsequent occurrence of postpartum depressive symptoms. Cortisol for all three trimesters of pregnancy was extracted from the hair of 775 women participating in the French ELFE cohort. Depressive symptomatology at two months postpartum was assessed through the Edinburgh Postpartum Depression Scale (EPDS). Associations between prenatal cortisol levels and EPDS scores were tested using propensity-score weighted logistic regression models to control for confounders. An increase in mean cortisol concentrations was observed from the first to the third trimester of pregnancy. No significant differences in hair cortisol concentrations were found during the first and second trimesters between women who experienced postpartum depressive symptoms and those who did not. However, an association was observed between third trimester hair cortisol concentrations and depressive symptoms at two months postpartum. Women whose cortisol concentrations fell within the second quartile had a higher risk of subsequent PPDS (aOR = 2.67, 95%CI [1.01, 7.08]). Using a large sample from the general population, we observed an association between hair cortisol levels during the third trimester of pregnancy and postpartum depressive symptoms. Nevertheless, our results suggest that future studies could benefit from investigating other biomarkers of the reactivity of the corticotropic axis.

The role of sleep protection in preventing and treating postpartum depression

Postpartum sleep disruption is a risk factor for postpartum depression (PPD) as well as a potential treatment target. In the first 6 months after delivery, when the risk of PPD is greatest, fragmented maternal sleep is most often related to necessary infant night feedings. Clinicians' conversations about planning for and navigating postpartum sleep should include questions about patient expectations, cultural traditions, and available support. For women at high risk of PPD, or with moderate to severe PPD or other symptoms of mental illness, protecting one 4-5 hour period of consolidated nighttime sleep may be necessary and effective. This can be achieved by having another adult step in for 1-2 infant night feedings or by employing other strategies. OBs can encourage high-risk patients to develop a postpartum plan for sleep protection by initiating this conversation during pregnancy.

Comparing the effect of haptonomy and CBT-based counseling on childbirth experience and postpartum depression of women with high fear of childbirth: A randomized clinical trial

BACKGROUND

Fear of childbirth (FOC) leads to the perception of more pain and a negative childbirth experience. Negative childbirth experience is related to postpartum depression. This study aimed to compare the effect of haptonomy and cognitive-behavioral therapy (CBT) on the childbirth experience and postpartum depression of women with high FOC.

MATERIALS AND METHODS

This randomized controlled trial was performed on 99 primigravida women referred to health centers in Tabriz, Iran, from January to August 2022. Participants with Wijma score above 65 were assigned into three groups using block randomization. One of the intervention groups (n = 33) received eight sessions of CBT from gestational age of 24-28 weeks and the other group (n = 33) received haptonomy during five sessions once a week. The control group (n = 33) received routine care. The data were collected using the Edinburgh Postpartum Depression Scale, and childbirth experiences questionnaire version 2.0 and were analyzed using ANOVA and ANCOVA.

RESULTS

The mean score of childbirth experience in the CBT and haptonomy groups was 70.67 (13.70) and 70.63 (14.48), respectively, which was more than that in the control group 61.63 (14.11) (P = 0.01). However, no statistically significant difference was observed between the intervention groups (P = 1.000). There wasn't significant difference in the mean score of postpartum depression among CBT 7.59 (3.03), haptonomy 7.47 (4.49), and control 9.71 (3.05) groups (P = 0.09).

CONCLUSIONS

Both CBT and haptonomy improved the childbirth experience, but did not affect postpartum depression. Considering the lack of significant difference between the CBT and haptonomy intervention groups in terms of childbirth experience and given that haptonomy intervention is employed by midwives with no need for CBT counseling skills and can be presented in fewer sessions than CBT, it can be used as a preferred intervention approach by midwives in the care of pregnant women with FOC to improve the childbirth experience.

Content, Behaviour Change Techniques, and Quality of Postpartum Depression Apps to Be Recommended by Midwives: Systematic Search and Evaluation

BACKGROUND

Postpartum depression is a public health problem that affects a considerable percentage of women. Despite the proliferation of related apps, there are limited data available on the best apps to prevent postpartum depression. We identified which apps available in Spanish could be recommended by midwives based on their content, quality, and behaviour change techniques, as a complementary tool for preventing postpartum depression in women.

METHODS

A systematic search was performed to identify apps available on iOS App Store and Google Play, which were used to replicate how patients' access "postpartum depression prevention" apps. Apps' quality, behaviour change potential, and contents were assessed.

