Postpartum Depressive Symptoms In Women Research Articles

Does mistreatment during institutional childbirth increase the likelihood of experiencing postpartum depressive symptoms? A prospective cohort study in Nepal

ABSTRACT Background Postpartum depression is associated with low socioeconomic status, adverse birthing processes, and life stress. Increasing evidence of mistreatment during childbirth, negative birth experiences, and poor quality of maternal care is of global concern. Objective To assess the risk of experiencing depressive symptoms among postpartum women exposed to mistreatment during institutional birthing in Nepal. Method We conducted a prospective cohort study from 29 March to 19 August 2022. Of 1629 women who gave birth in a hospital in Nepal, 1222 were assessed for mistreatment during childbirth and depressive symptoms using the Edinburgh Postnatal Depression Scale. We used binomial generalized linear mixed model to examine the risk ratio of postpartum depressive symptoms in women exposed to mistreatment during childbirth. Results The prevalence of postpartum depressive symptoms was 4.4%. Women exposed to mistreatment during childbirth were almost fifty percent more likely to have postpartum depressive symptoms (cRR 1.47; 95% CI 1.14, 1.89; p = 0.003) compared with the unexposed group. Furthermore, adolescent mothers exposed to mistreatment during childbirth had a seventy percent increased risk of depressive symptoms (aRR 1.72; 95% CI 1.23, 2.41; p = 0.002). Similarly, women who gave birth to female infants were thirty percent more likely to experience postpartum depressive symptoms (aRR 1.32; 95% CI 1.01–1.74; p = 0.039). Conclusion We observed an association between postpartum depressive symptoms and mistreatment during institutional births in Nepal. The implementation of appropriate respectful maternity care during childbirth and also routine screening for depressive symptoms is critical to improving perinatal mental health and well-being.

The Relationship Between Mode of Delivery and Postpartum Depressive Symptoms in Women

The Relationship Between Mode of Delivery and Postpartum Depressive Symptoms in Women

Postpartum depressive symptoms in women with female genital mutilation in Somalia

Objectives This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia. Methods This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu–Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale. Results Out of 446 postpartum mothers, 267 (59.9%) had increased depressive symptoms in the early postpartum period. PPD scale scores of mothers who were very poor were significantly higher depression scores than their counterparts (p = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups. Conclusions Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.

Effects of different doses of esketamine intervention on postpartum depressive symptoms in cesarean section women: A randomized, double-blind, controlled clinical study

BackgroundThe optimal dosage and method of esketamine for postpartum depressive symptoms (PDS) are unclear. We conducted a randomized controlled trial (RCT) to investigate the effect of different doses of esketamine on PDS in women undergoing cesarean section, with evidence of prenatal depression. MethodsThe three groups were high- (2 mg kg−1) and low-dose (1 mg kg−1) esketamine via patient controlled intravenous analgesia (PCIA), following an initial intravenous infusion of 0.25 mg kg−1 esketamine, compared to placebo (0.9 % saline infusion). All groups also received the sufentanil (2.2 μg kg−1). The primary outcome was the incidence of PDS at 7 and 42 days postpartum. The secondary outcomes were: the remission from depression and total EPDS scores at 7 days and 42 days postpartum; mean change from baseline in the EPDS score; postoperative analgesia. Resultsi). 0.25 mg kg−1 of esketamine intravenous infusion combined with 1 mg kg−1 (n = 99) or 2 mg kg−1 (n = 99) esketamine PCIA reduces PDS incidence at 7 days postpartum (p < 0.05), with high-dose esketamine PCIA also reduces PDS incidence 42 days postpartum (p < 0.05), compared to placebo (n = 97). ii). Low- and high-dose esketamine PCIA lowers NRS scores at rest within 48 h postoperatively (p < 0.01), with high-dose esketamine also reducing the NRS score during movement at 48 h postoperatively (p = 0.018). iii). Neither high- nor low-dose esketamine PCIA increased postoperative adverse reactions (p > 0.05). ConclusionsEsketamine (0.25 mg kg−1) intravenous infusion combined with 1 mg kg−1 or 2 mg kg−1 esketamine PCIA seems safe and with few adverse effects in the management of PDS and pain in women undergoing cesarean section. LimitationsThe tolerability and safety of esketamine requires further investigation based on more specific scales; the transient side effects of esketamine could have biased the staff and patients. Trial registrationChiCTR-ROC-2000039069.

