Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Oct 19, 2024; 14(10): 1448-1457
Published online Oct 19, 2024. doi: 10.5498/wjp.v14.i10.1448
Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia
Ran Wang, Xin Liang, Xing-Yan Su
Ran Wang, Department of Obstetrics and Gynecology, The First People's Hospital of Nanyang, Nanyang 473000, Henan Province, China
Xin Liang, Department of Nursing, The First People's Hospital of Nanyang, Nanyang 473000, Henan Province, China
Xing-Yan Su, Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Co-corresponding authors: Xin Liang and Xing-Yan Su.
Author contributions: Wang R analyzed the data and wrote the manuscript; Wang R and Liang X performed the primary literature and data extraction; Liang X and Su XY were responsible for revising the manuscript for important intellectual content; Wang R, Liang X, and Su XY designed the research study, contributed equally to this work; all of the authors read and approved the final version of the manuscript to be published.
Supported by The China Social Welfare Foundation Caring Fund, No. HLCXKT-20230105.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First People's Hospital of Nanyang City, Approval No. [2024-yxylllz]0401-01.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sxy46470916@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Yan Su, MM, Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, No. 158 Wuyang Avenue, Enshi 445000, Hubei Province, China. sxy46470916@163.com
Received: August 8, 2024
Revised: September 5, 2024
Accepted: September 11, 2024
Published online: October 19, 2024
Processing time: 70 Days and 0.4 Hours
Abstract
BACKGROUND

Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality. Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method. Although extensive research has explored the association between postpartum depression (PPD) and cesarean section, few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.

AIM

To examine these risk factors through a retrospective, observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.

METHODS

Participants were assessed in person during the 32nd week of pregnancy, 2 days post-cesarean, and 6 weeks postpartum. According to the Edinburgh Postnatal Depression Scale (EPDS), participants who underwent cesarean section were divided into PPD (n = 60) and non-PPD groups (n = 227). Furthermore, PPD was diagnosed at 6 weeks postpartum according to depressive symptoms (EPDS score ≥ 11). The demographic and clinical features of PPD were screened. Multivariate logistic regression analysis was used to identify PPD risk factors.

RESULTS

The prevalence of PPD was 20.9% (60/287) among the 287 women who underwent cesarean section for early-onset preeclampsia. Multivariate logistic regression analyses revealed that advanced age (age > 40 years) [odds ratio (OR) = 1.93, 95%CI: 1.31-2.82], previous preeclampsia (OR = 7.15, 95%CI: 5.81-8.85), pre-pregnancy obesity (OR = 2.42, 95%CI: 1.62-3.63), gestational diabetes mellitus (OR = 3.52, 95%CI: 2.51-4.92), preexisting hypertension (OR = 1.35, 95%CI: 1.03-1.89), PPD symptoms (EPDS ≥ 11) at 2 days postpartum (OR = 6.15, 95%CI: 1.32-28.35), high prenatal self-rating anxiety scale score (OR = 1.13, 95%CI: 1.06-1.18), and pain at 6 weeks postpartum (OR = 2.16, 95%CI: 1.28-3.66) were independently associated with PPD.

CONCLUSION

Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age (age > 40 years), pre-pregnancy obesity, previous preeclampsia, gestational diabetes mellitus, preexisting hypertension, PPD symptoms (EPDS ≥ 11) at 2 days postpartum, prenatal anxiety, and pain at 6 weeks postpartum. The early identification of these factors and interventions can mitigate the risk of PPD.

Keywords: Postpartum depression; Cesarean section; Early-onset preeclampsia; Depression; Depressive symptoms; Risk factor

Core Tip: Early-onset preeclampsia leads to considerable maternal and fetal morbidity and mortality. Many pregnant women with early onset preeclampsia opt for cesarean section as their delivery method. Although extensive research has explored the association between postpartum depression (PPD) and cesarean section, few studies have investigated the risk factors of PPD after cesarean section in women with early-onset preeclampsia. We found that the risk factors for PPD after cesarean section in women with early onset preeclampsia included advanced age, prepregnancy obesity, previous preeclampsia, gestational diabetes mellitus, preexisting hypertension, PPD symptoms at 2 days postpartum, prenatal anxiety, and pain at 6 weeks postpartum. The early identification of these factors and interventions can mitigate the risk of PPD.