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Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrisk forskning)ORCID iD: 0000-0001-7948-7912
Department of Biostatistics, Harokopio University, Athens, Greece.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Reproduktiv hälsa)
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, article id e0144274Article in journal (Refereed) Published
Abstract [en]

Objectives

To explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history.

Methods

A nested cohort study (n = 446), based on two population-based cohorts in Uppsala, Sweden. Exposed individuals were defined as having a bleeding of ≥1000ml (n = 196) at delivery, and non-exposed individuals as having bleeding of <650ml (n = 250). Logistic regression models with PPD symptoms (Edinburgh Postnatal Depression scale (EPDS) score ≥ 12) as the outcome variable and PPH, anaemia, experience of delivery, mood during pregnancy and other confounders as exposure variables were undertaken. Path analysis using Structural Equation Modeling was also conducted.

Results

There was no association between PPH and PPD symptoms. A positive association was shown between anaemia at discharge from the maternity ward and the development of PPD symptoms, even after controlling for plausible confounders (OR = 2.29, 95%CI = 1.15–4.58). Path analysis revealed significant roles for anaemia at discharge, negative self-reported delivery experience, depressed mood during pregnancy and postpartum stressors in increasing the risk for PPD.

Conclusion

This study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH.

Place, publisher, year, edition, pages
2016. Vol. 11, no 1, article id e0144274
Keywords [en]
postpartum haemorrhage, postpartum depression, anaemia, delivery experience, perinatal depression
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-279252DOI: 10.1371/journal.pone.0144274ISI: 000369527800002PubMedID: 26807799OAI: oai:DiVA.org:uu-279252DiVA, id: diva2:907769
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BASIC
Funder
Marianne and Marcus Wallenberg FoundationSwedish Society of MedicineAvailable from: 2016-02-29 Created: 2016-02-29 Last updated: 2018-10-08Bibliographically approved
In thesis
1. Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism
Open this publication in new window or tab >>Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Even though most pregnancies and deliveries are uncomplicated, still fifteen percent of all women in developed countries suffer pregnancy-related complications. The aim of this thesis was to explore the associations between perinatal complications and perinatal maternal health, with emphasis on postpartum depressive symptoms (PPDS) and neuroticism taking into account potential confounding or mediating factors such as history of depression, antenatal depressive symptoms and delivery experience.

In the first study (n=446), the association between heavy postpartum haemorrhage and PPDS at six weeks postpartum was delineated by using path-analysis in order to provide insight into the complex mediating roles of several consequences of postpartum haemorrhage. There was no direct association between postpartum haemorrhage and PPDS, only an indirect one via anaemia at discharge and negative delivery experience.

The second study (n=3888) examined the association of mode of delivery with PPDS at 6 weeks postpartum. The results indicate that the association between elective caesarean section and PPDS is highly confounded by history of depression and fear of delivery, while emergency caesarean section and vacuum extraction increase odds for PPDS by leading to postpartum complications and negative delivery experience.

The third study (n=1503) investigated the association between the use of epidural analgesia during delivery and PPDS. A positive association in the crude analysis was no longer present after adjustment for sociodemographic, psychosocial and obstetrical variables, indicating that pain relief through epidural analgesia is not likely to affect risk for PPDS.

In the last study (n=1969), the association between neuroticism and perinatal complications was explored. Neuroticism was not associated with adverse perinatal outcomes, except for gestational diabetes mellitus. The association, however, became statistically non-significant after adjusting for psychiatric morbidity.

In summary, the current studies do no find evidence for a direct association between perinatal complications and postpartum depressive symptoms or neuroticism. However, several important mediators have been identified, among which postpartum anaemia and negative delivery experience deserve special attention. Also, earlier psychiatric history needs to be addressed as an important confounder.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 87
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1503
Keywords
antenatal depression, ceasarean section, delivery complications, Edinburgh postnatal depression scale, EPDS, epidural analgesia, gestational diabetes mellitus, instrumental delivery, neonatal complications, neuroticism, obstetric complications, personality, perinatal complications, postpartum depression, postpartum haemorrhage, pregnancy complications, vacuum extraction, vaginal delivery
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Research subject
Obstetrics and Gynaecology; Psychiatry
Identifiers
urn:nbn:se:uu:diva-362566 (URN)978-91-513-0466-3 (ISBN)
Public defence
2018-11-30, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
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Supervisors
Available from: 2018-11-01 Created: 2018-10-08 Last updated: 2018-11-19

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Eckerdal, PatriciaHellgren, CharlotteHögberg, UlfWikström, Anna-KarinSkalkidou, Alkistis
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