Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD.

BACKGROUND: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. METHODS: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. RESULTS: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. CONCLUSION: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.

Dose-response associations of maternal prenatal noise exposure duration with antepartum depression status.

BACKGROUND: Antepartum depression has been reported to be associated with the intensity of maternal prenatal noise exposure; however, the association between noise exposure duration and the development of antepartum depression has not been established. This study aimed to determine the total and trimester-specific association of prenatal noise exposure duration with the development of antepartum depression. METHODS: From May 2018 to June 2021, we recruited 2,166 pregnant women from Shengjing Hospital, northeast China. We used a standardized questionnaire to assess women's prenatal noise exposure and used the Edinburgh Postnatal Depression Scale to assess pregnant women's antepartum depression during the 1st -, 2nd -, and 3rd - trimesters. We calculated a cumulative noise exposure score ranging from 0 to 3, with a higher score reflecting higher frequency and longer duration of noise exposure during pregnancy. RESULTS: Women who were exposed to noise for ≥ 15 min per day had an increased risk of antepartum depression compared with women who were not exposed to noise during pregnancy [odds ratio (OR) = 1.83, 95%CI:1.18, 2.83]. Noise exposure in a specific trimester was associated with higher risk of depression in the same trimester and subsequent trimesters. We observed increases in antepartum depression risk with increasing cumulative noise exposure scores (P for trend < 0.05 for all). Pregnant women with the highest scores had the highest risk of antepartum depression during the first (OR = 1.30, 95%CI:1.02, 1.65), second (OR = 1.75, 95%CI:1.23, 2.50) trimesters. Women with a cumulative noise exposure score of 2 had the highest risk of antepartum depression during the third trimester (OR = 1.79, 95%CI:1.14, 2.80), as well as during the whole pregnancy (OR = 1.94, 95%CI:1.14, 3.30). CONCLUSIONS: Maternal prenatal noise exposure duration was positively associated with antepartum depression risk in a dose-response manner. It is necessary to develop strategies by which pregnant women can avoid excessive exposure to noise to prevent antepartum depression.

The Role of Social Support in Perinatal Mental Health and Psychosocial Stimulation.

Social support refers to the help someone receives emotionally or instrumentally from their social network. Poor social support in the perinatal period has been associated with increased risk for symptoms of common mental disorders, including depression and posttraumatic stress symptoms (PTS), which may impact parenting behavior. Whether social support impacts parenting behaviors, independent of mental health symptomatology, remains unclear. Among N=309 participants of the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT Trial), a large perinatal depression and anxiety treatment trial, we explored the relations between perceived social support, perinatal depressive and PTS symptoms, and psychosocial stimulation provided by the parent in their home environment. Social support was measured at baseline using the Multidimensional Scale of Perceived Social Support (MSPSS). Perinatal depressive symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS) and PTS symptoms were measured by the Abbreviated PTSD Checklist (PCL-6) at baseline, 3-, and 6-months post-randomization. Psychosocial stimulation was assessed by the Home Observation Measurement of the Environment (HOME) when the infant was between 6 to 24 months. Using stepwise hierarchical regressions, we found: (1) perceived social support at baseline significantly predicted both depressive and PTS symptoms at 3-months post-randomization, even when controlling for baseline depressive and PTS symptoms; and (2) while neither depressive nor PTS symptoms were significantly associated with psychosocial stimulation, perceived social support at baseline was a significant predictor. Clinical implications regarding treatment of perinatal patients are discussed.

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

Selenium Intake and Postnatal Depression-A Short Review.

Postnatal depression is a common and severe complication of childbirth. It is an important public health problem with significant implications for both mothers and children. The exact mechanisms underlying and the factors influencing the occurrence of postnatal depression remain unclear. The literature suggests that certain dietary deficiencies during pregnancy and the postnatal period may contribute to a greater risk of maternal depression. This review focuses on the role of selenium in postnatal depression. It collects evidence from published interventional and observational studies investigating the relationship between selenium intake during the antenatal and postnatal periods and the mental status of postpartum women and summarises information about biological mechanisms that may underlie the association between selenium status and postnatal depression. The review includes studies identified through electronic searches of Medline (via PubMed) and Google Scholar databases until December 2023. Despite the small number of relevant studies and their potential methodological limitations, the findings suggest that optimizing selenium status may support the prevention and treatment of postnatal depression. Further longitudinal and interventional studies are necessary to confirm the clinical significance of these effects.

Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective. / Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Urban environment in pregnancy and postpartum depression: An individual participant data meta-analysis of 12 European birth cohorts.

