Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T16:10:49.143Z Has data issue: false hasContentIssue false
  • English
  • Français

Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother–child cohort in Crete, Greece

Published online by Cambridge University Press:  22 December 2016

K. Koutra ,
M. Vassilaki ,
V. Georgiou ,
A. Koutis ,
P. Bitsios ,
M. Kogevinas  and
L. Chatzi
K. Koutra*
Affiliation:
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
M. Vassilaki
Affiliation:
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
V. Georgiou
Affiliation:
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
A. Koutis
Affiliation:
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
P. Bitsios
Affiliation:
Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
M. Kogevinas
Affiliation:
National School of Public Health, Athens, Greece Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Municipal Institute of Medical Research, Barcelona, Spain CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
L. Chatzi
Affiliation:
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
*
*Address for correspondence: K. Koutra, MSc, Ph.D., Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion, 71003 Crete, Greece. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum.

Methods.

A total of 1037 women who enrolled in the Rhea mother–child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders.

Results.

The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother.

Conclusions.

We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.

Keywords

Perinatalpostpartum complicationspostpartum depressionpregnancy
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 3 , June 2018 , pp. 244 - 255
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bair, MJ, Robinson, RL, Katon, W, Kroenke, K (2003). Depression and pain comorbidity: a literature review. Archives of Internal Medicine 163, 2433–2445.Google Scholar
Bat-Pitault, F, Deruelle, C, Flori, S, Porcher-Guinet, V, Stagnara, C, Guyon, A, Plancoulaine, S, Adrien, J, Da Fonseca, D, Patural, H, Franco, F (2015). Sleep pattern during pregnancy and maternal depression: study of Aube cohort. Journal of Sleep Disorders and Management 1–7.Google Scholar
Beck, CT (1996). A meta-analysis of predictors of postpartum depression. Nursing Research 45, 297–303.Google Scholar
Beck, CT (2001). Predictors of postpartum depression: an update. Nursing Research 50, 275–285.Google Scholar
Bennett, HA, Einarson, A, Taddio, A, Koren, G, Einarson, TR (2004). Prevalence of depression during pregnancy: systematic review. Obstetrics & Gynecology 103, 698–709.CrossRefGoogle ScholarPubMed
Blom, EA, Jansen, PW, Verhulst, FC, Hofman, A, Raat, H, Jaddoe, VW, Coolman, M, Steegers, EA, Tiemeier, H (2010). Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG: an International Journal of Obstetrics & Gynaecology 117, 1390–1398.CrossRefGoogle ScholarPubMed
Bolte, AC, van Geijn, HP, Dekker, GA (2001). Pathophysiology of preeclampsia and the role of serotonin. European Journal of Obstetrics and Gynecol and Reproductive Biology 95, 12–21.Google Scholar
Borra, C, Iacovou, M, Sevilla, A (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women's intentions. Maternal & Child Health Journal 19, 897–907.CrossRefGoogle ScholarPubMed
Carpenter, MW, Coustan, DR (1982). Criteria for screening tests for gestational diabetes. American Journal of Obstetrics & Gynecology 144, 768–773.CrossRefGoogle ScholarPubMed
Chang, JJ, Pien, GW, Duntley, SP, Macones, GA (2010). Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep Medicine Reviews 14, 107–114.Google Scholar
Chatzi, L, Plana, E, Daraki, V, Karakosta, P, Alegkakis, D, Tsatsanis, C, Kafatos, A, Koutis, A, Kogevinas, M (2009 a). Metabolic syndrome in early pregnancy and risk of preterm birth. American Journal of Epidemiology 170, 829–836.CrossRefGoogle ScholarPubMed
Chatzi, L, Plana, E, Pappas, A, Alegkakis, D, Karakosta, P, Daraki, V, Vassilaki, M, Tsatsanis, C, Kafatos, A, Koutis, A, Kogevinas, M (2009 b). The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus. Diabetes & Metabolism 35, 490–494.CrossRefGoogle ScholarPubMed
Cornish, AM, McMahon, CA, Ungerer, JA, Barnett, B, Kowalenko, N, Tennant, C (2005). Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and infant gender. Infant Behavior and Development 28, 407–417.Google Scholar
Cox, JL, Holden, JM, Sagovsky, R (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782–786.CrossRefGoogle ScholarPubMed
