(513) Association between maternal anemia and postpartum depression in women with vaginal delivery

Prevention of postpartum depression(PPD) requires an understanding of its risk factors, particularly those that can be modified. Our objective was to assess the association between maternal anemia in the immediate postpartum and PPD 8 weeks after vaginal delivery.

Study Design:

Ancillary cohort study of the TRAAP trial, a French multicentric trial conducted in 2015-2016, which included women with a singleton pregnancy and vaginal delivery ≥ 35 weeks. The primary outcome was PPD at 8 weeks postpartum, defined as an Edinburgh Postpartum Depression Scale(EPDS) score ≥ 11. The exposure was the latest maternal hemoglobinemia measured in the postpartum before discharge(available per TRAAP trial’s protocol). We assessed the association between hemoglobin and PPD with multivariable logistic regression. A sensitivity analysis differentiated 2 levels of PPD severity: moderate(11≤ EPDS< 13) and severe(EPDS≥ 13) depressive symptoms.

Results:

Among the 2672 women included, 1115(43.6%) had postpartum anemia(hemoglobin< 11g/dL) and 369(13.8%) had PPD at 8 weeks. The relation between hemoglobinemia and PPD was linear. In multivariable analysis, the risk of PPD increased by 10% for each 1g/dL decrease in hemoglobinemia (aOR=0.90[0.81-0.998]). Sensitivity analysis showed that postpartum hemoglobinemia was associated with the risk of moderate depressive symptoms(18% increase for each 1g/dL reduction in hemoglobinemia) but not with severe depressive symptoms. We found a significant interaction with maternal place of birth: associations were found in European-born women but not in non-European-born women, in whom the prevalence of PPD was much higher.

Conclusion:

This study shows an association between hemoglobin level in the immediate postpartum period and PPD at 8 weeks, with a 10% increase in the risk of PPD for each 1g/dL reduction in hemoglobin. This association specifically concerns moderate depressive symptoms and European-born women. These results emphasize the importance of precise characterization of PPD risk factors to improve its prevention. This study highlights the importance of correcting postpartum anemia.