RESULTS

A total of 1408 apps were identified, of which 7 were retrieved for assessment (0.5%). The mean objective and subject quality were 3.1 (SD = 1.01) and 2.7 (SD = 1.27), respectively. A total of 24 topics were identified. The mean ABACUS score was 6.6 (SD = 3.64), and the mean number of topics addressed by the apps was 9.9 (SD = 5.90).

CONCLUSION

The results of the present study suggest that a specific free app is not available in Spanish for the prevention of postpartum depression, and only a small percentage of free apps should be recommended based on their quality, BCTs, and contents. The systematic review protocol was not registered.

The prevalence and related factors of post-partum anxiety and depression among mothers during COVID-19 pandemic in 2021

BACKGROUND

There are many factors effective on occurrence of post-partum anxiety and depression. COVID-19 pandemic, as a major health crisis, affected many countries and had undesirable mental health outcomes, especially for the vulnerable population. The aim of this study was to evaluate the prevalence of post-partum anxiety and depression and their related factors during COVID-19 pandemic.

METHODS

The present descriptive cross-sectional study was conducted on 360 mothers who delivered their child during COVID-19 pandemic and had referred to the comprehensive urban health canter of Lenjan city two months after their delivery (from November 10th, 2021, until March 19th, 2022). Data were gathered using 3 questionnaires including demographic characteristics, Edinburgh Postnatal Depression Scale (EPDS), and Beck Anxiety Inventory (BAI). Data were analyzed using SPSS software version 24 and the level of significance was set at p < 0.05.

RESULTS

The prevalence of anxiety and post-partum depression was 27% and 20%, respectively. None of the demographic characteristics had a significant relationship with anxiety and depression. Related factors to post-partum anxiety included desired pregnancy, premenstrual syndrome, marital conflicts, history of mother's hospitalization due to COVID-19, compliance rate with preventive health measures for COVID-19, stressful events, and social support.

CONCLUSION

It is suggested to screen mothers to detect significant related factors of post-partum anxiety and depression in other future pandemics or epidemics to support them.

Factors Associated with Poor Sleep Quality in Postpartum Women: A Crossectional Study

Objective  This study aimed to analyze the factors associated with poor sleep quality in women in the postpartum period who were assisted in a municipality in central Brazil. Material and Methods  This is a cross-sectional study ( n  = 400) conducted virtually from 2020 to 2021. Sociodemographic and clinical characteristics, self-perceived sleep, and the Pittsburgh Sleep Quality Index (PSQI) were assessed. Results  It was identified that 82% of postpartum women were between 18 and 35-years-old and had an average monthly household income of R$2,339.27 ± 1,812.95. It was also found that 33.50% (95% CI: 28.7-38.0) had sleep disorders (PSQI >10); 70.25% (95%CI 65.8-74.8) had poor sleep quality (PSQI >5); 57.4% (95% CI: 52.0-63.1) had inadequate sleep on weekdays/workdays; and 64.1% (95% CI 59.3-69.2) had unsuitable sleep on weekends/days off. It was found that the factors associated with sleep disturbance were: age between <18 years and >35 years ( p  = 0.048); difficulty to think clearly ( p  = 0.043); frequent sadness ( p  = 0.046); poor sleep quality; low income ( p  = 0.030); difficulty to think clearly ( p  = 0.013); and loss of interest in things ( p  = 0.030). As for sleep on weekdays, the associated factors were: marital status without a partner ( p  = 0.008); and being a victim of physical violence ( p  = 0.003). Finally, for sleep on weekends/off: nonwhite skin-color ( p  = 0.039); and having postpartum depression ( p  = 0.029). Conclusion  The findings of the present study call attention to the impacts of changes in women's bodies, behavior, and interpersonal relationships caused by the arrival of a newborn. We also highlight the need for a multidisciplinary and comprehensive medical approach in this period.

Maternal Postpartum Depression Screening and Early Intervention in the Neonatal Intensive Care Unit

Families with infants admitted to the neonatal intensive care unit (NICU) are at a markedly increased risk of developing postpartum depression (PPD) because of the stressors they experience by having an infant in this intensive setting. Routine screening for PPD is not regularly performed for these families because many NICUs do not offer it and well-child visits are missed while the infant is hospitalized. Because the identification and treatment of PPD is often missed in these families, screening needs to be administered in the NICU to ensure improved outcomes.

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research

OBJECTIVES

A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.

METHODS

This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a crosssectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8889 pregnant women and 77 012 women who had delivered between January 1, 2013 and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.

RESULTS

The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (adjusted odds ratio [aOR], 12.23; 95% confidence interval [CI], 9.01 to 16.60) and the postpartum period (aOR, 16.72; 95% CI, 14.85 to 18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, history of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include living in rural areas, history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.