Cox, JL, Murray, D, Chapman, G (1993). A controlled study of the onset, duration and prevalence of postnatal depression. British Journal of Psychiatry 163, 27–31.CrossRefGoogle ScholarPubMed
Davis, L, Edwards, H, Mohay, H, Wollin, J (2003). The impact of very premature birth on the psychological health of mothers. Early Human Development 73, 61–70.CrossRefGoogle ScholarPubMed
Dennis, CL, McQueen, K (2007). Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatrica 96, 590–594.Google Scholar
Dias, CC, Figueiredo, B (2015). Breastfeeding and depression: a systematic review of the literature. Journal of Affective Disorders 171, 142–154.Google Scholar
Evans, J, Heron, J, Francomb, H, Oke, S, Golding, J (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal 323, 257–260.CrossRefGoogle ScholarPubMed
Figueiredo, B, Canario, C, Field, T (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine 44, 927–936.CrossRefGoogle ScholarPubMed
Gaillard, A, Le Strat, Y, Mandelbrot, L, Keita, H, Dubertret, C (2014). Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Research 215, 341–346.CrossRefGoogle ScholarPubMed
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology 106, 1071–1083.Google Scholar
Giallo, R, Cooklin, A, Nicholson, JM (2014). Risk factors associated with trajectories of mothers’ depressive symptoms across the early parenting period: an Australian population-based longitudinal study. Archives of Women's Mental Health 17, 115–125.Google Scholar
Gonidakis, F, Rabavilas, AD, Varsou, E, Kreatsas, G, Christodoulou, GN (2008). A 6-month study of postpartum depression and related factors in Athens Greece. Comprehensive Psychiatry 49, 275–282.Google Scholar
Goyal, D, Gay, CL, Lee, KA (2007). Patterns of sleep disruption and depressive symptoms in new mothers. Journal of Perinatal & Neonatal Nursing 21, 123–129.CrossRefGoogle ScholarPubMed
Grace, SL, Evindar, A, Stewart, DE (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Archives of Women's Mental Health 6, 263–274.Google Scholar
Groer, MW (2005). Differences between exclusive breastfeeders, formula-feeders, and controls: a study of stress, mood, and endocrine variables. Biological Research for Nursing 7, 106–117.Google Scholar
Grundy, SM, Cleeman, JI, Daniels, SR, Donato, KA, Eckel, RH, Franklin, BA, Gordon, DJ, Krauss, RM, Savage, PJ, Smith, SC Jr., Spertus, JA, Costa, F, American Heart, A, National Heart, L, Blood, I (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 2735–2752.Google Scholar
Gulamani, SS, Premji, SS, Kanhi, Z, Azam, SI (2013). Preterm birth a risk factor for postpartum depression in Pakistani women. Open Journal of Depression 2, 72–81.CrossRefGoogle Scholar
Halbreich, U, Karkun, S (2006). Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders 91, 97–111.CrossRefGoogle ScholarPubMed
Howard, LM, Molyneaux, E, Dennis, CL, Rochat, T, Stein, A, Milgrom, J (2014). Non-psychotic mental disorders in the perinatal period. Lancet 384, 1775–1788.CrossRefGoogle ScholarPubMed
Irwin, MR, Wang, M, Campomayor, CO, Collado-Hidalgo, A, Cole, S (2006). Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Archives of Internal Medicine 166, 1756–1762.CrossRefGoogle ScholarPubMed
Johns, MW (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14, 540–545.CrossRefGoogle ScholarPubMed
Johnstone, SJ, Boyce, PM, Hickey, AR, Morris-Yatees, AD, Harris, MG (2001). Obstetric risk factors for postnatal depression in urban and rural community samples. Australian & New Zealand Journal of Psychiatry 35, 69–74.Google Scholar
Josefsson, A, Berg, G, Nordin, C, Sydsjo, G (2001). Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstetricia et Gynecologica Scandinavica 80, 251–255.Google Scholar
Koutra, K, Chatzi, L, Bagkeris, M, Vassilaki, M, Bitsios, P, Kogevinas, M (2013). Antenatal and postnatal maternal mental health as determinants of infant neurodevelopment at 18 months of age in a mother-child cohort (Rhea Study) in Crete, Greece. Social Psychiatry and Psychiatric Epidemiology 48, 1335–1345.Google Scholar
Koutra, K, Vassilaki, M, Georgiou, V, Koutis, A, Bitsios, P, Chatzi, L, Kogevinas, M (2014). Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete, Greece. Social Psychiatry and Psychiatric Epidemiology 49, 711–721.Google Scholar
Lee, KA, McEnany, G, Zaffke, ME (2000). REM sleep and mood state in childbearing women: sleepy or weepy? Sleep 23, 877–885.Google Scholar
