ArticlePDF Available
Systematic Review and Meta-Analysis
of the Prevalence of the Maternity Blues
in the Postpartum Period
Khadije Rezaie-Keikhaie, Mohammad Edris Arbabshastan, Hosein Raemanesh, Mehrbanoo Amirshahi,
Shokoufeh Mogharabi Ostadkelayeh, and Azizollah Arbabisarjou
ABSTRACT
Objective: To determine the prevalence of maternity blues among women in the postpartum period.
Data Sources: We conducted our systematic review and meta-analysis by searching the literature for relevant articles
published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through
December 11, 2019, using the keywords prevalence,incidence,maternity blues, and baby blues.
Study Selection: From 336 articles initially screened, we included 26 articles in the systematic review and meta-
analysis.
Data Extraction: Two independent reviewers used a standardized form to extract data from eligible articles. We
evaluated the quality of individual studies and the overall evidence according to Hoy et al.’s risk of bias tool.
Data Synthesis: The prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the
results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence
interval [32.3, 45.6]; I
2
¼96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.
Conclusion: Considering the great prevalence of maternity blues in women after childbirth, paying attention to the key
symptoms of maternity blues and implementing educational programs for health care providers and mothers after
childbirth are essential.
JOGNN, 49, 127–136; 2020. https://doi.org/10.1016/j.jogn.2020.01.001
Accepted January 2020
During the postpartum period, potential
complications can occur that have signifi-
cant effects on women and their neonates. The
lack of accurate and timely diagnosis and atten-
tion to physical and mental disorders, specifically
after birth, may result in irrecoverable emotional
and cognitive impairment for women and their
neonates (Norhayati, Hazlina, Asrenee, & Emilin,
2015). One such postpartum psychological dis-
order is maternity blues (Rai, Pathak, & Sharma,
2015), also referred to as mother’s blues or
third-,fourth-,ortenth-day blues. Maternity blues is
a transient physiologic and psychological disorder
with potential symptoms of depression, tearful-
ness, sorrow/weeping, unstable mood, insomnia,
anxiety, and confusion (Ntaouti et al., 2018).
Maternity blues may disrupt infant care and
increase the risk of symptoms of postpartum
depression (Zanardo et al., 2019), impair
maternal–infant interactions (Badr &
Zauszniewski, 2017; Bydlowski, Lalanne, Golse,
& Vaivre-Douret, 2013), and affect child devel-
opment (Mirhosseini et al., 2015). The exact
causes of maternity blues are unknown, but the
most probable cause is sudden hormonal
changes after childbirth; hence, women who are
more sensitive to hormonal changes have greater
incidence of maternity blues than women who are
not (Pop et al., 2015). Various researchers re-
ported that maternity blues is a definite and
important risk factor for postpartum depression
(Gerli et al., 2019; Meilina & Nasrudin, 2019).
Maternity blues may begin the first day after birth
and may continue for up to 10 days or several
weeks. The prevalence of maternity blues in in-
dividual studies was estimated to be 10% to
80% (O’Hara & McCabe, 2013). Although the
prevalence of maternity blues has been reported
in individual studies, to our knowledge, there is no
systematic review or meta-analysis about the
prevalence of maternity blues. Furthermore, the
The authors report no con-
icts of interest or relevant
nancial relationships.
Correspondence
Mohammad Edris
Arbabshastan, BSc, MSc,
Balouch St., Iranshahr
University of Medical
Sciences, Iranshahr, Iran
9916643535.
kanregeli@gmail.com
Keywords
maternity blues
meta-analysis
postpartum period
prevalence
Khadije Rezaie-Keikhaie,
MD, is an associate
professor, Department of
Obstetrics and Gynecology,
Zabol University of Medical
Sciences, Zabol, Iran.
Mohammad Edris
Arbabshastan, BSc, MSc, is
a lecturer, Department of
Nursing, Iranshahr
University of Medical
Sciences, Iranshahr, Iran.
(Continued)
ª2020 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Published by Elsevier Inc. All rights reserved.
http://jognn.org 127
REVIEW
precise estimation of the prevalence of maternity
blues may be helpful to provide timely and appro-
priate treatment for maternity blues. Therefore, the
aim of our systematic review and meta-analysis
was to determine the prevalence of maternity
blues among women in the postpartum period.
Methods
Search Strategy
We searched international databases PubMed,
Web of Science, and Scopus for relevant articles
published in English from the inception of the
databases through December 11, 2019. We
adapted the search strategy we used for MED-
LINE for the other databases. The specific search
strategy was created by a health sciences
librarian with expertise in systematic review
based on the Peer Review of Electronic Search
Strategies (PRESS) standard (McGowan et al.,
2016). Additionally, we used PROSPERO to
search for ongoing or recently completed sys-
tematic reviews. We used Boolean operators
(AND, OR, and NOT), medical subject headings,
truncation (*), and related words to search titles
and abstracts using the following keywords:
prevalence,incidence,occurrence,survey,fre-
quency,surveillance,maternity blues,baby
blues,postpartum blues, and maternal blues.
