Assessing high-risk perinatal complications as risk factors for postpartum mood disorders

Objectives: Postpartum mood disorders affect approximately 20 % of postpartum women. This study examines the association between postpartum mood disorders and preeclampsia with severe features (SPE), postpartum hemorrhage (PPH), very/extremely preterm delivery (EPTD), and fetal congenital malformations (FCM). Methods: A retrospective chart review was conducted at a large southeastern quaternary academic hospital using ICD-10 codes for the four high-risk perinatal complications. Medical records included 3,652 cases and 750 normal patient comparisons (NPC). Inclusion criteria: 1) prenatal visit at the institution, 2) live delivery at the institution, 3) postpartum visit at the institution, and 4) completed Edinburgh Postnatal Depression Scale (EPDS) at postpartum visit. EPDS scores >= 12 and EPDS-3A scores >= 5 were considered positive for depression and anxiety symptoms, respectively. Results: Five cohorts were analyzed [NPC (n=200), SPE (n=150), PPH (n=153), EPTD (n=102), and FCM (n=200)]. Independent sample t-tests revealed significant differences in mean EPDS scores between NPC and EPTD (p<0.001) and FCM (p=0.014) and in mean EPDS-3A scores between NPC and EPTD (p<0.001) and PPH (p=0.011). Conclusions: EPTD, FCM, and PPH are diagnoses associated with elevated EPDS and/or EPDS-3A scores. Increased mood surveillance in patients with these complications is warranted. Understanding the association of these conditions with increased depression and anxiety symptoms will allow for earlier identification and treatment of postpartum mood disorders.