Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & EMBASE  
     Home | Subscribe | Feedback  

[Download PDF
Year : 2020  |  Volume : 66  |  Issue : 1  |  Page : 7-8  

Maternal risk markers of postnatal depression

MS Bhatia 
 Department of Psychiatry, University College of Medical Sciences and G.T.B. Hospital, Delhi, India

Correspondence Address:
M S Bhatia
Department of Psychiatry, University College of Medical Sciences and G.T.B. Hospital, Delhi

How to cite this article:
Bhatia M S. Maternal risk markers of postnatal depression.J Postgrad Med 2020;66:7-8

How to cite this URL:
Bhatia M S. Maternal risk markers of postnatal depression. J Postgrad Med [serial online] 2020 [cited 2020 Mar 30 ];66:7-8
Available from:

Full Text

Puerperium is a well-established period with increased risk for the development of serious mood disorders.[1] The prevalence of postpartum depression (PPD) is 6%–13% in high-income nations, but it is highly variable in non-Western countries due to variations in methodology and its manifestations across cultures.[2] In India, the prevalence of PPD varies from 11% to 16%,[3] whereas in a recent study in Bangladesh, the prevalence was 39%.[4] PPD represents a considerable public health problem affecting women and their families. Feelings of hopelessness in severe cases can threaten life and lead to suicide.[5] In addition, factors such as fear of harming the baby (36%), weak attachment to the baby (34%), and, in extreme cases, suicide attempts are seen.[6] Therefore, susceptible women need to be identified before delivery to receive proper care measures.

World Health Organization report [1] enumerated a number of risk factors associated with the development of PPD. These are classified according to association and are as follows: strong to moderate [depression or anxiety during pregnancy, stressful recent life events, lack of social support (either perceived or received), and previous history of depression], moderate (high levels of childcare stress, low self-esteem, neuroticism, difficult infant temperament), and small (obstetric and pregnancy complications, cognitive attributions, quality of relationship with partner, socioeconomic status). The factors such as ethnicity, maternal age, level of education, parity, and gender showed no association. The occurrence of depression during pregnancy is a powerful factor in predicting PPD.[7]

The identified risk factors for PPD are socioeconomic (unemployment, low income, low education [8]), social (e.g., emotional and financial support and empathy relations,[9] sexual and domestic violence during pregnancy [10]), obstetrical (nulliparity, caesarean, low breast feeding, parenting stress, mother–child bonding, etc.[11]), biological (young age, glucose metabolism disorders, low serotonin and tryptophan, high oxytocin, rapid decline of reproductive hormones and corticosteroids after delivery [12]), lifestyle-related (food intake patterns, sleep status, exercise, and physical activities), and others (history of depression, negative attitude toward recent pregnancy, low self-esteem, high number of life events, and marital maladjustment [12]).

A relationship has been observed between low hemoglobin at day 7 after delivery (<120 g/L) and postpartum depressive symptoms at day 28.[13] The sufficient consumption of vegetables, fruits, legumes, seafood, milk, dairy products, and olive oil may reduce PPD by 50%.[10] Among the micronutrients, reduced intake of zinc and selenium is linked with the incidence of PPD.[14]

Anthropometric determinants have not been sufficiently researched in relation to suicidality and severity of illness in women with postnatal depression. This study [15] was the first one to look into the relation of anthropometric determinants and postnatal depression and suicidality. The anthropometric determinants assessed included height, weight, weight gain in pregnancy, weight at first antenatal visit, body mass index, and waist-to-hip ratio. The prevalence of PPD was 39%. About 31% had suicidal ideations. Waist-to-hip ratio was the most significant factor in all the models, having a negative correlation with suicidality and severity of depression. The only limitation was a small sample size.

Postnatal period influences infant development and childcare. In an Indian study, postnatal depression was a strong and independent predictor of low weight and length and was significantly associated with adverse mental development quotient scores.[16] Mother–child bonding is shaped during pregnancy and leads to the mental growth and development of infants. It is influenced by different factors, that is, infant-related including delayed birth, breastfeeding, physical problems, and restlessness; parental including attachment style, physical ailments, PPD, and social support networks; and maternal mental health problems. Mother–child bonding has a statistically significant association with mothers' state anxiety, trait anxiety, and depression.[17] The risk for emotional and behavioral problems is high among children of depressed mothers. Infants of prenatally depressed mothers show significantly more growth retardation than controls.[18]

High-risk women should be timely identified for possible early interventions so that the quality of life of mother, infant, and family can be improved.


1World Health Organization. Maternal Mental Health & Child Health and Development. Department of Mental Health and Substance Abuse. Geneva: WHO; 2008.
2Klainin P, Arthur DG. Postpartum depression in Asian cultures: A literature review. Int J Nurs Stud 2009;46:1355-73.
3Hegde S, Latha K, Bhat SM, Sharma P, Kamath A, Shetty A. Postpartum depression: Prevalence and associated factors among women in India. J Womens Health Issues Care 2012;1:1-7.
4Azad R, Fahmi R, Shrestha S, Joshi H, Hasan M, Khan AN, et al. Prevalence and risk factors of postpartum depression within one year after birth in urban slums of Dhaka, Bangladesh. PLoS ONE 2019;14:e0215735.
5Youn JH, Jeong IS. Predictive validity of the postpartum depression predictors inventory-revised. Asian Nurs Res (Korean Soc Nurs Sci) 2011;5:210-5.
6Thorsteinsson EB, Loi NM, Moulynox AL. Mental health literacy of depression and postnatal depression: A community sample. Open J Depress 2014;2014:101-11.
7Kheirabadi GR, Maracy MR, Barekatain M, Salehi M, Sadri GH, Kelishadi M, et al. Risk factors of postpartum depression in rural areas of Isfahan Province, Iran. Arch Iran Med 2009;12:461-7.
8Miyake Y, Tanaka K, Sasaki S, Hirota Y. Employment, income, and education and risk of postpartum depression: The Osaka Maternal and Child Health Study. J Affect Disord 2011;130:133-7.
9Feng Z, Jones K, Wang WW. An exploratory discrete-time multilevel analysis of the effect of social support on the survival of elderly people in China. Soc Sci Med 2015;130:181-9.
10Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: A prospective cohort study. Lancet 2010;376:903-10.
11Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: A narrative review. J Educ Health Promot 2017;6:60.
12Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry 2003;44:234-46.
13Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr 2003;133:4139-42.
14Ellsworth-Bowers ER, Corwin EJ. Nutrition and the psychoneuroimmunology of postpartum depression. Nutr Res Rev 2012;25:180-92.
15Nayak AS, Nachane HB. Maternal anthropometric determinants as risk markers of suicidality and severity of illness in women with postnatal depression. J Postgrad Med 2020;66:11-6.
16Patel V, DeSouza N, Rodrigues M. Postnatal depression and infant growth and development in low income countries: A cohort study from Goa, India. Arch Dis Child 2003;88:34-7.
17Borji M, Shahbazi F, Nariman S, Otaghi M, Safari S. Investigating the relationship between mother-child bonding and maternal mental health. J Compr Pediatr 2018;9:e14014.
18Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: A cohort study. Arch Gen Psychiatry 2004;61:946-52.

Monday, March 30, 2020
 Site Map | Home | Contact Us | Feedback | Copyright  and disclaimer