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Postpartum Depression: Epidemiological and Biological Aspects
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postpartum depression is by definition a major depression with an onset during the first weeks after delivery. In practice, however, the term, postpartum depression is used to characterize all kinds of depressive symptoms after childbirth. The aims of this thesis were to investigate the prevalence of depressive symptoms during late pregnancy, in the puerperium and four years after delivery, and to analyze the mothers’ estimation of personal health and their children’s behavior at the age of four. Additional goals were to test the predictive power of potential associated factors of postpartum depression during pregnancy and the puerperium and finally, to elucidate possible genetic or neuropeptidergic explanatory variables behind the development of postpartum depression.

A population-based sample of 1489 women was screened with the Edinburgh Postnatal Depression Scale and the prevalence of depressive symptoms was 17% in late pregnancy and 13% postpartum. Antenatal depressed mood was related to postpartum depression. In a cross-sectional study we later found that postpartum depression was associated with subsequent depressive symptoms and current health problems four years after childbirth. Four-year-old boys of postpartum depressed mothers and children of mothers with a subsequent depressive status had more behavior problems than children of non-symptomatic mothers did, according to the mothers’ opinion.

The strongest associated factors for postpartum depression, in a case-control study, were sick leave during pregnancy mainly due to pregnancy complications, e.g. hyperemesis and premature contractions and a high number of visits to the antenatal care clinic. There was no association between delivery complications or complications in the perinatal period and postpartum depression. The theory that depressive symptoms in late pregnancy or postpartum are connected with CYP2D6 genotype could not be confirmed.

In a rat model, we found that pregnancy and parturition influence the concentrations of neuropeptide Y, cholecystokinin, substance P and galanin in the rat brain. This result supports the hypothesis that neuropeptidergic systems in the brain influence the mood changes around childbirth. In conclusion, postpartum depression is a common feature with influence on both maternal and child well being.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. , 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 781
Keyword [en]
Postpartum depression, pregnancy, childbirth, case-control study
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5208ISBN: 91-7373-537-X (print)OAI: oai:DiVA.org:liu-5208DiVA: diva2:21141
Public defence
2003-04-11, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
Pages 26 and 57 containing illustrations are removed from the electronic version. On the day of the public defence the status of article IV was: Accepted for publication.Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Prevalence of depressive symptoms in late pregnancy and postpartum
Open this publication in new window or tab >>Prevalence of depressive symptoms in late pregnancy and postpartum
2001 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 80, no 3, 251-255 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Postnatal depression refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology.

METHODS: A longitudinal study with a total population of 1,558 consecutively registered pregnant women in the southeast region of Sweden. Presence of depressive symptoms was measured with the Edinburgh Postnatal Depression Scale on four occasions namely in gestational week 35-36, in the maternity ward, 6-8 weeks and 6 months postpartum.

RESULTS: The prevalence of depressive symptoms during late pregnancy was 17%; in the maternity ward 18%; 6-8 weeks postnatally 13%; and 6 months postnatally, 13%. A correlation between antenatal and postnatal depressive symptoms was found (r=0.50, p<0.0001).

CONCLUSION: Detection of women at risk for developing postnatal depressive symptoms can be done during late pregnancy. Antenatal care clinics constitute a natural and useful environment for recognition of women with depressive symptoms.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13667 (URN)10.1034/j.1600-0412.2001.080003251.x (DOI)
Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2009-08-19
2. Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms
Open this publication in new window or tab >>Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms
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2002 (English)In: Obstetrics and gynecology, ISSN 0029-7844, Vol. 99, no 2, 223-228 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To identify and test the predictive power of potential independent risk factors of postpartum depressive symptoms during pregnancy and the perinatal period.

METHODS: We conducted a case-control study where 132 women with postpartum depressive symptoms were selected as an index group and 264 women without depressive symptoms as a control group. Data related to sociodemographic status, medical, gynecologic, and obstetric history, pregnancy, and perinatal events were collected from standardized medical records.

RESULTS: The strongest risk factors for postpartum depressive symptoms were sick leave during pregnancy and a high number of visits to the antenatal care clinic. Complications during pregnancy, such as hyperemesis, premature contractions, and psychiatric disorder were more common in the postpartum depressed group of women. No association was found between parity, sociodemographic data, or mode of delivery and postpartum depressive symptoms.

CONCLUSION: Women at risk for postpartum depression can be identified during pregnancy. The strongest risk factors, sick leave during pregnancy and many visits to the antenatal care clinic, are not etiologic and might be of either behavioral or biologic origin. The possibilities of genetic vulnerability and hormonal changes warrant further investigation to reach a more thorough understanding.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13668 (URN)10.1016/S0029-7844(01)01722-7 (DOI)
Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2009-08-19
3. A follow-up study of postnatal depressed women: Recurrent maternal depressive symptoms and child behaviour after four years
Open this publication in new window or tab >>A follow-up study of postnatal depressed women: Recurrent maternal depressive symptoms and child behaviour after four years
2007 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, Vol. 10, no 4, 141-145 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression.

Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.

Keyword
Postpartum depression, maternal depression, child behavior, follow-up study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13669 (URN)10.1007/s00737-007-0185-9 (DOI)
Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2009-08-19
4. CYP2D6 genotypes and depressive symptoms during late pregnancy and postpartum
Open this publication in new window or tab >>CYP2D6 genotypes and depressive symptoms during late pregnancy and postpartum
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2004 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, Vol. 58, no 1, 61-64 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this exploratory was to investigate the theory of a relation between cytochrome P450 2D6 (CYP2D6) genotype and depressive symptoms in late pregnancy and/or postpartum. We studied 145 women with depressive symptoms. CYP2D6 genotype was analysed in leukocyte DNA by polymerase chain reaction (PCR). There were no significant differences in CYP2D6 genotypes between the groups of women being depressed during and/or after pregnancy. The frequencies of CYP2D6 genotypes did not differ from other European studies. This study cannot confirm that depressive symptoms in late pregnancy and postpartum are connected with CYP2D6 genotype. It is, however, noteworthy that the frequency of ultrarapid metabolizers was higher than in a general Caucasian population. This warrants further exploration in a greater study sample, but should also be investigated in a general population with major depression.

Keyword
CYP2D6, Depression, Pregnancy, Postpartum
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13670 (URN)10.1080/08039480310000815 (DOI)
Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2009-08-19
5. Pregnancy and parturition influence neuropeptide concentrations in the rat brain
Open this publication in new window or tab >>Pregnancy and parturition influence neuropeptide concentrations in the rat brain
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Manuscript (Other academic)
Identifiers
urn:nbn:se:liu:diva-13671 (URN)
Available from: 2003-04-30 Created: 2003-04-30 Last updated: 2010-01-13

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