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Pregnancy Complications Can Increase Development Of Postnatal Depression (Medical

News Today-10 August 2010)

Complications around the time of birth can increase the risk of postnatal depression, says new
research published today in BJOG- An International Journal of Obstetrics and Gynaecology.

Many women experience complications during pregnancy. These can include medical problems
such as pre-eclampsia , deep vein thrombosis, problems with the baby for example poor growth
and fetal distress and problems during labour leading to emergency caesarean section.

Dutch researchers looked at 4941 pregnant women who had enrolled in the Generation R Study,
a multi-ethnic population-based cohort following urban babies from in the womb through to
young adulthood. Information on pregnancy complications was gathered and researchers
calculated the risk of postnatal depression for the various complications.

Two months after giving birth, the mothers were assessed for signs of postnatal depression using
the Edinburgh scale, a widely used scoring method looking at how the mother is feeling which
ranges from 0, meaning no depression, to 30, meaning very depressed. Little research has been
undertaken before looking at how complications during pregnancy are associated with postnatal
depression.

The results showed that several pregnancy complications were associated with postnatal
depression and the risk of developing depression increased with the number of complications
women experienced.

Of the total number who took part in the study, eight percent of women went on to develop
postnatal depression. Women who experienced one complication were given an odds ratio of
2.26 for developing postnatal depression and this rose to 5.47 for women who had four or five
complications.

The most important risk factors for developing depression included pre-eclampsia, hospitilisation
during pregnancy, emergency caesarean section, concern about fetal distress and admission of
the baby to special care. Women who developed depression were more likely to be young,
poorly educated and of non-Western origin.

It is estimated around 10 percent of new mothers encounter postnatal depression with most cases
developing in the first three months after giving birth. Depressive symptoms can vary from mild
complaints and 'maternity blues' to clinically diagnosed postnatal depression. It is often not
diagnosed early enough, resulting in women being depressed for longer before they are given
effective treatment.

Pauline Jansen, from the Department of Child and Adolescent Psychiatry at Erasmus MC-Sophia
and co-author on the paper said- "Our study showed that various complications during pregnancy
and delivery are associated with an increased risk of postpartum depression in women 2 months
after giving birth. Women who experienced more than two perinatal complications are especially
at a high risk of developing postpartum depression.

"These are important findings, particularly given the high prevalence of some of the perinatal
complications. Health care practitioners involved in the care for pregnant or postpartum women
and their babies should be aware of the substantially increased risk of postpartum depression
associated with complicated pregnancies and difficult deliveries. This increased awareness might
contribute to quicker diagnosies of postpartum depression."

Professor Philip Steer, BJOG editor-in-chief, said- "The detection and treatment of postnatal
depression is an essential part of caring for new mothers and their babies. It is important that
healthcare professionals are aware of the link between complications and postnatal depression
and work together to detect depressive symptoms in women. Few studies before this have looked
at this area and further research is needed to build on these findings."