BACKGROUND: Urban environmental exposures associate with adult depression, but it is unclear whether they are associated to postpartum depression (PPD). OBJECTIVES: We investigated associations between urban environment exposures during pregnancy and PPD. METHODS: We included women with singleton deliveries to liveborn children from 12 European birth cohorts (N with minimum one exposure = 30,772, analysis N range 17,686-30,716 depending on exposure; representing 26-46 % of the 66,825 eligible women). We estimated maternal exposure during pregnancy to ambient air pollution with nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10), road traffic noise (Lden), natural spaces (Normalised Difference Vegetation Index; NDVI, proximity to major green or blue spaces) and built environment (population density, facility richness and walkability). Maternal PPD was assessed 3-18 months after birth using self-completed questionnaires. We used adjusted logistic regression models to estimate cohort-specific associations between each exposure and PPD and combined results via meta-analysis using DataSHIELD. RESULTS: Of the 30,772 women included, 3,078 (10 %) reported having PPD. Exposure to PM10 was associated with slightly increased odds of PPD (adjusted odd ratios (OR) of 1.08 [95 % Confidence Intervals (CI): 0.99, 1.17] per inter quartile range increment of PM10) whilst associations for exposure to NO2 and PM2.5 were close to null. Exposure to high levels of road traffic noise (≥65 dB vs. < 65 dB) was associated with an OR of 1.12 [CI: 0.95, 1.32]. Associations between green spaces and PPD were close to null; whilst proximity to major blue spaces was associated with increased risk of PPD (OR 1.12, 95 %CI: 1.00, 1.26). All associations between built environment and PPD were close to null. Multiple exposure models showed similar results. DISCUSSION: The study findings suggest that exposure to PM10, road traffic noise and blue spaces in pregnancy may increase PPD risk, however future studies should explore this causally.

Prospective analysis of factors associated with perinatal depression.

BACKGROUND: Perinatal depression is a significant public health problem that has adverse effects on both mothers and infants. Little research has been conducted on how depressive symptoms change throughout the perinatal period, especially in the Middle East. This study examines changes in depressive symptoms from pregnancy to the postnatal period, and what explains these changes. METHODS: This prospective study recruited 306 Omani women in the third trimester of pregnancy and followed them up two to eight weeks after delivery. The Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥12, was used to assess depressive symptoms in both the antenatal and postnatal periods. Independent t-tests, one-way ANOVA, Tukey's honestly significant difference test and Chi-square tests were used to analyse the data. RESULTS: The prevalence of depressive symptoms was 27.12 % (n = 83) during late pregnancy and 29.30 % (n = 81) during the postnatal period. Four groups of women were identified based on the EPDS scores: 1) antenatal depression group (8.82 %; n = 27); 2) ante- and postnatal depression group (14.38 %; n = 44); 3) postnatal depression group (12.09 %; n = 37); and 4) non-depression group (54.90 %; n = 168). Depressive symptoms were associated with low birth weight babies (d = 0.50), which confirms the negative effects of depression on perinatal health outcomes. When compared to the non-depression group, the three depressed groups had higher antenatal Perceived Stress Scale (PSS) scores (ds > 0.52), while the non-depression group had higher antenatal and postnatal Maternity Social Support Scale (MSSS) scores (ds > 0.63), and better relationships with the mother-in-law antenatally (d= 0.57). CONCLUSION: The present study of this Middle Eastern cohort shows that there were distinct groups of women experiencing perinatal depressive symptoms, influenced by various psychosocial and obstetric factors, which were comparable to those identified in more regularly studied populations. However, this study also identified other novel factors, such as the quality of family relationships. There is a need for additional research into the factors associated with these groups in order to develop appropriate interventions.

Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica / Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Mecanismos neuroendocrinos a la base de la asociación entre salud mental materna y lactancia / Neuroendocrine mechanisms underlying the association between maternal mental health and breastfeeding

La lactancia materna es fundamental para la salud del infante y se ve influida por diversos factores, entre ellos la salud mental materna. En particular, las madres que tienen síntomas depresivos tienen mayor riesgo de presentar dificultades de lactancia y de interrumpir tempranamente la lactancia exclusiva y la lactancia en general. Por otra parte, la lactancia materna actúa como un factor protector de la salud mental materna en algunas circunstancias, en tanto las dificultades de lactancia tienen un impacto negativo en la salud mental de la mujer. La presente revisión describe algunos de los mecanismos fisiológicos que subyacen al establecimiento y la mantención de la lactancia, asociados a la prolactina, la oxitocina, la dopamina y la serotonina, así como a la experiencia de la lactancia y la presencia de dificultades en esta área, y como estas interactúan con las dificultades emocionales de la madre. Se ofrece un modelo integrativo que considera aspectos hormonales y fisiológicos para comprender la asociación compleja y bidireccional entre el establecimiento de una lactancia exitosa y la salud mental materna.