CONCLUSIONS

CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.

Prevalence and Risk Factors of Prenatal and Postnatal Depressive Symptoms in Babol Pregnancy Mental Health Registry: A Cross-Sectional Study

BACKGROUND

Prenatal and postnatal depression (PND) is associated with adverse outcomes for mother, fetus, and child. The aim of study was to examine the prevalence and risk factors of prenatal and postnatal depressive symptoms.

MATERIALS AND METHODS

This was a cross-sectional and hospital-based survey of 2305 pregnant women and post-partum women (18-48 years) that was registered in the Babol Pregnancy Mental Health Registry (BPMHR) database from June 2020 to March 2021. Two questionnaires, including demographics and depression, were analyzed in this study. Also, the Edinburg Postnatal Depression Scale (EPDS) was used to assess the depressive symptoms. Independent t test and the analysis of variance were used to compare the means. Multiple logistic regressions were used to determine risk factors for depressive symptoms.

RESULTS

According to the EPDS scale, the prevalence of depressive symptoms was 19.8% in the pregnant woman group in comparison with the postpartum period (11.6%). Risk factors for antenatal depressive symptoms were parity (women with parity ≥ 4 vs. 1 parity, ß=1.808, P=0.020), two groups of gestational age (gestational age ≤12 weeks vs. 28 weeks, ß=1.562 P=0.030) as well as (gestational age 21-27 weeks vs. 28 weeks (ß=1.586, P=0.033), and high-risk pregnancy (high-risk vs. low-risk pregnancy, ß=1.457, P=0.003). For postnatal depressive symptoms, none of the factors were a significant risk.

CONCLUSION

Prenatal and postnatal depressive symptoms should be screened, particularly for women in the first and second trimesters, with high parity, and those with a high-risk pregnancy, as recommended by the present study.

Efficacy of Nurse-led Telepsychological Intervention for Patients with Postpartum Depression: A Systematic Review and Meta-analysis

Objective

The aim of the study was to systematically evaluate the therapeutic effect of nurse-led telepsychological intervention on patients with postpartum depression.

Methods

PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and China VIP database were searched for articles on the effectiveness of remote psychological intervention in improving postpartum depression. The search time was limited from the establishment of the database to December 2023. The literature was screened, and data were extracted. The Cochrane risk of bias assessment tool was used to evaluate the quality of randomized controlled trials that met standards, and RevMan5.4 was used for meta-analysis.

Results

A total of 14 studies involving 1765 patients from 9 countries were included. Meta-analysis results showed that compared with routine care, telepsychological intervention can alleviate maternal depression (Standard Mean Difference [SMD] = -0.60, 95% CI [-0.91, -0.29], I 2 = 88%, P < .01). Sensitivity and subgroup analyses revealed that 3 studies using the Edinburgh Postpartum Depression Scale evaluation tool were the source of heterogeneity in the meta-analysis.

Conclusion

Telepsychological postpartum depression intervention can effectively improve postpartum depression, indicating that it has a certain clinical application value.

Mendelian randomization analyses for the causal relationship between early age at first sexual intercourse, early age at first live birth, and postpartum depression in pregnant women

Introduction

There are insufficient epidemiological studies on the impact of age at first sexual intercourse (AFS) and age at first live birth (AFB) on postpartum depression (PPD) in pregnant women, and the conclusions of these studies are inconsistent.

Methods

We performed a Mendelian randomization (MR) study to determine the causal relationship between AFS or AFB and the risk of PPD. The summary data were extracted from genome-wide association study (GWAS) summary datasets. We selected the instrumental variables according to the P value of exposure-related single nucleotide polymorphisms (P<5 ×10-9 for AFS and P<5 ×10-8 for AFB) and estimated the linkage disequilibrium using the clump parameter (10,000 kb, r2 < 0.001). Single nucleotide polymorphisms were considered instrumental variables that were significantly associated with exposure factors without linkage disequilibrium. The F-statistics of the instrumental variables should all be larger than 10. A random-effects model of IVW was constructed as the main method in our study.

Results and discussion

MR studies based on GWAS data revealed that both AFS (OR = 0.4, P <0.001) and AFB (OR = 0.38, P <0.001) were negatively correlated with the risk of PPD. Early AFS and early AFB should be studied as possible risk factors for PPD in the future. Public health departments should attach importance to sex education for young girls. The results of our TSMR should be verified by high-quality prospective epidemiological studies in the future.