Leonardou, AA, Zervas, YM, Papageorgiou, CC, Marks, MN, Tsartsara, EC, Antsaklis, A, Christodoulou, GN, Soldatos, CR (2009). Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers. Journal of Reproductive and Infant Psychology 27, 28–39.CrossRefGoogle Scholar
Matthey, S, Henshaw, C, Elliot, S, Barnett, B (2006). Variability in use of cut off scores and formats on the Edinburh Postnatal Depression Scale – implications for clinical and research practice. Archives of Women's Mental Health 9, 309–315.Google Scholar
Mercier, RJ, Garrett, J, Thorp, J, Siega-Riz, AM (2013). Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort. BJOG: an International Journal of Obstetrics and Gynaecology 120, 1116–1122.Google Scholar
Mezzacappa, ES, Katlin, ES (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology 21, 187–193.Google Scholar
Micheli, K, Komninos, I, Bagkeris, E, Roumeliotaki, T, Koutis, A, Kogevinas, M, Chatzi, L (2011). Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology 22, 738–744.Google Scholar
Nielsen Forman, D, Videbech, T, Hedegaard, M, Dalby Salvig, J, Secher, N (2000). Postpartum depression: identification of women at risk. British Journal of Obstetrics and Gynaecology 107, 1210–1217.Google Scholar
Nonacs, R, Cohen, LS (2002). Depression during pregnancy: diagnosis and treatment options. Journal of Clinical Psychiatry 63 (Suppl. 7), 24–30.Google Scholar
Norhayati, MN, Hazlina, NH, Asrenee, AR, Emilin, WM (2015). Magnitude and risk factors for postpartum symptoms: a literature review. Journal of Affective Disorders 175, 34–52.CrossRefGoogle ScholarPubMed
O'Hara, M, Swain, A (1996). Rates and risk of postpartum depression: a meta-analysis. International Review of Psychiatry 8, 37–54.CrossRefGoogle Scholar
O'Hara, MW (1997). The nature of postpartum depressive disorders. In Postpartum Depression and Child Development (ed. Murray, L. and Cooper, P.), pp. 3–31. Guilford: New York.Google Scholar
Okun, ML, Hall, M, Coussons-Read, ME (2007). Sleep disturbances increase interleukin-6 production during pregnancy: implications for pregnancy complications. Reproductive Sciences 14, 560–567.Google Scholar
Robertson, E, Grace, S, Wallington, T, Steward, DE (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry 26, 289–295.Google Scholar
Rubertsson, C, Waldenstrom, U, Wickberg, B (2003). Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample. Journal of Reproductive and Infant Psychology 21, 113–123.Google Scholar
Sabanayagam, C, Shankar, A (2010). Sleep duration and cardiovascular disease: results from the National Health Interview Survey. Sleep 33, 1037–1042.Google Scholar
Sahota, PK, Jain, SS, Dhand, R (2003). Sleep disorders in pregnancy. Current Opinion in Pulmonary Medicine 9, 477–483.CrossRefGoogle ScholarPubMed
Sundaram, S, Harman, JS, Cook, RL (2014). Maternal morbidities and postpartum depression: an analysis using the 2007 and 2008 Pregnancy Risk Assessment Monitoring System. Women's Health Issues 24, e381–e388.Google Scholar
Tebeka, S, Le Strat, Y, Dubertret, C (2016). Developmental trajectories of pregnant and postpartum depression in an epidemiologic survey. Journal of Affective Disorders 203, 62–68.CrossRefGoogle Scholar
Tomfohr, LM, Buliga, E, Letourneau, NL, Campbell, TS, Giesbrecht, GF (2015). Trajectories of sleep quality and associations with mood during the perinatal period. Sleep 38, 1237–1245.CrossRefGoogle ScholarPubMed
Vivilaki, VG, Dafermos, V, Kogevinas, M, Bitsios, P, Lionis, C (2009). The Edinburgh Postnatal Depression Scale: translation and validation for a Greek sample. BMC Public Health 9, 329.Google Scholar
Warner, R, Appleby, L, Whitton, A, Faragher, B (1996). Demographic and obstetric risk factors for postnatal psychiatric morbidity. British Journal of Psychiatry 168, 607–611.Google Scholar
Watkins, S, Meltzer-Brody, S, Zolnoun, D, Stuebe, A (2011). Early breastfeeding experiences and postpartum depression. Obstetrics & Gynecology 118, 214–221.CrossRefGoogle ScholarPubMed
Wolfson, AR, Crowley, SJ, Anwer, U, Bassett, JL (2003). Changes in sleep patterns and depressive symptoms in first-time mothers: last trimester to 1-year postpartum. Behavioral Sleep Medicine 1, 54–67.Google Scholar
Woolhouse, H, Gartland, D, Mensah, F, Brown, SJ (2015). Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG: an International Journal of Obstetrics & Gynaecology 122, 312–321.Google Scholar
Ystrom, E (2012). Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth 12, 36.Google Scholar