Breastfeeding is essential for infant health and development. It is influenced by multiple factors, including maternal mental health. In particular, mothers who present depressive symptoms are at greater risk of presenting breastfeeding difficulties and presenting shorter exclusive breastfeeding and breastfeeding in general. On the other hand, breastfeeding acts as a protective factor for maternal mental health in some circumstances. Also, breastfeeding difficulties have a negative impact on womens mental health. This review describes some of the physiological mechanisms underlying the establishment and maintenance of lactation, associated with prolactin, oxytocin, dopamine, and serotonin. As well as how the lactation experience and the presence of difficulties in this area interact with the mothers emotional functioning. An integrative model is proposed, which considers hormonal and physiological aspects involved in the complex and bidirectional association between breastfeeding successful establishment and maternal mental health.

Factores asociados a depresión posparto / Associated factors for postpartum depression

Fundamento: la depresión posparto afecta a la mujer entre los primeros tres y seis días luego del parto.Objetivo: determinar la incidencia y los factores asociados a la aparición de depresión posparto en puérperas. Métodos: se realizó un estudio cuantitativo de corte transversal en un universo de 139 puérperas fisiológicas residentes en Bartolomé Masó de la provincia Granma, en el último semestre del año 2018. Se realizó una entrevista estructurada que incluía como instrumento de pesquiza la Escala de Depresión Posparto de Edimburgo, se consideró que 10 puntos o más suponen la presencia de depresión. Resultados: la depresión posparto tuvo una incidencia alta en la población al asociarse estadísticamente a la edad menor de 20 años, el estado civil soltera, la tenencia de dos hijos, el antecedente de depresión previo al embarazo y el antecedente de violencia. La presencia de la enfermedad tuvo un riesgo de ideación suicida muy elevado. Conclusiones: la depresión posparto es una enfermedad prevenible con una morbilidad oculta importante, lo que la convierte en un problema de salud demandante de mayor atención por parte de las autoridades sanitarias(AU)

Background: the postpartum depression affects the woman among the 3 to first 6 days after labor. Objective: to establish the incidence and associated factors to the appearance of postpartum depression in postpartum mothers. Methods: a quantitative study of traverse court in a universe of 139 physiologic postpartum mothers resident in Bartolomé Masó town, Granma, in the last semester of the year 2018. It was carried out a structured interview that included inquiry instrument the Edinburgh Scale for Postpartum Depression being considered that 10 points or more supposes the depression presence. Results: the postpartum depression had a high incidence in the population associating statistically to the age smaller than 20 years, the single civil state, the holding of 2 children, the depression antecedents foresaw to the pregnancy and the antecedent of violence. The presence of the decease had a risk of very high suicidal ideation. Conclusions: the postpartum depression is a preventable decease with an important hidden morbidity, what transforms it into a problem of health plaintiff of more attention on the part of the sanitary authorities(AU)

The influence of mode of delivery on neonatal and maternal short and long-term outcomes

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45-60 days and 6-8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1-0.31 and elective C-section: 0.36, 95%CI 0.27-0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29-0.63 and elective C-section: 0.44, 95%CI 0.33-0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2-0.88) and roomed-in less 0.85 (95%CI 0.77-0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04-1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14-2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

Institutional violence and quality of service in obstetrics are associated with postpartum depression

ABSTRACT OBJECTIVE To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression) and the potential effect of race, age, and educational level in this outcome. METHODS This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression. RESULTS The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race. CONCLUSIONS The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

Depresión posparto en padres: ¿por qué también es importante? / Paternal postpartum depression. Why is it also important?

La supervisión de salud es una oportunidad privilegiada para acompañar a las nuevas familias en su transición a la parentalidad. Este período trae importantes desafíos para la madre y el padre, y en ocasiones la demanda puede superar los recursos emocionales de la familia; este desbalance puede favorecer que madres y padres presenten sintomatología depresiva. La depresión posparto puede afectar de uno a dos de cada diez hombres, siendo la depresión materna un factor de riesgo importante para desarrollarla. La depresión posparto en el padre impacta a todos los miembros de la familia, siendo el desarrollo infantil, el vínculo y la salud mental del niño los que pueden verse alteradas a corto, mediano y largo plazo. Parece relevante por lo tanto pensar en un tamizaje para pesquisar precozmente la depresión posparto no sólo en madres sino también en padres y dar así un primer paso a ampliar la mirada desde la diada madre-hijo a la triada. El control de salud del niño es una oportunidad única para poder realizar esta pesquisa, sin embargo la validación de una escala de tamizaje de depresión posparto en padres chilenos es una tarea pendiente.

