Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective FinnBrain Birth Cohort Study

Abstract

Background Gestational anemia, most commonly caused by iron deficiency, may increase the risk of maternal anxiety and depression and have a potentially far-reaching impact on mother’s and newborn’s health. Several mechanisms, such as effects of iron deficiency on cerebral neurotransmitter metabolism, have been suggested. None of the earlier studies have assessed the association between gestational anemia and depression, anxiety and pregnancy-related anxiety simultaneously. Methods Women, participating in the FinnBrain Birth Cohort Study and attending maternity welfare clinics in Turku, whose hemoglobin (Hb) values during pregnancy were available were included in this study (n = 1273). The study group consisted of 301 women with Hb levels < 11.0 g/dL at any time during pregnancy, and 972 women with Hb ≥ 11.0 g/dL were included in the control group. Symptoms of depression, anxiety, and pregnancy-related anxiety were assessed using the Edinburgh Postnatal Depression Scale (EPDS), Symptom Checklist-90 (SCL), and Pregnancy-Related Anxiety Questionnaire (PRAQ) questionnaires at 14, 24, and 34 gestational weeks, and EPDS and SCL were also performed 3 and 6 months postpartum. Results Gestational anemia was not associated with an increased risk of depression either prenatally or postpartum when the analyses were adjusted for maternal age at birth, parity, smoking during pregnancy, maternal education, and gestational age. However, a weak connection was found between gestational anemia and prenatal anxiety in the early pregnancy. Furthermore, the analysis between women with Hb < 10.0 g/dL and those with Hb ≥ 10.0 g/dL showed an association between gestational anemia and anxiety in the late pregnancy, but otherwise no difference in psychological distress was found. Conclusions No evidence supporting the association between gestational anemia and antenatal or postpartum depression was found. However, a weak connection between gestational anemia and antenatal anxiety was observed. This finding needs further investigation to establish timing and investigate causality.

Socioeconomic and health predictors of perinatal mental health in a rural area of The Gambia

“…Iron is vital for a number of biochemical processes in the brain, as well as general health and wellbeing (Abbaspour et al, 2014;Beard and Connor, 2003;Kim and Wessling-Resnick, 2014;Wang et al, 2019). In line with this, in HIC settings, IDA has been associated with increased depression during pregnancy (Dama et al, 2018;Kemppinen et al, 2022), but remains under-investigated in LMICs. Additionally, a large proportion of women in LMICs work in agriculture (Anderson et al, 2020); the heavy physical work and exposure to heat stress during pregnancy have been related to compromised maternal and infant physical health (Bonell et al, 2022;Pradeilles et al, 2019;Spencer et al, 2022).…”

Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia

“…Maternal or prepartum IDA and excessive blood loss at delivery are the leading causes of postpartum anemia. 73 , 84 , 85 Reduced milk production and resultant shortening of lactation periods are also characteristic of ID/IDA during the postpartum period. The emotional well‐being of postpartum women with IDA can also be seriously affected, with an increased risk of postpartum anxiety and depression and a decreased quality of life.…”

“…The emotional well‐being of postpartum women with IDA can also be seriously affected, with an increased risk of postpartum anxiety and depression and a decreased quality of life. 85 , 86 …”

“…Maternal or prepartum IDA and excessive blood loss at delivery are the leading causes of postpartum anemia 73,84,85 . Reduced milk production and resultant shortening of lactation periods are also characteristic of ID/IDA during the postpartum period.…”

Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era: a cross-sectional study

“…For instance, we propose intervention strategies based on risk factors in the post-COVID-19 era rather than the previous pandemic stages, to promote health care and establish a mental health system linking families, hospitals and communities, to enhance the mental health of pregnant women. Although there have been prior studies conducted [ 28 – 30 ], it is important to further explore the impact of the post-COVID-19 era on the mental health of pregnant women in order to expand our knowledge. We hypothesized that the prevalence of prenatal depression and anxiety symptoms may be higher, and that various demographic and socioeconomic factors including region, employment status, gestational age, complications, marital relationship, and annual household income may contribute to the risk factors associated with these symptoms.…”