Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression

Abstract

ObjectivesTo explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history.MethodsA 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.ResultsThere 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.ConclusionThis study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH.

Association between perinatal anemia and postpartum depression: A prospective cohort study of Japanese women

“…PPH is the primary cause of postpartum anemia among women without anemia during pregnancy and may increase the risk of PPD by causing postpartum distress and turning delivery into a negative experience . However, PPH has not yet been proven to be a direct risk factor of PPD; a previous cohort study showed a non‐significant association between PPH and symptoms of PPD even while observing a significant association between postpartum anemia . As we were unable to explain the extent to which the observed association between postpartum anemia and PPD may be mediated by PPH in the present study, further studies are warranted to determine if there is a relationship.…”

“…5 However, PPH has not yet been proven to be a direct risk factor of PPD; a previous cohort study showed a non-significant association between PPH and symptoms of PPD even while observing a significant association between postpartum anemia. 24 As we were unable to explain the extent to which the observed association between postpartum anemia and PPD may be mediated by PPH in Larger, future studies may succeed in detecting the effect of anemia in the second and third trimesters of pregnancy.…”

Delineating the association between mode of delivery and postpartum depression symptoms: a longitudinal study

“…In this sample, both EmCS and VE were associated with lower Apgar score and transfer to a neonatal unit, which could initiate existential worries. All those parameters generate a negative delivery experience that could trigger depressive symptomatology .…”

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

“…However, on postpartum day 3, the authors noted that women in the no intervention group only had a 0.78 higher mean physical fatigue score compared with those receiving RBC (physical fatigue scores range from 4 to 20; higher scores indicating more fatigue). These data should not discount the need to consider treatment for postpartum anemia, especially as important maternal morbidities are associated with this condition, including depression, 72–74 fatigue, 75 and impaired cognition. 76 These morbidities can negatively impact maternal-child bonding and the mother's ability to provide newborn care.…”