RF16 | PSUN177 Predictors of Postpartum Depressive Symptoms in Women with Recent GDM

Abstract Background Patients with gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes mellitus (T2DM) after delivery and are encouraged to practice behaviors, such as healthy nutrition, physical activity and weight loss to attenuate future risk of T2DM. GDM has been shown to significantly increase the risk for post-partum depressive symptoms, which can impair a woman's ability to engage in and adhere to diabetes prevention efforts. To further inform the development and adapation of lifestyle interventions to prevent T2DM, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. Methods Participants are from the baseline cohort of the Balance after Baby Intervention study, a two-year randomized clinical trial of a lifestyle intervention for women with recent history GDM conducted in Boston, MA and Denver, CO between 2016-2019. Prior to randomization, a study visit was scheduled at approximately 6 weeks post-partum. At this visit, weight and height were measured for determination of BMI. We administered the Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10). We used an EPDS score of ≥9 as depressive symptoms and a PSS score of ≥14 as moderate to high perceived stress. We collected self-reported pre-pregnancy weight, and reviewed medical records to obtain medical history, including GDM diagnosis, mode of delivery, gestational weight gain and insulin use during pregnancy. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of post-partum depressive symptoms using multivariate logistic regression. Results Our study included 181 women (mean age, SD 32.6 ± 5.3 years, 51.4% White/14.4% Black/33.7% Latinx, mean pre-pregnancy BMI 29.8 ± 6.0 kg/m2). 19% of women scored ≥9 on EPDS and 53% of women scored ≥14 on PSS at the post-partum visit. Variables included in the bivariate analysis were age, Black/Latinx-identifying, college completion, perceived stress, primiparity, having a partner, pre-pregnancy BMI, gestational weight gain, C-section, insulin use during pregnancy, breastfeeding, 1st GDM pregnancy, exceeding IOM weight gain guidelines and income level. Of those variables, the best fit multivariate model with the lowest Akaike information criterion (AIC) included perceived stress, C-section and 1st GDM pregnancy. Using this model, the regression analysis showed that only perceived stress (4.5 OR, 95% CI [2.6-7.7], p was predictive of post-partum depressive symptoms. Conclusion Perceived stress was predictive of post-partum depressive symptoms in women with recent GDM. Addressing perceived stress in the early post-partum period may be an important target for development or adaptations of future lifestyle interventions to prevent T2DM in women with recent GDM. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:18 p.m. - 1:23 p.m.

839 The association between early breastfeeding cessation and postpartum depressive symptoms among women intending to breastfeed

An association between sustained breastfeeding and a decrease in postpartum depression has been identified. However, over half of US women cease breastfeeding earlier than desired. Our objective was to evaluate whether early cessation of breastfeeding is associated with postpartum depressive symptoms in women with identified mental health conditions. This retrospective cohort study included women enrolled in an outpatient collaborative care perinatal mental health program (COMPASS) during pregnancy and reported an intent to breastfeed at delivery between 02/2017-02/2020. Women were referred to COMPASS either due to a history of mental health conditions or due to incident mental health concerns. Women completed validated depression screens [Patient Health Questionnaire-9 (PHQ-9)] during pregnancy and at the postpartum visit. Scores were compared between women who intended to breastfeed but were exclusively formula feeding at the postpartum visit and women who reported continued breastfeeding. Worsening depression was defined as an increase of one standard deviation (i.e. 5 or more) on the PHQ-9 between the 2nd or 3rd trimester screen and the postpartum screen, an increase in antidepressant medication requirement, or subjective report of worsening of mood symptoms in the absence of a formalized screen. Bivariable and multivariable analyses were performed. Of the 377 women who met inclusion criteria, 314 (83%) reported continued breastfeeding at the postpartum visit. Women who intended but were not breastfeeding at the postpartum visit were more likely to experience a worsening of postpartum depressive symptoms (19.0% vs 9.2%, p=.02). After controlling for potential confounders, women who ceased breastfeeding by the postpartum visit had a greater odds of worsening depressive symptoms (aOR 2.58, 95% CI 1.15-5.78). Women with known mental health conditions or at risk for perinatal mental health conditions who desire to breastfeed but are unable to continue past the immediate postpartum period are at an increased risk of worsening mood symptoms.

