Preeclampsia and Its Complications Exacerbate Development of Postpartum Depression: A Retrospective Cohort Study

Abstract

Background. Hypertensive disorders were proved to be associated with the development of depression. But it is unclear if pregnancy-induced hypertensive diseases, especially preeclampsia (PE), will affect postpartum moods. We aimed to determine the incidence rate of postpartum depression (PPD) in PE patients and comprehensively evaluate the association between PPD and PE, including its severity and complications. Methods. 425 participants including 130 PE mothers were enrolled in this retrospective cohort study. Each woman was asked to complete a questionnaire integrating the Edinburgh Postnatal Depression Scale (EPDS), the Leakage Index Questionnaire, and a pain scale questionnaire within 6 weeks after delivery. The EPDS cut-off score above 13 was recognized as screening positive for PPD. Data between groups were compared by bivariate analysis. Results. PE mothers showed a direct tendency to PPD development. The positive screening for PPD in the PE group was significantly higher than that of the control group (30.77% vs. 14.58%). Based on the results of the regression model, women diagnosed with severe PE and fetal growth restriction were more inclined to develop PPD than normal ones (AOR: 2.759, 95% CI: 1.206-6.315 and AOR: 3.450, 95% CI: 1.596-7.458). It is also indicated that postpartum pain exacerbated the odds of PPD in PE patients (AOR: 1.509, 95% CI: 1.078-2.114). Conclusions. PE was an independent risk factor for PPD. Its severity and complications exacerbate the development of PPD. Doctors and society should pay more attention to PE patients after delivery against the development of PPD.

Evidence of Anxiety, Depression and Learning Impairments following Prenatal Hypertension

“…To our knowledge, this is the first study to evaluate post-partum anxiety among HDP rats beyond the immediate post-partum period; however, clinical studies do report increases in depression and anxiety among women with HDP [ 8 , 42 , 43 ]. Furthermore, a study by Ying et al recently reported that PreE is an independent risk factor for the development of post-partum depression [ 6 ]. Thus, our findings support the link between HDP and changes in maternal mood contributing to the development of post-partum depression and/or anxiety.…”

“…Women with a history of HDPs are at an increased risk of developing mood disorders, such as anxiety and depression [ 3 , 4 , 5 ]. Women with advanced HDPs, such as preeclampsia (PreE; new onset of high blood pressure after 20 weeks gestation) or HELLP (hemolysis, elevated liver enzyme, low platelet; considered to be a variant of PreE with more severe organ dysfunction and often life threatening) syndrome, are even more susceptible to these mood disorders and have been reported by some to have disturbances in cognitive function [ 6 , 7 , 8 ]. There have been several theories as to why women affected by HDPs are more susceptible to these changes, ranging from cerebral vascular dysfunction during pregnancy to long-term complications due to hypertension [ 9 , 10 ]; however, to date, none have been conclusive.…”

The immune checkpoint pathophysiology of depression and chronic fatigue syndrome due to preeclampsia: focus on sCD80 and sCTLA-4

“…A significant proportion of women with PE experience perinatal or postpartum depression (61). Furthermore, it has been established that PE itself is a contributing factor to the development of post-partum depression, as highlighted by the study conducted by Ye et al (62).…”

“…Previously, it was shown that there is a connection between depressive symptoms in early pregnancy and the mother's blood pressure during the first trimester (9). Other researchers have found that women with higher blood pressure in the third trimester tend to experience increased depression (5,62). There is a correlation between immune activation and oxidative and nitrosative stress, which has been linked to hypertension in individuals with depression (114).…”

Perinatal predictors of postpartum depression

“…Postpartum depression is affecting about one in seven women [14]. With a global prevalence of PPD ranging from 3% to 38%, it impacts a significant number of mothers [15].…”