Postpartum depression and its relationship with the positive and negative perfectionism

BACKGROUND

Depression is a common mental disorder after childbirth, which has serious consequences for the mother, baby, and family. A wide range of causes, including some personality traits of mothers, are involved in its etiology. Therefore, this study was conducted aiming to determine the factors related to postpartum depression (PPD) and its relationship with positive and negative perfectionism in Qom, Iran.

MATERIALS AND METHODS

This cross-sectional analytical study was conducted on 162 mothers who had been referred to health centers in Qom during 6-8 weeks after normal vaginal delivery (NVD) in 2020. After randomly classifying the health centers, the convenience sampling method was carried out. Data collection tools included social-individual information form, Edinburg Postnatal Depression Scale (EPDS), and Positive and Negative Perfectionism Questionnaire of Terry-Short. The data were analyzed using the Chi-square and Pearson correlation tests and multivariate logistic regression analysis.

RESULT

The prevalence of PPD in this study was 29.6%. The results showed that with the increase in the negative dimension of perfectionism, the chance of PPD in people increases by 14% (OR = 1.14, CI = 1.06-1.21), while there was no significant correlation between the positive dimension of perfectionism and PPD (r = 0.006, P > 0.05). Furthermore, the chance of PPD was higher in student mothers, mothers who had a history of PPD, and unintended pregnancy. Moreover, some factors such as multigravidity, breastfeeding, and not worrying about body image reduce the chance of occurrence.

CONCLUSION

Since mothers' negative perfectionism is associated with PPD, it is recommended to identify perfectionist individuals during pregnancy and after delivery and provide counseling service to them.

Does preterm birth increase the initiation of antidepressant use during the postpartum? A population-based investigation

Background

Preterm birth may affect maternal mental health. We explored the relationship between preterm birth and the risk of initiating antidepressant use during the year after birth.

Methods

We conducted a population-based investigation using regional healthcare utilization databases. The exposure considered was preterm birth. The outcome was having at least one prescription for antidepressant medications during the year after birth. We used a log-binomial regression model including terms for maternal age at birth, nationality, educational level, parity, modality of conception, modality of delivery, use of other psychotropic drugs, and diabetes to estimate relative risk (RR) and 95% confidence intervals (CI) for the association between preterm birth and the initiation of antidepressant use. In addition, the absolute risk differences (ARD) were also computed according to the timing of birth.

Results

The cohort included 727,701 deliveries between 2010 and 2020 in Lombardy, Northern Italy. Out of these, 6,522 (0.9%) women had at least one prescription for antidepressant drugs during the year after birth. Preterm births were related to a 38% increased risk of initiation of antidepressant use during the year after birth (adjusted RR = 1.38; 95% CI: 1.25-1.52) for moderate to late preterm and to 83% (adjusted RR = 1.83; 95% CI: 1.46-2.28) for extremely and very preterm. Excluding women with only one antidepressant prescription, the association was consistent (adjusted RR = 1.41, 95%CI: 1.23-1.61 for moderate to late preterm and adjusted RR = 1.81, 95% CI: 1.31-2.49 for extremely and very preterm). Also, excluding women who used other psychotropics, the association remained consistent (adjusted RR = 1.39, 95%CI: 1.26-1.54 and adjusted RR = 1.91, 95% CI: 1.53-2.38, respectively for moderate to late and extremely and very preterm).

Conclusion

Women who delivered preterm may have an excess risk of initiation of antidepressant consumption during the first year after birth.

Social support during pregnancy and the risk of postpartum depression in Polish women: A prospective study

Social support has been proposed as an important determinant of women's physical and emotional well-being during pregnancy and after childbirth. Our study aimed to examine the association between the risk of postpartum depression (PPD) and perceived social support during pregnancy. A web-based prospective study survey was conducted among Polish women. The level of social support was measured with the Berlin Social Support Scales during pregnancy. Four weeks after the birth the risk of PPD was assessed using the Edinburgh Postpartum Depression Scale. Data from 932 mothers aged 19-43 (mean 30.95; SD 3.83) were analyzed using multinomial logistic regression. Higher perceived available support (emotional and instrumental), currently received support (emotional, instrumental and informational), satisfaction with the support, and sum of score were all associated with lower risk of PPD, after controlling for selected covariates (woman's age, socioeconomic status, parity status, place of residency, education, child's Apgar score, type of delivery, complications during birth, kin assisting the labor, breastfeeding). Our results suggest that the more social support the pregnant woman receives, the lower is her risk of PPD. Since humans evolved as cooperative breeders, they are inherently reliant on social support to raise children and such allomaternal help could improve maternal well-being.

