Am J Perinatol 2022; 39(08): 797-802
DOI: 10.1055/s-0041-1740214
SMFM Fellowship Series Article

Incidence and Risk Factors for Postpartum Depression among Women with Preterm Prelabor Rupture of Membranes

Gregory E. Zemtsov
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
Carmen M. Avram
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
Alice Darling
2   Duke University School of Medicine, Durham, North Carolina
,
2   Duke University School of Medicine, Durham, North Carolina
,
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
Sarah K. Dotters-Katz
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
› Author Affiliations
Funding None.

Abstract

Objective Patients admitted for preterm prelabor rupture of membranes are more likely to have risk factors for postpartum depression, including preterm delivery, low-birthweight infants, and a stressful life event. However, there is a paucity of data characterizing the development of postpartum depression in this population. We aim to evaluate the incidence of and describe risk factors for postpartum depression among patients admitted with preterm prelabor rupture of membranes.

Study Design This is a retrospective cohort study of patients admitted for preterm prelabor rupture of membranes in a single health system between 2013 and 2019. Patients who developed depression were compared with patients who did not develop depression. Demographic, antepartum/intrapartum/postpartum, and neonatal characteristics were compared. Bivariate statistics were used to compare outcomes and logistic regression was used to estimate adjusted odds ratios.

Results Of 132 included patients with preterm prelabor rupture of membranes, 25 (18.9%) had postpartum depression. Factors significantly (p < 0.05) associated with postpartum depression included history of depression, anxiety, or any prior mental health condition. Earlier admission gestational age, rupture of membranes < 28 weeks, earlier delivery gestational age, neonatal morbidity, and neonatal necrotizing enterocolitis also were significantly associated with postpartum depression. Latency, maternal postpartum length of stay, and neonatal intensive care unit length of stay were not significantly associated. In regression models, only a history of depression (odds ratio [OR], 11.89; 95% confidence interval [CI], 2.78–50.95) and neonatal morbidity (OR, 5.01; 95% CI, 1.15–21.89) remained associated with postpartum depression.

Conclusion Postpartum depression occurred in nearly one in five patients with preterm prelabor rupture of membranes. Pre-existing depression and adverse neonatal outcomes strongly predicted postpartum depression. There is an urgent need to prioritize maternal mental health among patients with preterm prelabor rupture of membranes in the peripartum period. Further research is needed to identify optimal resources for mitigating the risk of postpartum depression in this cohort.

Key Points

  • After PPROM, postpartum depression is common.

  • Maternal depression and neonatal morbidity are risk factors for PPD.

  • Hospital admission permits intervention for PPD.

Note

This data was presented in part as a virtual poster presentation (poster number 254) at the Society for Maternal Fetal Medicine 41st Annual Pregnancy Meeting on January 25–30, 2021.




Publication History

Received: 14 June 2021

Accepted: 06 October 2021

Article published online:
02 December 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Banasiewicz J, Zaręba K, Bińkowska M, Rozenek H, Wójtowicz S, Jakiel G. Perinatal predictors of postpartum depression: results of a retrospective comparative study. J Clin Med 2020; 9 (09) 2952
  • 2 Banti S, Mauri M, Oppo A. et al. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Compr Psychiatry 2011; 52 (04) 343-351
  • 3 Blom EA, Jansen PW, Verhulst FC. et al. Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG 2010; 117 (11) 1390-1398
  • 4 O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013; 9: 379-407
  • 5 Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004; 26 (04) 289-295
  • 6 ACOG Committee Opinion No. 757: screening for perinatal depression. Obstet Gynecol 2018; 132 (05) e208-e212
  • 7 Barber KS, Brunner Huber LR, Portwood SG, Boyd AS, Smith J, Walker LS. The association between having a preterm birth and later maternal mental health: an analysis of U.S. pregnancy risk assessment monitoring system data. Womens Health Issues 2021; 31 (01) 49-56
  • 8 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005; 106 (5, Pt 1): 1071-1083
  • 9 Helle N, Barkmann C, Bartz-Seel J. et al. Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: cross-sectional results from a controlled multicentre cohort study. J Affect Disord 2015; 180: 154-161
  • 10 Nelson DB, Freeman MP, Johnson NL, McIntire DD, Leveno KJ. A prospective study of postpartum depression in 17 648 parturients. J Matern Fetal Neonatal Med 2013; 26 (12) 1155-1161
  • 11 Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG 2010; 117 (05) 540-550
  • 12 Paulson JF, Dauber S, Leiferman JA. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics 2006; 118 (02) 659-668
  • 13 Stein A, Pearson RM, Goodman SH. et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384 (9956): 1800-1819
  • 14 Palladino CL, Singh V, Campbell J, Flynn H, Gold KJ. Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol 2011; 118 (05) 1056-1063
  • 15 Porter T, Gavin H. Infanticide and neonaticide: a review of 40 years of research literature on incidence and causes. Trauma Violence Abuse 2010; 11 (03) 99-112
  • 16 Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 188: prelabor rupture of membranes. Obstet Gynecol 2018; 131 (01) e1-e14
  • 17 Pace CC, Spittle AJ, Molesworth CM. et al. Evolution of depression and anxiety symptoms in parents of very preterm infants during the newborn period. JAMA Pediatr 2016; 170 (09) 863-870
  • 18 Treyvaud K. Parent and family outcomes following very preterm or very low birth weight birth: a review. Semin Fetal Neonatal Med 2014; 19 (02) 131-135
  • 19 Zhao XH, Zhang ZH. Risk factors for postpartum depression: an evidence-based systematic review of systematic reviews and meta-analyses. Asian J Psychiatr 2020; 53: 102353
  • 20 Drewett R, Blair P, Emmett P, Emond A. ALSPAC Study Team. Failure to thrive in the term and preterm infants of mothers depressed in the postnatal period: a population-based birth cohort study. J Child Psychol Psychiatry 2004; 45 (02) 359-366
  • 21 Beck CT. Predictors of postpartum depression: an update. Nurs Res 2001; 50 (05) 275-285
  • 22 Hymas R, Girard LC. Predicting postpartum depression among adolescent mothers: a systematic review of risk. J Affect Disord 2019; 246: 873-885
  • 23 Whitton A, Warner R, Appleby L. The pathway to care in post-natal depression: women's attitudes to post-natal depression and its treatment. Br J Gen Pract 1996; 46 (408) 427-428