Postpartum Depression Without Antenatal Depression in Primiparous Women

Antenatal depression has been suggested to be the strongest predictor of postnatal depression; and in turn postpartum depression has seemed to be the strongest predictor for parenting stress [1-4]. To date, some studies have suggested that maternal depressive symptoms during pregnancy are associated with postpartum depressive symptoms, especially those are depressed during the third trimester of pregnancy [1-4]. In our earlier small study [4], depressive and/or anxiety symptoms showed somewhere during pregnancy in 86% of the women who had depressive symptoms during postpartum. Therefore, early identification and treatment of perinatal depression has been suggested to be important [5, 6]. On the other hand, some women develop depressive symptoms during postpartum without any depressive symptoms during pregnancy [4]. Although we have tended to get caught up in the former as “high-risk approach”, we must always keep in mind that the latter is present, because it is undeniable that they also have a potential risk of maltreatment. Based on these backgrounds, we examined the factors associated with the symptoms of maternal depression developing for the first time during postpartum by increasing the number of subjects. The protocol for this study was approved by the Ethics Committee of Japanese Red Cross Katsushika Maternity Hospital. Informed consent concerning retrospective analyses was obtained from all subjects. Between April 2016 and March 2018, we requested all Japanese nulliparous women (n = 1,131) who delivered single baby at term at our institute to answer the Whooley’s two questions [7, 8], a self-administered questionnaire at first, second and third trimesters of pregnancy (8 11, 20 24 and 34 37 weeks of gestation) and postpartum (1 month after delivery). In this study, 29 women were excluded because of current mental disorders with psychotherapies and/or medications, and 1,097 women of the rest (/1,102: 99.5%) gave us analyzable answers. The Whooley’s two questions have been reported to be used as a screening tool for adult depression including women at perinatal period [7, 8]. It consists of the following two questions: 1) Have you often been bothered by feeling down, depressed or hopeless during the past 1 month? 2) Have you often been bothered by having little interest or pleasure in doing things during the past month? If at least one of the two questions is “yes”, the woman was rated as having depressive symptom. Using medical charts of the women who responded validly, we examined maternal age, history of mental disorders, delivery mode and the most troubled problem at 2 4 weeks after delivery such as feeling of insufficient breastfeeding, baby crying at night, wound pain, breast trouble, et al. “Crying at night” means that baby suddenly starts crying in midnight and does not stop crying for no reason. Table 1 shows the results of Whooley’s two questions during pregnancy and postpartum. The prevalence of women with postpartum depressive symptoms was 13.9% (153/1,097). Of the 153 women who had depressive symptoms during postpartum, 128 women (83.7%) showed depressive symptoms somewhere during their pregnancies, while 25 women (16.3%) showed no depressive symptoms during pregnancy. As a result of examining their medical charts, seven of the 25 women (28.0%) were worried about baby crying at night as shown in Table 2. Based on the current results, antenatal depressive symptoms seemed to be an obvious predicting factor for postnatal depressive symptoms. The tendency was similar to that in our previous small study [4], and it will support some previous studies [1-3]. On the other hand, 16% of women who had postpartum depressive symptoms did not have depressive symptoms during pregnancy. The most common cause of their depressive symptoms was baby crying at night. Pregnancy/delivery is a life-altering event, and everybody is supposed to be aware of that raising baby is not a piece of cake. However, night time waking and crying have been frequently culturally constructed as behavioural sleep “problems” [9, 10]. Mothers are usually the principal caregivers, providing extensive body contact day and night and prolonged breastfeeding with immediate nurturant response to crying. However, separate sleeping arrangements and delayed response to crying have been recommended regManuscript submitted October 22, 2021, accepted October 30, 2021 Published online November 20, 2021