Objective To examine whether specific pregnancy and delivery complications are risk factors for postpartum depression.Design A prospective longitudinal study.Setting Rotterdam, the Netherlands.Population A cohort of 4941 pregnant women who enrolled in the Generation R Study.Methods Information on perinatal complications was obtained from the midwife and hospital registries or by questionnaire. Logistic regression analyses were used to calculate the risk of postpartum depression for the separate perinatal complications.Main outcome measures Postpartum psychiatric symptoms were assessed 2 months after delivery using the Edinburgh postnatal depression scale.Results Several perinatal complications were significantly associated with postpartum depression, namely: pre-eclampsia (adjusted OR, aOR 2.58, 95% CI 1.30-5.14), hospitalization during pregnancy (aOR 2.25, 95% CI 1.19-4.26), emergency caesarean section (aOR 1.53, 95% CI 1.02-2.31), suspicion of fetal distress (aOR 1.56, 95% CI 1.08-2.27), a medically indicated delivery provided by an obstetrician (aOR 2.43, 95% CI 1.56-3.78), and hospital admission of the baby (aOR 1.45, 95% CI 1.10-1.92). Unplanned pregnancy, thrombosis, meconium-stained amniotic fluid, and Apgar score were not associated with postpartum depression after adjustment for confounding factors, such as pre-existing psychopathological symptoms and sociodemographic characteristics. The risk of postpartum depression increased with the number of perinatal complications women experienced (P < 0.001).Conclusions We showed that several pregnancy and delivery complications present a risk for women's mental health in the postpartum period. Obstetricians, midwives, general practitioners, and staff at baby well clinics should be aware that women who experienced perinatal complications-especially those with a number of perinatal complications-are at risk for developing postpartum depression.

ObjectivesIn patients after a transient ischaemic attack (TIA) or minor stroke, dysfunction is often underestimated by clinical measures due to invisible symptoms, including cognitive and emotional problems. Many of these patients need stroke care programme, but others do not. In this study, we aim to identify potential predictors of quality of life (QoL) in patients with TIA or minor stroke 1 year poststroke to be able to select which of these patients will need aftercare.DesignProspective observational cohort study.SettingSingle-centre hospital in the Netherlands.Participants120 patients, diagnosed with TIA or minor stroke and discharged without rehabilitation treatment, completed the study.Primary and secondary outcome measuresQoL (RAND-36), anxiety and depressive symptoms (Hospital Anxiety and Depression scale), the degree of disability or functional dependence after stroke (modified Rankin Scale (mRS)) and symptoms of anxiety and depression specific to stroke (SSADQ) were assessed at baseline (2–6 weeks poststroke) and compared with follow-up at 1 year poststroke.ResultsDepression (B=−1.35, p<0.001) and anxiety (B=−0.57, p=0.041) at baseline predicted a worse mental component of QoL after 1 year. Depression (B=−1.100, p<0.001) at baseline, but also age (B=−0.261, p=0.002) and female sex (B=4.101, p=0.034) predicted a worse physical component of QoL after 1 year.ConclusionWith the identification of these predictors, we might be able to select more efficiently and timely the patients with TIA or minor stroke who need stroke aftercare.