Perinatal depression trajectories and child development at one year: a study in China

BACKGROUND

The objective of the current study was to investigate the correlation between trajectories of maternal perinatal depression (PND) spanning from early pregnancy to one year postpartum and developmental delays observed in one-year-old children.

METHODS

The dataset under examination encompassed 880 women who took part in a mother-child birth study conducted in China. Latent class growth analysis (LCGA) was employed to identify patterns in Edinburgh Postnatal Depression Scale (EPDS) scores of women, spanning from early pregnancy to one year postpartum. To assess the neurodevelopment of one-year-old children, a Chinese version of the Bayley Scale of Infant Development (BSID-CR) was employed. Logistic regression was employed to explore the association between PND trajectories and developmental delays in children, with appropriate covariate adjustments.

RESULTS

The trajectories of maternal PND identified in this study included a minimal-stable symptom group (n = 155), low-stable symptom group (n = 411), mild-stable symptom group (n = 251), and moderate-stable symptom group (n = 63). Logistic regression analysis revealed that mothers falling into the moderate-stable symptom group exhibited a notably heightened risk of having a child with psychomotor developmental delays at the age of one year.

CONCLUSIONS

The findings drawn from a representative sample in China provide compelling empirical evidence that bolsters the association between maternal PND and the probability of psychomotor developmental delays in children. It is imperative to develop tailored intervention strategies and meticulously design mother-infant interactive intervention programs for women with PND.

The bidirectional association between premenstrual disorders and perinatal depression: A nationwide register-based study from Sweden

BACKGROUND

Premenstrual disorders (PMDs) and perinatal depression (PND) share symptomology and the timing of symptoms of both conditions coincide with natural hormonal fluctuations, which may indicate a shared etiology. Yet, there is a notable absence of prospective data on the potential bidirectional association between these conditions, which is crucial for guiding clinical management. Using the Swedish nationwide registers with prospectively collected data, we aimed to investigate the bidirectional association between PMDs and PND.

METHODS AND FINDINGS

With 1,803,309 singleton pregnancies of 1,041,419 women recorded in the Swedish Medical Birth Register during 2001 to 2018, we conducted a nested case-control study to examine the risk of PND following PMDs, which is equivalent to a cohort study, and transitioned that design into a matched cohort study with onward follow-up to simulate a prospective study design and examine the risk of PMDs after PND (within the same study population). Incident PND and PMDs were identified through clinical diagnoses or prescribed medications. We randomly selected 10 pregnant women without PND, individually matched to each PND case on maternal age and calendar year using incidence density sampling (N: 84,949: 849,482). We (1) calculated odds ratio (OR) and 95% confidence intervals (CIs) of PMDs using conditional logistic regression in the nested case-control study. Demographic factors (country of birth, educational level, region of residency, and cohabitation status) were adjusted for. We (2) calculated the hazard ratio (HR) and 95% CIs of PMDs subsequent to PND using stratified Cox regression in the matched cohort study. Smoking, BMI, parity, and history of psychiatric disorders were further controlled for, in addition to demographic factors. Pregnancies from full sisters of PND cases were identified for sibling comparison, which contrasts the risk within each set of full sisters discordant on PND. In the nested case-control study, we identified 2,488 PMDs (2.9%) before pregnancy among women with PND and 5,199 (0.6%) among controls. PMDs were associated with a higher risk of subsequent PND (OR 4.76, 95% CI [4.52,5.01]; p < 0.001). In the matched cohort with a mean follow-up of 7.40 years, we identified 4,227 newly diagnosed PMDs among women with PND (incidence rate (IR) 7.6/1,000 person-years) and 21,326 among controls (IR 3.8). Compared to their matched controls, women with PND were at higher risk of subsequent PMDs (HR 1.81, 95% CI [1.74,1.88]; p < 0.001). The bidirectional association was noted for both prenatal and postnatal depression and was stronger among women without history of psychiatric disorders (p for interaction < 0.001). Sibling comparison showed somewhat attenuated, yet statistically significant, bidirectional associations. The main limitation of this study was that our findings, based on clinical diagnoses recorded in registers, may not generalize well to women with mild PMDs or PND.

CONCLUSIONS

In this study, we observed a bidirectional association between PMDs and PND. These findings suggest that a history of PMDs can inform PND susceptibility and vice versa and lend support to the shared etiology between both disorders.

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

BACKGROUND

Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period.

METHODS

A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality.

RESULTS

A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions.

DISCUSSION

Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD

BACKGROUND

Empirical evidence shows that 4.6-6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10-15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes.

METHODS

The study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS).

RESULTS

For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size).

LIMITATION

Delivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation.

