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Biological and Psychosocial Aspects of Postpartum Depression
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Reproduktiv hälsa)
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postpartum depression (PPD) is one of the most common complications of childbirth around the world. Despite several studies on the underlying mechanisms, the pathophysiology remains elusive. The aims of this thesis were to assess possible associations between the risk for self reported PPD and serum levels of leptin, the season of delivery, the gender of the newborn, and the history of premenstrual symptoms, respectively.

A population based cohort of 2318 newly delivered women in Sweden were screened five days, six weeks and six months postpartum, using the Edinburgh Postnatal Depression Scale. This cohort comprised 60% of the total population, and the prevalence of self reported PPD was 11.1% six weeks after the delivery.

A negative association between leptin levels at delivery and self reported PPD at six weeks and six months postpartum was evident, even after adjusting for confounding factors. 

An increased risk for self reported PPD was noted among women delivering during the last three months of the year, compared to those giving birth in April through June. This is of clinical importance, since women delivering at the end of the year could benefit from a closer follow-up after delivery. 

Despite previous varying findings – depending on study population and consequently different cultural settings – in our study, no association between infant gender and self reported PPD could be detected at six weeks or six months postpartum. However, women giving birth to baby boys had a higher risk for postpartum blues.  

Lastly, an increased risk for self reported PPD among women with a history of premenstrual symptoms was noted. Interestingly, after stratification for parity, the association between PPD and premenstrual symptoms remained only among multiparas. The association between PPD and premenstrual symptoms might shed light on the many possible routes by which hormonal changes may influence mood in women.

In conclusion, this population based study strengthens the notion that PPD is a complex multifactorial disorder, with biological, social and psychological parameters shaping each individual’s risk.  Further research is needed in this field, in order to investigate underlying pathophysiological mechanisms, propose more effective diagnostic tests and assess therapeutic interventions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 751
Keyword [en]
Depression, postpartum, biological, seasonality, gender, premenstrual
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Research subject
Psychiatry; Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-170818ISBN: 978-91-554-8302-9 (print)OAI: oai:DiVA.org:uu-170818DiVA: diva2:509540
Public defence
2012-05-11, Rosénsalen, Akademiska sjukhuset, ing 95/96, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Projects
UPPSAT
Available from: 2012-04-12 Created: 2012-03-13 Last updated: 2012-04-19
List of papers
1. Risk of postpartum depression in association with serum leptin and interleukin-6 levels at delivery: a nested case-control study within the UPPSAT cohort
Open this publication in new window or tab >>Risk of postpartum depression in association with serum leptin and interleukin-6 levels at delivery: a nested case-control study within the UPPSAT cohort
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2009 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 34, no 9, p. 1329-1337Article in journal (Refereed) Published
Abstract [en]

Although postpartum depression (PPD) is a common condition, it often goes undiagnosed and untreated, with devastating consequences for the woman's ability to perform daily activities, to bond with her infant and to relate to the infant's father. Leptin, a protein synthesised in the adipose tissue and involved in regulation of food intake and energy expenditure has been related to depressive disorders, but studies report conflicting results. The aim of this study was to evaluate the association between serum leptin levels at the time of delivery and the subsequent development of postpartum depression in women, using data from a population-based cohort of delivering women in Uppsala, Sweden. Three hundred and forty seven women from which serum was obtained at the time of delivery filled out at least one of three structured questionnaires containing the Edinburgh Scale for Postnatal Depression (EPDS) at five days, six weeks and six months after delivery. Mean leptin levels at delivery did not significantly differ between the 67 cases of PPD and the 280 controls. Using linear regression analysis and adjusting for maternal age, body-mass index, smoking, interleukin-6 levels, duration of gestation and gender of the newborn, the EPDS scores at six weeks and six months after delivery were found to be negatively associated with leptin levels at delivery (p<0.05). Serum leptin levels at delivery were found to be negatively associated with self-reported depression during the first six months after delivery. No such association was found concerning serum IL-6 levels at delivery. If these finding are replicated by other studies, leptin levels at delivery could eventually serve as a biological marker for the prediction of postpartum depression.

