A prospective study of postpartum depression in 17648 parturients

Objective: To assess perinatal antecedents to postpartum depression (PPD). Methods: This was a prospective population-based, observational study of women screened for symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) with scores ≥13 referred for psychiatric evaluation. Obstetric and neonatal outcomes were analyzed using univariable and multivariable analysis for associations with postpartum depressive symptoms. Results: Of 25050 women delivered, 17648 (71%) completed EPDS questionnaires with 1106 (6.3%) scoring ≥13. Perinatal complications most associated with EPDS scores ≥13 included major malformation (adjusted OR 1.5; 95% CI, 1.1-2.3), neonatal death (adjusted OR 5.8; 95% CI, 2.9-11.4), stillbirth (adjusted OR 9.4; 95% CI, 6.0-14.8), and necrotizing enterocolitis (adjusted OR 21.7; 95% CI, 1.9-244.3). A total of 238 (22%) women kept their psychiatric referral appointment, and 111 (47%) were diagnosed with PPD. Perinatal factors were also found to be significantly associated with PPD. Conclusions: PPD is significantly increased in women with adverse pregnancy outcomes, especially involving the infant.