CONCLUSION

The study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.

Sociodemographic Correlates of Postpartum Depression: A Survey-Based Study

Objective: Post-partum depression (PPD) has been reported in about one-seventh to one-tenth of women. The aim of this study is to identify the demographic, obstetrics, social, and psychological risk factors of PPD among the eastern region of the United Arab Emirates. Method : A community-based cross-sectional study was performed on 200 women who had a recent singleton pregnancy and delivered newborn within past six months via convenience sampling and email snowballing. Several demographics, obstetrics, social, and psychological factors of the respondents were assessed using a survey form. The Edinburgh depression rating scale (EDRS) was used for the identification of women with possible PPD. Descriptive statistics were utilized for the representation of demographic variables, whereas Chi-square test was employed to assess categorical variables. Also, logistic regression was applied to evaluate the association of investigated variables and PPD. Results: The median EDRS score amongst the study participants was found to be 11 (0-26). The prevalence of PPD was found to be 57% in the studied population. Significant differences were observed in the adverse life events, emotional supports, marital conflicts and history of depression of the participants with and without PPD (P < 0.01). The risk factors significantly associated with PPD were age of the newborn (OR = 6.50, 95%CI: 1.17-19.91), marital relationship (OR = 4.15, 95%CI: 1.31-15.22), maternal educational level (OR = 5.10, 95%CI: 4.30-16.58), adverse life events (OR = 9.32, 95%CI: 1.33-35.32), and history of depression (OR = 5.24, 95%CI: 3.14-11.96). Conclusion: Given the findings, there is an urgent need for policy initiatives to address the identified risk factors, such as improving access to education, strengthening supportive marital relationships, and providing comprehensive mental health services for pregnant women.

The Role of Social Support and Acculturation Factors on Postpartum Mental Health Among Latinas in the MADRES Pregnancy Cohort

We examined the associations between social support and postpartum mental health in 137 U.S. and foreign-born Latinas in the MADRES pregnancy cohort. We also examined whether language, years in the U.S., and country of birth moderates these relationships. Participants were administered PROMIS support measures 1 month postpartum; the Perceived Stress and Postpartum Distress Measure 3, 6, and 12 months postpartum; and the CESD scale 12 months postpartum. Perceived stress was lower at 6 months postpartum for women reporting higher emotional (p = 0.01), informational (p = 0.03), and instrumental support (p < 0.001); and lower at 12 months postpartum for women reporting higher emotional support (p = 0.01). Distress at 6 months was lower in women reporting higher emotional support (p = 0.03). Interactions suggest that associations were stronger for mothers that speak Spanish, spent fewer years in the U.S., and were born in Central America.

Postpartum Depressive Symptoms: An Analysis of Social Determinants Using the Pregnancy Risk Assessment Monitoring System

Background

Approximately one in every eight mothers experience symptoms of postpartum depression (PPD) in the United States.1 Existing literature lacks an in-depth exploration of the social context from which symptoms of PPD arise. The objectives of this study were to (1) determine the prevalence of postpartum depressive symptoms (PDS) among new mothers and to explore relationships between selected social determinants of health (SDOH) and the likelihood of experiencing PDS.

Materials and Methods

Data were from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016 and 2017 Questionnaires. Measured SDOH included socioeconomic status, social network support, psychosocial stress, and availability of resources to meet basic daily needs. Outcome measurement included a combination of two symptom indicator questions. Univariate analyses yielded weighted frequencies of descriptive statistics according to PDS status, and bivariate and multivariate logistic regression analyses yielded odds of reporting PDS.

Results

The prevalence of self-reported PDS was 3.5%. Among mothers with PDS, most (54%) lived at or below the federal poverty guideline. Mothers who experienced psychosocial stress (e.g., intimate partner violence) during pregnancy had the highest likelihood of reporting PDS (adjusted odds ratio [aOR] = 3.60; confidence interval [95% CI], 2.12-6.12). Mothers who considered their most recent pregnancy unintended or mistimed were more likely to report PDS (aOR = 1.36; 95% CI, 1.01-1.82), (aOR = 1.65; 95% CI, 1.19-2.27), respectively.

Conclusion

Results demonstrate that several social and psychosocial risk factors significantly impact the likelihood of experiencing PDS. The risk of PDS was particularly significant among lower socioeconomic status mothers, especially those with inadequate social network support. Public health efforts to mitigate potentially harmful social factors should focus on transforming public policies and social programs and increasing screening opportunities.

