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.