Stressful life events and postpartum depressive symptoms among women with disabilities.

Purpose:Although research evidence indicates positive associations between stressful life events and postpartum depression, limited research assessed these associations in women with disabilities. This study examined the effects of stressful life events on postpartum depressive symptoms in women with disabilities.Methods:Data from the 2012–2017 Massachusetts Pregnancy Risk Assessment Monitoring System (n = 8453) were used in this study. Women were asked if they experienced any life stressors (e.g. financial, traumatic, relational, and emotional) during the 12 months prior to giving birth. Disability was measured based on reports of emotional and physical functioning. Descriptive statistics, bivariate, and binary logistic regression analyses were conducted to estimate the effect of stressful life events on postpartum depressive symptoms among women with and without disabilities.Results:Findings show that 37.4% of women with disabilities had postpartum depressive symptoms, which was significantly higher than 8.79% of women without disabilities. Stressful life events were reported in 86.6% of women with disabilities, compared to 66.6% for women without disabilities. Prevalence of three or more stressful life events and postpartum depressive symptoms was greater among women with disabilities (50.8% and 62.9%, respectively) than women without disabilities (22.6% and 37.0%, respectively). Women with disabilities experiencing six or more stressful life events were more likely (odds ratio = 3.78, 95% confidence interval = [1.57–9.10]) to report postpartum depressive symptoms, compared to those with no stressful life events. Women with disabilities who experienced relational (odds ratio = 2.36, 95% confidence interval = [1.44–3.87]) and traumatic (odds ratio = 1.75, 95% confidence interval = [1.02–3.00]) life stressors had higher odds for postpartum depressive symptoms relative to those reporting no such life stressors.Conclusion:Women with disabilities are at an amplified risk for stressful life events and postpartum depressive symptoms. Relational and traumatic stressful life events particularly increase the odds for postpartum depressive symptoms among this group of mothers. Early prenatal and postnatal screening for life stressors and depressive symptoms, coupled with timely referral for appropriate prenatal and postnatal care, are vital to mitigate the harmful effects of depression among mothers with disabilities and the health of their children.

Correlations Between SIRT Genetic Polymorphisms and Postpartum Depressive Symptoms in Chinese Parturients Who Had Undergone Cesarean Section.

ObjectiveTo investigate the association of genetic polymorphisms of SIRT with postpartum depressive symptoms and analyze the risk factors for postpartum depressive symptoms in women following cesarean section.MethodsA total of 368 Chinese woman undergoing cesarean section were enrolled in this study. A cutoff of ≥10 for the Edinburgh Postnatal Depression Scale identified postpartum depressive symptoms. Genotypes of SIRT1, SIRT2, and SIRT6 were determined using Sequenom MassArray single-nucleotide polymorphism (SNP) analysis. We analyzed the contribution of genetic factors (SNPs, linkage disequilibrium, and haplotype) to postpartum depressive symptoms and performed logistic regression analysis to identify all potential risk factors for postpartum depressive symptoms and define interactions between genetic and environmental factors.ResultsThe incidence of postpartum depressive symptoms was 18.7% in this cohort. Univariate analysis suggested that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 ((TT genotype) and SIRT6 polymorphism at rs350846 (CC genotype) and rs107251 (TT genotype) were significantly correlated with the occurrence of postpartum depressive symptoms (p<0.05). Linkage disequilibrium was identified between SIRT6 polymorphisms rs350846 and rs107251. Incidence of postpartum depressive symptoms in cesarean-section parturients with SIRT2 haplotype CCC was decreased (OR 0.407, 95% CI 0.191–0.867; p=0.016). SIRT2 polymorphisms rs2873703 and rs4801933 were multiply collinear. Logistic regression analysis showed that SIRT2 polymorphism at rs2873703 (TT genotype) and rs4801933 (TT genotype), domestic violence, stress during pregnancy, and depressive prenatal mood were risk factors for postpartum depressive symptoms (p<0.05).ConclusionPregnant women with SIRT2 genotypes rs2873703 TT and rs4801933 TT and experiencing domestic violence, stress during pregnancy, and prenatal depression are more likely to suffer from postpartum depressive symptoms.

Sociocultural stressors across the perinatal period and risk for postpartum depressive symptoms in women of Mexican descent.

In the United States, women of Mexican descent are affected by postpartum depression at disproportionate rates, often two to three times higher than the general population. Sociocultural stressors may contribute to this disparity. Traditionally, these stressors are measured at a single time point, and it is unknown if sociocultural stressors change from pregnancy to the postnatal period and if they are related to postpartum depressive symptoms. Pregnant women of Mexican descent (N = 159) were assessed for acculturation (Mexican and Anglo orientation), perceived discrimination, acculturative stress, perceived stress, and depressive symptoms during the first trimester and postpartum period. Women reported increases in Mexican orientation, t(126) = -3.503, p = .01, and decreases in acculturative stress, t(159) = -3.503, p < .001, and perceived stress, t(159) = 6.332, p < .001, from pregnancy to postpartum. Only increases in Mexican orientation were associated with less postpartum depressive symptoms (R² = 0.050, B = -2.210, SE = 0.996, t = -2.120, p = .028), even when controlling for covariates. In addition, postnatal measurements of elevated acculturative stress and less Mexican orientation (R² = 0.127, B = 0.133, SE = 0.036, t = 3.721, p < .001; B = -2.194, SE = 0.769, t = -2.853, p < .001, respectively) were associated with more postpartum depressive symptoms; however, only Mexican orientation remained significant after covariates. Sociocultural stressors change across the perinatal period and contribute to postpartum depressive symptoms. Findings implicate a need for consideration of sociocultural stressors in postpartum depression prevention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Post-partum depressive symptoms and medically assisted conception: a systematic review and meta-analysis

Does medically assisted conception increase the risk of post-partum depressive symptoms? Our literature review and meta-analysis showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. Women who conceive with medically assisted conception, which can be considered as a stressful life event, could face an increased risk of depressive symptoms. However, no previous meta-analysis has been performed on the association between medically assisted conception and post-partum depressive symptoms. A systematic review with electronic searches of PubMed, ISI Web of Knowledge and PsycINFO databases up to December 2014 was conducted to identify articles evaluating post-partum depressive symptoms in women who had benefited from medically assisted conception compared with those with a spontaneous pregnancy. Meta-analyses were also performed on clinically significant post-partum depressive symptoms according to PRISMA guidelines. From 569 references, 492 were excluded on title, 42 on abstract and 17 others on full-text. Therefore, 18 studies were included in the review and 8 in the meta-analysis (2451 women) on clinically significant post-partum depressive symptoms after medically assisted conception compared with a spontaneous pregnancy. A sensitivity meta-analysis on assisted reproductive technologies and spontaneous pregnancy (6 studies, 1773 women) was also performed. The quality of the studies included in the meta-analyses was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology Statement for observational research. The data were pooled using RevMan software by the Cochrane Collaboration. Heterogeneity between studies was assessed from the results of the χ(2) and I(2) statistics. Biases were assessed with funnel plots and Egger's test. A fixed effects model was used for the meta-analyses because of the low level of heterogeneity between the studies. The systematic review of studies examining post-partum depressive symptoms after medically assisted conception compared with spontaneous pregnancy is not in favor of an association. Our meta-analysis on clinically significant post-partum depressive symptoms showed no significant difference between women who used medically assisted conception and those with spontaneous pregnancy: odds ratio (OR) = 0.93 (0.67-1.31), Z = 0.40, P = 0.69. The sensitivity meta-analysis reported no significant difference either: OR = 1.04 (0.71-1.52), Z = 0.18, P = 0.86. The literature on post-partum depressive symptoms and medically assisted conception is sparse. Only eight studies were available for our meta-analysis taking into account the rates of clinically significant post-partum depressive symptoms after medically assisted conception. However, the quality of the studies was high and the heterogeneity between trials was not significant. Whilst post-partum anxiety is more prevalent than depressive states and they can co-occur, it was not considered in these review and meta-analyses. In addition, other risk factors, such as maternal age, socio-demographic data or obstetric factors, are important for the assessment of post-partum depressive symptoms. Our review reported that several of these confounding risk factors were, however, analyzed and controlled for in the studies. Our literature review and meta-analyses showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. Even if the rates of depressive symptoms are the same in the medically assisted conception population as among controls, the risk factors could be different. Though medically assisted conception can be considered as a stressful life event, these women have also lower prevalence of the usual risks. Professionals should also be careful to screen for prenatal and post-partum depressive symptoms, as with all pregnant women. Further studies are needed to clarify the specific features of post-partum depressive symptoms in this population.

Incidence and Risk Factor of Postpartum Depressive Symptoms in Women: A Population Based Prospective Cohort Study in a Rural District in Bangladesh

Objective: Limited evidence exists on the incidence of postpartum depressive symptoms (PDS) in low-income countries. This study aims to determine the incidence of and risk factors for developing PDS in a cohort of women in rural Bangladesh. Methods: A total of 588 consecutive women were assessed during the last trimester of pregnancy, 2-3 and 6-8 months postpartum for depressive symptoms and for putative risk factors. The validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure PDS. Background information was collected using a structured questionnaire at the respondents' homes. Multiple Cox's regression analyses identified risk factors of PDS. Results: The incidence proportion of PDS from third trimester of pregnancy to 2-3 months postpartum was 8.0%, and from 2-3 to 6-8 months postpartum 18.4%. Poor socioeconomic status (HR 2.62, 95% CI 1.83-3.73), physical partner violence during pregnancy (HR 1.65, 95% CI 1.08-2.50), anxiety symptoms during pregnancy (HR 1.69, 95% CI 1.16-2.46), and previous depressive symptoms (HR 2.95, 95% CI 1.80-4.84) were identified as risk factors. Conclusion: PDS are common, heterogeneous and largely undetected public health problem in Bangladesh. Screening for depressive symptoms in the last trimester of pregnancy or in the 6-8 months postpartum ought to be integrated into maternal and child health programmes. Intervention to reduce depressive symptoms during postpartum needs to target those women who are poor, experienced violence during pregnancy, had anxiety symptoms during pregnancy, and had a previous history of depressive symptoms.

Infertility History

The aim of this cohort study was to assess postpartum depressive symptoms in women who had been successfully treated for primary infertility at 2 teaching hospitals in Turkey in 2008. The study groups comprised 51 fertile and 105 infertile women. The number of participants lost to follow-up was 28 fertile and 8 infertile women. "Descriptive Information Questionnaire" developed by the authors, the adapted "Beck Depression Inventory," and the adapted "Postpartum Depression Scanning Scale" were used to collect data. The probability of developing postpartum depression in the infertile group is 1.352 times higher than that in the fertile group. However, this result cannot be considered to be statistically meaningful. A similar correlation was present between the level of depressive symptoms during pregnancy and in the postpartum period in both the infertile and fertile groups. Additional risk factors such as health issues during pregnancy, the notion that pregnancy causes a decrease in libido and negative body image, the infant's gender, pain from incision or infection, and dyspareunia were manifest in the fertile women, but not in the infertile women. A history of infertility is not a major factor in postpartum depression. However, a history of depression may contribute to its development during pregnancy and in the postpartum period. Infertile women who experience severe anxiety and stress could be more prone to depression and should therefore be monitored closely.

Family structure and depressive symptoms in men preceding and following the birth of a child. The Avon Longitudinal Study of Pregnancy and Childhood Study Team.

The prevalence and etiology of pre- and postpartum depressive symptoms in women in a variety of family forms have been well documented, but relatively little research has been conducted on the adjustment of their male partners. The authors' goals in this study were 1) to estimate rates of depression during the pregnancy and 8 weeks following the birth of a child in a large representative community sample of fathers in different family structures and 2) to explore the role of stressful life events, social and emotional support, the quality of the partner relationship, and socioeconomic circumstances. This study describes the relations of family setting and other correlates to men's depressive symptoms during the pregnancies (18 weeks gestation, on average) and 8 weeks after the births of children for 7,018 partners of female participants in the Avon Longitudinal Study of Pregnancy and Childhood. Men living in stepfamilies had-significantly higher levels of depressive symptoms before and after the birth than did men in more traditional families. The effect of stepfamily status on depression was mediated by education, life events, social support, social network, and level of aggression in the partnership. There are similarities in the patterns and correlates of depression after the birth of a child for men and women. These findings point to the importance of family and partnership ecology in the adjustment of men before and after the birth of a child.