Etiology and incidence of postpartum depression among birthing women in the scenario of pandemics, geopolitical conflicts and natural disasters: a systematic review

Postpartum depression (PPD) is classified under postpartum psychiatric disorders and initiates soon after birthing, eliciting neuropsychological and behavioral deficits in mothers and offspring. Globally, PPD is estimated to be associated with 130-190 per 1000 birthing. The severity and incidences of PPD have aggravated in the recent years due to the several unfavorable environmental and geopolitical circumstances. The purpose of this systematic review hence is to explore the contributions of recent circumstances on the pathogenesis and incidence of PPD. The search, selection and retrieval of the articles published during the last three years were systematically performed. The results from the primary studies indicate that unfavorable contemporary socio-geopolitical and environmental circumstances (e.g. Covid-19 pandemic, political conflicts/wars, and natural calamities; such as floods and earthquakes) detrimentally affect PPD etiology. A combination of socio-economic and psychological factors, including perceived lack of support and anxiousness about the future may contribute to drastic aggravation of PPD incidences. Finally, we outline some of the potential treatment regimens (e.g. inter-personal psycho- and art-based therapies) that may prove to be effective in amelioration of PPD-linked symptoms in birthing women, either alone or in complementation with traditional pharmacological interventions. We propose these psychological and art-based intervention strategies may beneficially counteract the negative influences of the unfortunate recent events across multiple cultures, societies and geographical regions.

Folic acid supplementation during pregnancy and postpartum depressive symptoms

OBJECTIVE

To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort.

METHODS

This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity).

RESULTS

The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum.

CONCLUSION

There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.

The mediating role of body image concern in the relationship between immature defense mechanisms and postpartum depression in Iranian women

BACKGROUND

Postpartum depression leaves irredeemable impacts on a mother's mental health and her child. Little is known about the relationship between immature defense mechanisms and body image concerns or postpartum depression. The present study examines the mediating role of body image concerns in the relationship between immature defense mechanisms and postpartum depression.

MATERIALS AND METHODS

In a correlational study, 227 women were selected through a convenience sampling method from all women in the postpartum period in medical centers in 2021 in Tehran, Iran. The participants were asked to fill out the Edinburgh Postnatal Depression Scale (EPDS), the Defense Style Questionnaire-40 (DSQ-40) by Andrews et al., and the Body Image Concern Inventory (BICI). The collected data was analyzed using the IBM SPSS Amos 24 and SPSS 21 software.

RESULTS

There was a positive correlation between body image concern, immature defense mechanisms, and postpartum depression. Furthermore, body image concern was a mediator in the relationship between immature defense mechanisms and postpartum depression. The immature defense mechanisms had an indirect positive impact on depression due to the concerns over one's body image after giving birth (P > 0.05).

CONCLUSION

Immature defense mechanisms and body image concerns can increase the risk of postpartum depression. Therefore, providing mental health and psychiatric services to expecting mothers is an effective tool to decrease the activation of immature defense mechanisms, which would reduce their body image concerns and prevent them from falling into postpartum depression.

Breastfeeding Self-efficacy is Inversely Associated with Postpartum Depression: Findings from a Tertiary Hospital in Saudi Arabia

Background

High breastfeeding self-efficacy is linked with lower rates of postpartum depression. No study from Saudi Arabia has previously assessed the relation between breastfeeding self-efficacy and postpartum depression.

Objective

To determine the correlation between breastfeeding self-efficacy and postpartum depression in a cohort from Saudi Arabia.

Materials and Methods

This cross-sectional study included mothers who had given birth between February to June 2022 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were between 2 weeks and 3 months postpartum. Data were collected using a self-administered questionnaire comprising the following three sections: sociodemographic characteristics, Edinburgh Postpartum Depression Scale (EPDS), and Breastfeeding Self Efficacy Scale-Short Form (BSES-SF).

Results

A total of 257 participants completed the questionnaire, with most aged 25-34 years (59.1%). The prevalence of postpartum depression was 25.3%, and it was significantly associated with lack of support from the husband and family during pregnancy (for both, P < 0.001), history of violence (P < 0.001), family history of depression (P = 0.045), complications during pregnancy (P = 0.004), and multiple pregnancies (P = 0.004). The mean score on the BSES-SF was 47.4, and participants who scored above the mean had significantly lower rates of postpartum depression (P = 0.003). In addition, an inverse relation was noted between BSES-SF and postpartum depression scores (r = -0.297): when the scores of BSES-SF increased, the scores of postpartum depression decreased.

Conclusion

The rate of postpartum depression was high in Jeddah, Saudi Arabia; nonetheless, positive breastfeeding self-efficacy was found to be correlated with lower rates of postpartum depression. These findings indicate the need for careful screening of patients at risk of postpartum depression and for providing breastfeeding support/knowledge, both in the antenatal and postpartum periods.

