Introduction
Postpartum depression (PPD) is a major depressive episode that begins
within 3-6 months after
delivery1. PPD affects a
significant number of mothers, children, and families, as the global
prevalence of PPD reportedly ranges from 3% in Singapore to 38% in
China2,3.
Mothers with PPD often exhibit sadness, loss of interest and joy,
feelings of helplessness, difficulty concentrating and remembering, and
sleep disturbances. PPD may negatively impact maternal health,
parenting, and subsequently the development of children. It may result
in abusive parenting, maternal suicide, and
infanticide4,5.
Besides, it can lead to negative sequelae for the offspring, including
delayed cognitive development, behavioral problems, and even suicidal
ideation6-8. Therefore,
identifying the risk factors of PPD is important for earlier detection
and prevention of negative consequences of PPD.
This disorder may be caused by multiple risk factors, include the
history of depression, cesarean delivery, preterm delivery, poor marital
relationship, and low social
income9,10.
These factors have been fully elucidated to be associated with PPD, but
few studies have evaluated the effects of pregnant complications on PPD,
such as preeclampsia (PE).
As reported, the hypertensive disorder in pregnancy (HDP) is a risk
factor for depression, and the prevalence is about
20%-30%11,12.
PE is one HDP characterized as hypertension developing after 20 weeks of
gestation with the coexistence of ≥1 of a new onset of (1) proteinuria,
(2) maternal organ dysfunction, or (3) uteroplacental
dysfunction13. PE is
one of the leading causes of maternal/fetal mortality and morbidity
worldwide and is responsible for around 60,000 deaths14. PE directly
threatens mothers and causes various adverse fetal outcomes, leading to
small-for-gestational-age babies, premature delivery, and infant death15.
Our previous study demonstrated that PE patients had nearly 3-fold
increased odds for PPD compared to normal women, and patients with
severe PE had a more than 4-fold higher risk of screening positive for
PPD16. However, whether
the severity of PE and fetal outcomes would contribute to PPD has not
been investigated.
Herein, we aimed to compare the incidence rate of PPD in PE and normal
women by employing the EPDS, and to comprehensively evaluate the
association between PPD and PE, especially its severity and
complications. In addition, it has been previously reported the pelvic
floor symptoms, urinary incontinence and pain would affect postpartum
moods17,18,
so we also employed the Leakage Index Questionnaire and the Pain Scale.