Eligibility Criteria
The methods adapted for this systematic review
were developed in accordance with the
Cochrane Handbook for Systematic Reviews
(Higgins & Green, 2011), and results are reported
using the Preferred Reporting Items for System-
atic Reviews and Meta-Analyses (PRISMA) tool
(Moher, Liberati, Tetzlaff, & Altman, 2009).
Descriptive cross-sectional, retrospective, and
prospective studies were included. We excluded
reviews, letters to the editor, correspondence,
case reports, and case series; articles published
in languages other than English; articles without
available full texts; studies with poor methodo-
logic quality based on Hoy et al.’s (2012) quality
assessment tool; and studies in which the tools
used to measure maternity blues were not spec-
ified accurately. We excluded randomized
controlled trials because our study aim was to
find observational studies on prevalence;
because the randomized controlled trials were
conducted with specific populations, prevalence
may have been erroneously estimated. The target
population consisted of women in the postpartum
period. The prevalence of maternity blues after
childbirth was calculated based on the available
standard instruments. The included studies were
conducted using prospective and retrospective
approaches.
Selection of Studies and Data Extraction
According to the study protocol, two researchers
(M.E.A. and M.A.) independently screened the
titles and abstracts based on the eligibility
criteria. After removal of the duplicate articles, the
full texts of the remaining articles were screened
based on the eligibility criteria, and the required
information was extracted. Disagreements be-
tween the two researchers were resolved by
consensus. We extracted the following data from
each article: first author information, year of
publication, country, sampling method, age of
participants, design, name of tool, day after birth
of measurement for maternity blues, income level
(defined based on the World Bank categories of
high income, high-middle income, low-middle
income, and low income), risk of bias, and prev-
alence of maternity blues.
Quality Assessment
To assess the methodologic quality and risk of
bias, we evaluated each observational study us-
ing Hoy et al.’s (2012) tool. This 10-item tool is
used to evaluate the quality of studies in two di-
mensions: external validity (Items 1–4: target
population, sampling frame, sampling method,
and nonresponse bias minimal) and internal val-
idity (Items 5–9: data collection method, case
definition, study instrument, and mode of data
collection). Item 10 assesses bias related to the
analysis. Two researchers (K.R.K. and M.E.A.)
independently evaluated risk of bias.
Data Synthesis
We recorded the frequency with percentage of
prevalence of maternity blues from each study.
We then tested for pooled effect size of preva-
lence and evaluated the heterogeneity of the
preliminary studies by I
2
, tau-square, and chi-
square tests. Because of great variability among
study results, we reported pooled prevalence
based on the random-effects model and used a
forest plot to present the results. We conducted
subgroup analyses to determine heterogeneity
based on the location of the studies and
instruments used to assess the prevalence of
maternity blues. We conducted univariate meta-
regression to assess the heterogeneity of studies
Hosein Raemanesh, BSc,
MSc, is a PhD candidate,
Student Research
Committee, Department of
Epidemiology, School of
Public Health and Safety,
Shahid Beheshti University
of Medical Sciences,
Tehran, Iran.
Mehrbanoo Amirshahi, BSc,
MSc, is a lecturer,
Department of Midwifery,
School of Nursing and
Midwifery, Zabol University
of Medical Sciences, Zabol,
Iran.
Shokoufeh Mogharabi
Ostadkelayeh, BSc, MSc, is
an instructor, Faculty of
Nursing, Iranshahr Branch,
Islamic Azad University,
Iranshahr, Iran.
Azizollah Arbabisarjou,
BSc, MSc, PhD, is an
associate professor, Health
Promotion Research Center,
Zahedan University of
Medical Sciences, Zahedan,
Iran.
Maternity blues is one of the most common complications
in the postpartum period.
Prevalence of the Maternity Blues in the Postpartum PeriodREVIEW
128 JOGNN, 49, 127–136; 2020.https://doi.org/10.1016/j.jogn.2020.01.001 http://jognn.org
and the proportion of between-study variance
explained by covariates using regression coeffi-
cient with 95% confidence interval (CI) and
adjusted R
2
. We performed meta-analysis using
Stata (Version 14; StataCorp, College Station, TX).
Results
We retrieved 336 articles from the initial search in
the three electronic databases. Among the 231
nonduplicated articles, we excluded 188 after
review of abstracts. