Postpartum Depression In Patients Research Articles

Stratifying Risk for Postpartum Depression at Time of Hospital Discharge.

Postpartum depression (PPD) represents a major contributor to postpartum morbidity and mortality. Beyond efforts at routine screening, risk stratification models could enable more targeted interventions in settings with limited resources. Thus, we aimed to develop and estimate the performance of a generalizable risk stratification model for PPD in patients without a history of depression using information collected as part of routine clinical care. We performed a retrospective cohort study of all individuals who delivered between 2017 and 2022 in one of two large academic medical centers and six community hospitals. An elastic net model was constructed and externally validated to predict PPD using sociodemographic factors, medical history, and prenatal depression screening information, all of which was known before discharge from the delivery hospitalization. The cohort included 29,168 individuals; 2,703 (9.3%) met at least one criterion for postpartum depression in the 6 months following delivery. In the external validation data, the model had good discrimination and remained well-calibrated: area under the receiver operating characteristic curve 0.721 (95% CI: 0.707-0.734), Brier calibration score 0.088 (95% CI: 0.084 - 0.092). At a specificity of 90%, the positive predictive value was 28.0% (95% CI: 26.0-30.1%), and the negative predictive value was 92.2% (95% CI: 91.8-92.7%). These findings demonstrate that a simple machine-learning model can be used to stratify the risk for PPD before delivery hospitalization discharge. This tool could help identify patients within a practice at the highest risk and facilitate individualized postpartum care planning regarding the prevention of, screening for, and management of PPD at the start of the postpartum period and potentially the onset of symptoms.

Analysis of factors related to postpartum depression in pregnancy-induced hypertension syndrome patients and construction and evaluation of nomograms.

It is positive to integrate and evaluate the risk factors for postpartum depression in patients with pregnancy-induced hypertension syndrome and to detect high-risk patients as early as possible, which has application value for the clinical development of personalized prevention programs and prognosis of patients. To analyze factors related to postpartum depression in patients with pregnancy-induced hypertension and construct and evaluate a nomogram model. The clinical data of 276 patients with pregnancy-induced hypertension admitted to Huzhou Maternity and Child Health Care Hospital between January 2017 and April 2022 were retrospectively analyzed. We evaluated the depression incidence at 6 wk postpartum. The depression group included patients with postpartum depression, and the remainder were in the non-depression group. Multivariate logistic regression analysis and the LASSO regression model were applied to analyze the factors related to postpartum depression in patients with pregnancy-induced hypertension. After that, a risk prediction model nomogram was constructed and evaluated. Multivariate logistic regression analysis showed that vitamin A deficiency (VAD) during pregnancy and puerperium, family history of hypertension, maternal intestinal flora imbalance, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were independent risk factors for postpartum depression in patients with pregnancy-induced hypertension (P < 0.05). We constructed the nomogram model based on these five risk factors. The area under the curve, specificity, and sensitivity of the model in predicting postpartum depression in patients with pregnancy-induced hypertension was 0.867 (95% confidence interval: 0.828-0.935), 0.676, and 0.889, respectively. The average absolute error was 0.037 (Hosmer-Lemeshow test χ2 = 10.739, P = 0.217). VAD during pregnancy and puerperium, family history of hypertension, maternal intestinal flora imbalance, EPA, and DHA affect postpartum depression in patients with pregnancy-induced hypertension.

Clinical factors associated with a positive postpartum depression screen in people with cardiac disease during pregnancy.

While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies. This retrospective cohort study included pregnant patients with congenital and/or acquired cardiac disease who delivered at a single institution between 2014 and 2020. The primary outcome was a positive postpartum depression screen, defined as Edinburgh Postpartum Depression Score (EPDS) ≥10. Potential exposures were selected a priori and compared between patients with and without a positive postpartum depression screen using Wilcoxon rank-sum and Fisher's exact tests. Secondary outcomes were responses to a longitudinal follow-up survey sent to English-speaking patients evaluating cardiac status, mental health, and infant development. Of 126 eligible cardiac patients, 23 (18.3%) had a positive postpartum depression screen. Patients with a positive postpartum depression screen were more likely to have had antepartum anticoagulation with heparin or enoxaparin (56.5% versus 26.2%, p=0.007), blood transfusion during delivery (8.7% versus 0%, p=0.032), and maternal-infant separation postpartum (52.2% versus 28.2%, p=0.047) compared to patients with a negative screen. Among 29 patients with a positive screen who responded to the follow up survey, 50% reported being formally diagnosed with anxiety or depression and 33.3% reported child development problems. Our results highlight the importance of screening for postpartum depression in patients with cardiac disease, especially those requiring antepartum anticoagulation or maternal-infant separation postpartum.

Prevalence of postpartum depression in patients with migraine

Introduction Migraine is a disease of the central nervous system characterized by moderate or severe headache. Migraine is considered the third most prevalent disease and the seventh specific cause of incapacity in the world. The prevalence of migraine in women increase after menarche compared with the prevalence of migraine in men. According to previous population-based studies, during reproductive years, a woman who has the diagnosis of menstrual migraine experiences the same symptoms throughout pregnancy and postpartum. Childbirth is a major event in a woman’s life. However, some mothers might present symptoms of postnatal depression. Postpartum depression is a mental disorder that reflects on the maternal role. Thus, it has negative consequences for them and their children. Postpartum depression is associated with increased risk for cognitive BB impairment, emotional difficulties and behavioral problems. Clinically, headache influences the mental and physical health of pregnant and postpartum women. Studies reported that anxiety and depression disorders are two to ten times more common in migraineurs than in the general population. Therefore, it can be a risk for postpartum depression development. Objective To verify postpartum depression in migraine and non-migraine parturients. Methods Data was collected from a sample of 155 women, older than 18 years old, in the obstetric center of Santa Casa de Misericórdia de Barbacena, between October 2021 and August 2022, in the first 24 hours after labor by the members of the research. Clinic and concomitant disorders were collected from the patient's record. Parturients who did not agree to participate in the study and those with cognitive impairment were excluded. All the patients signed an informed consent form to participate in the study. All the patients answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-Migraine... (To see the complet abstract, please, check out the PDF.)

Prevalence of postpartum depression in patients with migraine

Introduction Migraine is a frequent and chronic condition that affects 3 times more women than men. Overall, it shows that migraine is influenced by variables such as fluctuating hormones levels throughout life with migraine. Women can also experience symptoms of postpartum depression (PPD) which can cause issues for new moms in terms of behavior, emotion and cognition. Clinical investigations have shown that headaches affects pregnants and parturients. Objective To verify PPD in migraine and non-migrainous parturients. Methods Data was collected from a sample of 155 women over 18 years old in the obstetric center of Santa Casa de Misericórdia de Barbacena, from October 2021 to August 2022, in the first 24 hours after labor. Parturients who did not agree to participate and those with cognitive impairment were excluded. All patients signed an informed consent form and answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-MigraineTM, in addition to clinic data and concomitant disorders from the patient's record. Results 25 of the 155 postpartum women achieved the criteria for migraine and 130 for non-migraine. Of the patients with postpartum depression associated with migraine, 4 were classified as migraine and 8 as non-migrainous. Among patients who had headaches during pregnancy, 11 had PPD compared to those who did not have headaches during pregnancy: 1. The OR=8.9 (CI 1.12-70) and RR=7.9 (CI 1.05-60) were higher compared to those who did not have PPD. The analysis did not find a relation between migraine and PPD. However, a relation was found between headaches during pregnancy and the presence of PPD (p&lt;0.05). Conclusion Patients who experienced headaches while pregnant are more likely to have postpartum depression. However, migraine-diagnosed puerperal women do not present considerable concerns for the development of depression.

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara.

Purpose To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara. Methods 300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T0), at full opening of the uterus (T1), at the end of the second stage of labor (T2), and at the end of the third stage of labor (T3); stress response indicators at T0 and T1: epinephrine (E), norepinephrine (NE), glucose (Glu), and β-endorphin (β-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2); incidence of postpartum depression (PPD) at 6 weeks after delivery. Results At T1, T2, and T3, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W (P < 0.05). At T0, there was no significant difference in the comparison of E, NE, Glu, and β-EP levels among the three groups (P > 0.05). At T1, the levels of E, NE, Glu, and β-EP were higher in the three groups than in the same group at T0, the levels of E, NE, and Glu were lower, the levels of β-EP were higher in groups W and WM than in group A, and the levels of β-EP were higher in group WM than in group W (P < 0.05). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W (P < 0.05). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference (P > 0.05). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference (P > 0.05). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference (P > 0.05). Comparing the PH, BE, PaO2, and PaCO2 of three groups of newborns after delivery, there were no significant differences (P > 0.05). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) (P < 0.05). Conclusion The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.

Association between labor and delivery pain and postpartum pain with symptoms and clinical diagnosis of postpartum depression in patients with overweight and obesity

PurposeChildbirth pain has been associated with the risk for postpartum depression. However, existing studies have been limited by the use of depression screening tools as outcomes, and none to date have used a structured clinical interview for DSM-V (SCID), which is considered the gold standard for psychiatric diagnoses. This study aimed to quantify the relationships between labor and postpartum pain and postpartum depression diagnosis detected by SCID, as well as depression symptoms detected by the Center for Epidemiological Studies Depression Scale (CESD) screening tool, among a high-risk cohort.MethodsThe study was a secondary analysis of a prospective observational study of a cohort of women enriched for high risk for depression, i.e., pregnant women originally enrolled in a prospective study investigating factors leading to excessive gestational weight gain. Subjects were assessed prospectively for depression using both SCID and CESD at the third trimester and at 6 months postpartum. Overweight and obesity were defined as pre-gravid body mass index (BMI) ≥ 25 kg/m2. Both vaginal and cesarean deliveries were included in the cohort. Pain scores (0–10 numeric rating scale) during childbirth and after delivery were correlated with CESD and SCID. Propensity score matching was performed with propensity groups defined as those with low–moderate postpartum pain and those with high postpartum pain. The relationships between pain measures and 6-month postpartum depression diagnosis by SCID, and between pain measures and 6-month postpartum depression symptoms by CESD, were assessed by unweighted logistic regression and by logistic regression weighted by propensity score derived by average treatment effect (ATE) adjusted for baseline covariates.ResultsThere were 237 subjects in the cohort for analysis. Labor and postpartum pain were not associated with depression diagnosis by SCID at 6 months postpartum. However, postpartum pain, but not labor pain, was associated with depressive symptoms on the CESD at 6 months postpartum. Women with higher maximum postpartum pain scores had significantly higher odds of developing clinically significant postpartum depressive symptoms at 6 months, compared to those with lower pain scores in the unweighted model (OR: 1.3, 95% CI 1.0, 1.5; P = 0.005) and ATE-weighted models (OR: 1.2, 95% CI 1.0, 1.5; P = 0.03). Consistent with prior work, SCID and CESD were strongly associated, and 92.9% (13/14) of participants with postpartum depression diagnosis by 6-month SCID also showed high CESD symptomology, P < 0.0001).ConclusionsAlthough labor and postpartum pain were not associated with clinical diagnosis of depression (SCID) at 6 months postpartum, postpartum pain was linked to 6-month postpartum depression symptoms. Depressive symptoms are more likely to be exhibited in women with higher postpartum pain, potentially reflecting poorer birth recovery. The contribution of postpartum pain and depressive symptoms to overall patterns of poor recovery after childbirth should be assessed further.

Incidence and Risk Factors for Postpartum Depression Among Women with Early Severe Preeclampsia

Patients admitted with severe preeclampsia before 34 weeks (early sPREX) have multiple known risk factors for postpartum depression (PPD) including preterm delivery, low birthweight infants, and a stressful life event. Minimal data exist characterizing the development of PPD in patients with early sPREX. We aim to evaluate the incidence and identify risk factors of PPD in this population.

112 Incidence of postpartum depression (PPD) in SARS-CoV-2 positive mothers who underwent maternal-neonatal separation

To evaluate the incidence of postpartum depression in mothers who endured maternal-neonatal separation at delivery and in the postpartum period due to their SARS-CoV-2 positive PCR status. We conducted a retrospective cohort study of women who delivered during the height of the COVID-19 pandemic from March 18th to May 12th 2020, when maternal-neonatal separation was recommended for SARS-CoV-2 positive mothers by the American Academy of Pediatrics. We excluded women who were less than 18 years of age at the time of delivery and those who experienced an IUFD or neonatal death. We investigated the difference in postpartum depression rates between SARS-CoV-2 positive and SARS-CoV-2 negative mothers. SARS-CoV-2 status was determined using a nasopharyngeal PCR swab upon admission to labor and delivery. We conducted analyses using Fischer Exact Tests, where a p-value of less than 0.05 was considered to be statistically significant. The incidence of postpartum depression was 2.4% in SARS-CoV-2 negative mothers versus 10.3% in SARS-COV-2 positive mothers with a p-value of 0.02. The relative risk of developing PPD in SARS-CoV-2 positive mothers was 3.73 with a 95% confidence interval of 1.03-13.4 with a p-value of 0.04. There was increased incidence and relative risk of postpartum depression in patients who were positive for SARS-CoV-2. Patients and providers should be made aware of this possible association. One possible contributing factor to the increased incidence of postpartum depression may have been maternal-neonatal separation. Current CDC evidence demonstrates low risk of neonatal acquisition of SARS-CoV-2 from asymptomatic positive mothers. The results of this study suggest another reason to follow the updated American Academy of Pediatrics SARS-CoV-2 recommendation, that asymptomatic mothers positive for SARS-CoV-2 should be allowed to room in with their neonate and not endure maternal-neonatal separation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk Factors for the Development of Antepartum &amp; Postpartum Depression in Patients Hospitalized During Pregnancy [16D

INTRODUCTION: Postpartum depression is a recognized public health issue that affects 1 in 9 women nationally. However, less is known about antepartum depression in women, especially those hospitalized during their pregnancies. METHODS: This is a prospective cohort study that analyzes how certain characteristics influence the likelihood of pregnant women to develop anxiety and depression during their hospitalizations and in the postpartum period. Patients completed the Edinburgh Postnatal Depression Scale (EPDS) on admission and six week follow-up and an additional questionnaire. RESULTS: Of 93 women, 33% had a positive EPDS on admission. For the 49 women with six week follow-up data, 20% had a positive EPDS. High EPDS on admission was not correlated with high EPDS on follow-up. Number of living children, and maternal cause for this admission were correlated with higher EPDS scores on admission, and spirituality, greater gestational age, and fetal cause for this admission were correlated with lower EPDS scores. At six week follow-up visits, NICU admission during this pregnancy and previous hospitalization in pregnancy were associated with higher EPDS, and number of days in the NICU during this pregnancy was associated with lower EPDS scores. CONCLUSION: There are many unmet needs for women during pregnancy and in in the postpartum period. It is therefore imperative that we include depression screening as a routine part of admission for high risk pregnancies. Additionally, by identifying certain factors that may prevent or predispose women to depression, we can better screen patients who may benefit from increased psychosocial support surrounding their pregnancy.

Development of Postpartum Depression in Pregnant Women with Preeclampsia: A Retrospective Study.

Background Postpartum depression (PPD) and preeclampsia (PE) are both common diseases in obstetrics that affect maternal health and infant development. However, the relationship between the two diseases still requires clarification. Objective The purpose of this study was to (1) determine the incidence rate of PPD in patients with PE and (2) identify the association between the prevalence of PPD and the severity of PE. Methods We conducted a retrospective analysis of women with and without PE who delivered between January 1, 2017, and August 30, 2018, in the First Affiliated Hospital of Chongqing Medical University. We used a questionnaire survey methodology that included the Edinburgh Postnatal Depression Scale (EPDS) to test the influence of PE on the development of new-onset PPD in the 6 weeks after delivery. We determined PPD based on a score ≥10 on the EPDS. Bivariate analysis was used to compare data between the two groups. Results A total of 180 women participated in this study. Thirty-five people screened positive for PPD, while the remaining 145 screened negative. The prevalence of PPD was 26.67% (24/90) in patients with PE, which was two times the prevalence in normal women (12.22%). Multiple logistic regression showed that women who had PE had nearly 3-fold increased odds of PPD compared to normal women and the risk of PPD increased with the aggravation of PE. Patients with severe PE had a more than 4-fold increased risk of screening positive for PPD. Conclusion PE was independently associated with PPD. Furthermore, the risk of PPD seemed to increase with the aggravation of PE. Thus, additional prevention efforts and support methods should be provided for women with PE to reduce the incidence of PPD.

Clinical features and risk factors for post-partum depression in a large cohort of Chinese women with recurrent major depressive disorder

BackgroundPost partum depression (PPD) is relatively common in China but its clinical characteristics and risk factors have not been studied. We set out to investigate whether known risk factors for PPD could be found in Chinese women.MethodsA case control design was used to determine the impact of known risk factors for PPD in a cohort of 1970 Chinese women with recurrent DSM-IV major depressive disorder (MDD). In a within-case design we examined the risk factors for PPD in patients with recurrent MDD. We compared the clinical features of MDD in cases with PPD to those without MDD. Odds ratios were calculated using logistic and ordinal regression.ResultsLower occupational and educational statuses increased the risk of PPD, as did a history of pre-menstrual symptoms, stressful life events and elevated levels of the personality trait of neuroticism. Patients with PPD and MDD were more likely to experience a comorbid anxiety disorder, had a younger age of onset of MDD, have higher levels of neuroticism and dysthymia.LimitationsResults obtained in this clinical sample may not be applicable to PPD within the community. Data were obtained retrospectively and we do not know whether the correlations we observe have the same causes as those operating in other populations.ConclusionsOur results are consistent with the hypothesis that the despite cultural differences between Chinese and Western women, the phenomenology and risk factors for PPD are very similar.

Identification of bipolar disorder in women with postpartum depression

No studies to date have assessed the pharmacological management of treatment-resistant postpartum depression. We reviewed the pharmacological treatment of postpartum depression in patients diagnosed with treatment-resistant 'unipolar' depression. We conducted a chart review of patients treated consecutively at a perinatal clinic. Treatment-resistant postpartum depression was defined as a failure to respond to at least one adequate antidepressant trial. Patients were diagnosed using the DSM-IV criteria, and the Clinical Global Impression-Improvement (CGI-I) rating scale was used to assess response to various pharmacological interventions. The majority of patients (57%, 34/60) referred for postpartum depression actually suffered from bipolar disorder. All patients were on antidepressants at the time of referral, but by the end of the study 37% (22/60) continued on antidepressants alone or in combination with other medications. CGI-I ratings showed appreciable improvement in depression at the end of six months following the initial consultation. Very much improvement was noted in 65% (39/60) of patients, and 22% (13/60) were considered much improved. The most common change in medication was a switch to or addition of an atypical neuroleptic. Retrospective design, small sample size, and lack of a control group. Management of treatment resistance in women with postpartum depression should be considered within the context of types of mood disorders. Atypical neuroleptics and mood stabilizers used alone or as adjuncts should be considered in the treatment of resistant postpartum depression in patients with a bipolar diathesis.

Epilepsy and postpartum depression

Postpartum depression occurs in 10-20% of women who have recently given birth, but less than half of cases are recognized. The purpose of this study was to examine whether there was a difference in the rate of postpartum depression between patients with epilepsy and healthy controls, and to determine the relationship between epilepsy and postpartum depression. The sample consisted of 55 patients with epilepsy and 55 patients without epilepsy. All patients were recruited at the Regional Epilepsy Center and at the Department of Obstetrics and Gynecology, University of Milan, St. Paolo Hospital (Italy). Every woman was assessed with the Edinburgh Postnatal Depression Scale and a clinical interview to screen for postpartum depression. We found a statistically significant higher rate of postpartum depression in patients with epilepsy compared with controls (p < 0.05). These findings highlight the importance of screening for postpartum depression; it can improve the recognition of the disorder and can provide adequate treatment and follow-up.

Postpartum depression in women with epilepsy versus women without epilepsy

The goal of this study was to determine if there is a significant difference in the rate of postpartum depression among patients with epilepsy and healthy controls. All patients were recruited from the Epilepsy Center and the Department of Obstetrics and Gynecology, University of Milan, St. Paolo Hospital (Milan, Italy). Thirty-five pregnant women with epilepsy and an equal number of pregnant women without epilepsy were assessed with the Edinburgh Postnatal Depression Scale (EPDS), a clinical interview used to screen for postpartum depression (PPD), and a sociodemographic questionnaire. The rate of PPD in patients with epilepsy was statistically significantly higher than that of the controls ( P < 0.05). PPD was present in 29% of the patients with epilepsy and 11% of the controls. In conclusion, it is very important to point out that in our pilot study, the rate of PPD was higher among women with epilepsy than among women without epilepsy. In this regard, women at higher PPD risk can be identified earlier and treated as soon as possible to alleviate their symptoms and improve their quality of life.

Omega-3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open-label pilot study.

Based on the putative relationship between depleted omega-3 fatty acids and postpartum depression, we initiated an open-label pilot study of omega-3 fatty acid supplementation with the aim of preventing postpartum depression. Euthymic pregnant females with a past history of depression in the postpartum period were started on 2960 mg of fish oil (1.4:1 eicosapentaenoic acid:docosahexaenoic acid) per day between the 34th to 36th week of pregnancy and assessed through 12 weeks postpartum. Four of seven participants had a depressive episode during the study period. No participants withdrew from the study due to adverse events. This preliminary, small, open-label pilot study failed to show promising results for the use of omega-3 fatty acid monotherapy beginning at 34 to 36 weeks gestation for the prevention of postpartum depression in patients with a prior postpartum depression history. Controlled studies are lacking.