Health supervision is a privileged opportunity to walk along with the new families during their transition to parenthood. This period is challenging for both mother and father, and there is the potential danger that demand surpasses the existing resources of the family. This imbalance may lead to mothers and fathers to develop depressive symptomatology. Postpartum depression may affect one to two out of ten men, and maternal depression is a major risk factor for developing it. The postpartum depression in the father impact all the family members, being the child development, the bonding, and the child´s mental health which can be disturb at a short, medium and long term. Therefore, it seems to be relevant to think about screening for post partum depression not only in mothers but also fathers, and give a first step to broaden the gaze from the dyad to the triad. The health supervision is a unique opportunity to be able to carry out this screening; however, the validation of a postpartum screening test for Chilean fathers is a pending task.

Actualización en depresión postparto: el desafío permanente de optimizar su detección y abordaje / An update on postpartum depression

Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers’ methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered.

Postpartum depression among women with unintended pregnancy / Depressão pós-parto entre mulheres com gravidez não pretendida

OBJECTIVE To analyze the association between unintended pregnancy and postpartum depression.METHODS This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis.RESULTS The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97).CONCLUSIONS Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy.

OBJETIVO Analisar a associação entre gravidez não pretendida e depressão pós-parto.MÉTODOS Estudo de coorte prospectivo realizado com 1.121 mulheres grávidas de 18 a 49 anos, acompanhadas no pré-natal pela Estratégia de Saúde da Família, Recife, PE, entre julho de 2005 e dezembro de 2006. Durante a gravidez e após o parto foram entrevistadas, respectivamente, 1.121 e 1.057 mulheres. A gravidez não pretendida foi avaliada durante a primeira entrevista e os sintomas depressivos após o parto foram avaliados utilizando-se a Edinburgh Postnatal Depression Screening Scale. Foram estimados os odds ratios simples e ajustados para a associação estudada, utilizando-se análise de regressão logística.RESULTADOS A frequência de gravidez não pretendida foi de 60,2%; 25,9% apresentaram sintomas depressivos após o parto. Aquelas com gravidez não pretendida tiveram maior chance de apresentar esse desfecho, mesmo após ajuste para variáveis de confundimento (OR = 1,48; IC95% 1,09;2,01). Ao se incluir a variável Self Reporting Questionnaire (SRQ-20), a associação diminuiu, mas manteve-se estatisticamente significativa (OR = 1,42; IC95% 1,03;1,97).CONCLUSÕES Gravidez não pretendida mostrou-se associada a sintomas depressivos após o parto. Isso sugere que valores elevados na Edinburgh Postnatal Depression Screening Scale podem resultar de gravidez não pretendida.

Development of a Prediction Model for Postpartum Depression: Based on the Mediation Effect of Antepartum Depression

PURPOSE: This study was done to develop a prediction model for postpartum depression by verifying the mediation effect of antepartum depression. A hypothesized model was developed based on literature reviews and predictors of postpartum depression by Beck. METHODS: Data were collected from 186 pregnant women who had a gestation period of more than 32 weeks and were patients at a maternity hospital, two obstetrics and gynecology specialized hospitals, or the outpatient clinic of K medical center. Data were analysed with descriptive statistics, correlation and exploratory factor analysis using the SPSS/WIN 18.0 and AMOS 18.0 programs. RESULTS: The final modified model had good fit indices. Parenting stress, antepartum depression and postpartum family support had statistically significant effects on postpartum depression, and defined 74.7% of total explained variance of postpartum depression. Antepartum depression had significant mediation effects on postpartum depression from stress in pregnancy and self-esteem. CONCLUSION: The results of this study suggest that it is important to develop nursing interventions including strategies to reduce parenting stress and improve postpartum family support in order to prevent postpartum depression. Especially, it is necessary to detect and treat antepartum depression early to prevent postpartum depression as antepartum depression can affect postpartum depression by mediating antepartum factors.

Effects of a Postpartum Back Pain Relief Program for Korean Women / 간호학회지

PURPOSE: Despite the high prevalence of back pain and its subsequent effects in post-partum women, intervention programs are scarce. The purpose of this study was to test the effects of a back-pain-reducing program on post-partum women who experienced low-back pain during pregnancy. METHODS: A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended a hospital for prenatal check-ups and experienced back pain participated in an intervention program (n=27), and the results were compared with women in a control group from another hospital (n=25). RESULTS: At 8 weeks post-partum, the pain intensity, functional limitations were lower in the intervention group than in the control group. However, differences in mean change of the pain intensity and functional limitations between 36 and 39 weeks of gestation and at 8 weeks post-partum were not statistically significant between the groups. Moreover, the flexibility, post-partum functional status, and post-partum depression did not differ significantly between the groups. CONCLUSIONS: A back-pain-relief program in this study was not effective to reduce the back-pain intensity in post-partum women and to decrease the associated functional limitations. The implications for nursing practice and directions for future research are discussed.