Association between Maternal Anaemia and Postpartum Depression in an Urban Sample of Pregnant Women in Iran
Goshtasebi, Azita, Alizadeh, Mozhgan, Gandevani, Samira Behboudi, Journal of Health Population and Nutrition
Postpartum depression (PPD) is a major episode that most often emerges within 6 to 12 weeks after delivery (1,2). The prevalence of postpartum depression is about 10-15%, depending on the diagnostic criteria, timing of screening, and screening instruments used (3). Apart from affecting mental health of a mother, it also disturbs family relationships and emotional and cognitive development of a child (4,5).
A number of psychosocial risk factors have been identified that entail the development of PPD but few studies have recognized physiologic variables contributing to PPD (6). Recently, the role of iron-deficiency anaemia (IDA) has been considered. Prevalence of IDA during pregnancy is around 7.5%, and recovery of iron stores in the postpartum period is often delayed in women who experience IDA during pregnancy (6,7). Behavioural symptoms associated with anaemia in adults include changes in cognition, emotions, irritability, apathy, fatigue, depressive symptoms, and hypoactivity (7,8).
Alterations in thyroid hormone metabolism (6), changes in the neurotransmitters function (9), and reduction in some inflammatory cytokines, such as interleukin 2 in iron deficiency, might be underlying causes for the development of PPD (10-12).
There is a relative lack of information regarding the influence of maternal anaemia on postpartum depression. The aim of our study was to determine the relationship between anaemia during pregnancy and postpartum depression.
MATERIALS AND METHODS
For a significance level of 0.05 and to find a 10% prevalence of postpartum depression, the number of subjects required was 216. Two hundred eighty-one healthy pregnant women were included in the study from February to December 2009. The study population consisted of primipara women aged 18-35 years with normal BMI (19.8-26) with singleton pregnancy. Women with iron-deficiency anaemia (defined as Hb <10.5 g/dL), history of chronic disease or other diseases known to interfere with iron metabolism, history of antidepressant-use, stressful life-events, consumption of alcohol, cigarette smoking, or drug-abuse, were not recruited.
The participants were registered at prenatal clinic of Imam Hospital at Sari, a coastal city located in north of Iran.
During a longitudinal study, low-risk pregnant mothers with parity [less than or equal to] 2 and singleton pregnancy were enrolled in the first prenatal visit at 14-20 weeks of gestation. Demographic and obstetric data and laboratory test results were collected. The eligible mothers in their first prenatal visit were examined for iron-deficiency anaemia, and women with Hb <11 g/dL and ferritin <15 mcg/dL were not recruited. All mothers received routine prenatal care (including standard vitamin and mineral supplementation) and followed up during the prenatal period till delivery. Maternal blood haemoglobin and ferritin concentrations were determined at birth. According to the CDC reference values for haemoglobin (Hb <11 g/dL in the third trimester for anaemia), the women were divided into anaemic and non-anaemic groups. They were followed up till 4-6 weeks after delivery. Iranian version of the Edinburgh Postpartum Depression Scale (EPDS) was employed 4-6 weeks after delivery. The EPDS score 13 was used as cutoff point for screening depression in the mothers under study.
Two mothers were excluded (one with severe preeclampsia and pregnancy termination before week 34, one having idiopathic thrombocytopenic purpura), and 25 (10%) mothers were not accessible and did not complete the EPDS. Demographic and obstetric characteristics of these mothers did not differ from the others.
Iranian version of the Edinburgh Postnatal Depression Scale (EPDS) was used as the screening tool for postpartum depression. This scale was used successfully in previous studies on postnatal depression in Iran (13,14). …