Keyword
Biological marker, Postpartum depression, Postnatal depression, Leptin, Interleukin, EPDS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-120838 (URN)10.1016/j.psyneuen.2009.04.003 (DOI)000270777500007 ()19427131 (PubMedID)
Available from: 2010-03-16 Created: 2010-03-16 Last updated: 2017-12-12Bibliographically approved
2. Seasonality patterns in postpartum depression
Open this publication in new window or tab >>Seasonality patterns in postpartum depression
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2011 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 204, no 5, p. 413.e1-6Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the possible association between postpartum depressive symptoms and season of delivery. STUDY DESIGN: During 1 year, delivering women in the Uppsala University Hospital were asked to participate in the study by filling out 3 postpartum questionnaires containing the Edinburgh Postnatal Depression scale and questions assessing life style, medical history, breast-feeding, and social support. RESULTS: Two thousand three hundred eighteen women participated. Women delivering in the last 3 months of the year had a significantly higher risk of self-reported depressive symptomatology both at 6 weeks (odds ratio, 2.02, 95% confidence interval, 1.32-3.10) and at 6 months after delivery (odds ratio, 1.82, 95% confidence interval, 1.152.88), in comparison to those delivering April-June, both before and after adjustment for possible confounders. CONCLUSION: Women delivering during the last quartile of the year had a significantly higher risk for depressive symptoms 6 weeks and 6 months postpartum and would thus benefit from a closer support and follow-up after delivery.

Keyword
postnatal depression, postpartum depression, risk factor, season
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-154124 (URN)10.1016/j.ajog.2011.01.022 (DOI)000290206200028 ()
Available from: 2011-05-26 Created: 2011-05-26 Last updated: 2017-12-11Bibliographically approved
3. Newborn gender as a predictor of postpartum mood disturbances in a sample of Swedish women
Open this publication in new window or tab >>Newborn gender as a predictor of postpartum mood disturbances in a sample of Swedish women
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2011 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 14, no 3, p. 195-201Article in journal (Refereed) Published
Abstract [en]

Postpartum depression (PPD) is a condition that affects about 10% of newly delivered women. The aim of this study was to examine the possible association between offspring gender and risk for development of PPD in Sweden. The study was undertaken as part of the UPPSAT project, a population-based longitudinal study in Uppsala, Sweden. From May 2006 to June 2007, women who gave birth at Uppsala University Hospital and fulfilled the inclusion criteria were asked to participate. The participating women filled out, at three points during the first 6 months after delivery, questionnaires containing the Edinburgh Postnatal Depression Scale as well as questions concerning various lifestyle factors, medical history, breast feeding habits, social support parameters, and diet factors. No significant difference in risk of PPD in relation to baby gender could be shown 6 weeks and 6 months after delivery. However, women who gave birth to a male offspring had a significantly higher risk of self-reported depressive symptomatology 5 days after delivery. The association remained statistically significant after adjustment for possible confounders in a logistic regression model. This longitudinal study demonstrates that, in Sweden, the gender of the offspring is not associated with a higher risk for self-reported postpartum depression in the mother 6 weeks or 6 months after delivery. The birth of a baby boy, however, gives the mother a higher risk of postpartum blues 5 days after delivery.

Keyword
Depression, Postpartum, Postnatal, Gender, Newborn, Risk factor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-149394 (URN)10.1007/s00737-011-0211-9 (DOI)000290536200003 ()21311924 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2017-12-11Bibliographically approved
4. Premenstrual syndrome and dysphoric disorder as risk factors for postpartum depression
Open this publication in new window or tab >>Premenstrual syndrome and dysphoric disorder as risk factors for postpartum depression
2013 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 2, p. 178-184Article in journal (Refereed) Published
Abstract [en]

Objective To investigate a possible association between postpartum depression and premenstrual symptoms. Design Population-based cohort. Setting University Hospital, Sweden. Population During one year, May 2006 to June 2007, all delivering women in the hospital were asked to participate. Methods The participating women answered three questionnaires, at five days, six weeks and six months postpartum, containing the Edinburgh Postnatal Depression Scale (EPDS) and questions assessing previous premenstrual symptoms, medical history and life style. Main outcome measures The woman's self-reported depressive case/control status, women with 12 or more points on the EPDS being considered as cases. Results Among the 2318 participating women, 7.1% had a history of premenstrual syndrome and 2.9% a history of premenstrual dysphoric disorder. Previous premenstrual syndrome/premenstrual dysphoric disorder was associated with self-reported postpartum depression at five days, six weeks and six months postpartum. After stratification for parity, the associations remained significant solely among multiparas. Conclusions There appears to be an association between a history of premenstrual symptoms and development of self-reported postpartum depression. Parity was identified as effect modifier. This finding is clinically important for health care professionals working in maternity care.

Keyword
Depression, postpartum, premenstrual
National Category
Psychiatry Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology; Psychiatry
Identifiers
urn:nbn:se:uu:diva-170796 (URN)10.1111/aogs.12041 (DOI)000313914200009 ()23157487 (PubMedID)
Available from: 2012-03-13 Created: 2012-03-13 Last updated: 2017-12-07Bibliographically approved

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