The end of Roe v. Wade: implications for Women's mental health and care

The Supreme Court decision in Dobbs v. Jackson in June 2022 reversed precedent which had previously protected abortion prior to fetal viability as a universal right within the United States. This decision almost immediately led to abortion restrictions across 25 states. The resulting lack of access to abortion care for millions of pregnant people will have profound physical and mental health consequences, the full effects of which will not be realized for years to come. Approximately 1 in 5 women access abortions in the U.S. each year. These women are diverse and represent all American groups. The Supreme court decision, however, will affect populations that have and continue to be marginalized the most. Forcing pregnant individuals to carry unwanted pregnancies worsens health outcomes and mortality risk for both the perinatal individual and the offspring. The US has one of the highest maternal mortality rates and this rate is projected to increase with abortion bans. Abortion policies also interfere with appropriate medical care of pregnant people leading to less safe pregnancies for all. Beyond the physical morbidity, the psychological sequelae of carrying a forced pregnancy to term will lead to an even greater burden of maternal mental illness, exacerbating the already existing maternal mental health crisis. This perspective piece reviews the current evidence of abortion denial on women's mental health and care. Based on the current evidence, we discuss the clinical, educational, societal, research, and policy implications of the Dobbs v. Jackson Supreme Court decision.

The Effect of Delivery Mode, ABO Blood Type, and Passive Smoking on Postpartum Depression: A Cross-Sectional Study in Saudi Arabia

Background Postpartum depression (PPD) is a form of depression that can occur after childbirth and is characterized by feelings of sadness. It is a common psychological problem that affects women and children. This study aimed to assess the association between PPD and risk factors, such as delivery mode, ABO blood group, and passive smoking in Saudi Arabia. Methods PPD was assessed in this cross-sectional using an Arabic version of the Edinburgh postnatal depression scale through an online questionnaire distributed to women in Saudi Arabia between January and March 2022. The data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Results A total of 354 postpartum women completed the questionnaire within six weeks of giving birth. Their mean age and BMI were 30.1±6.78 years and 25.98±5.84 kg/m², respectively. PPD occurred in 56.2% of the participants. Elective cesarean section and operative vaginal delivery were associated with the presence of PPD symptoms in 17.6% and 7% of the women, respectively. The majority of those with third and fourth degrees and those who had instrumental assisted delivery had postpartum depression and this was statistically significant (p=0.017). About 26.6% of the participants were exposed to passive smoking, and 21.9% of them developed PPD. However, it was not statistically significant. Moreover, women with PPD were more likely to have blood type O+, followed by A+. Demographic factors did not show a significant correlation with developing PPD except for age (p=0.01), those who developed PPD were much younger on average than those who did not develop PPD (29.28±6.61 years vs. 31.15±6.86 years). Conclusion A significant association was found between PPD and the type of delivery. The association between PPD and passive smoking, ABO blood groups was insignificant. However, women who developed PPD were younger on average than those who did not develop PPD.

Exploring the Relationship between Anemia and Postpartum Depression: Evidence from Malawi

PURPOSE

Study findings suggest association between anemia and postpartum depression, but available evidence is scant and inconsistent. We investigate whether anemia is related to postpartum depression among women who have recently given birth in Malawi, where anemia prevalence is high.

METHODS

We use cross-sectional data from 829 women who were 18-36 years old, married, lived in Lilongwe, Malawi, and gave birth between August 2017 and February 2019. The primary outcome is postpartum depression in the year after birth, defined by the Patient Health Questionnaire-9 (PHQ-9). Anemia status was assessed using hemoglobin levels that were measured at the time of the interview. Multivariate logistic regression analyses were used to investigate the relationship between postpartum depression and anemia status.

RESULTS

Our analysis sample consists of 565 women who completed the PHQ-9, tested for anemia, and had no missing values for covariates. Of these women, 37.5% had anemia (hemoglobin levels ≤ 110 g/L), and 2.7% were classified as showing symptoms of a major depressive disorder (MDD). After adjusting for potential confounders, anemia was significantly associated with increased risk of MDD (OR: 3.48, 95% CI: 1.15-10.57, p-value: 0.03). No significant associations were found between other covariates and postpartum depression.

CONCLUSIONS

Our findings suggest a potential association between anemia and postpartum depression among women in Malawi. Policies that aim to improve nutrition and health outcomes for pregnant and postpartum women could generate a "double benefit" by both preventing anemia and reducing the risk of postpartum depression.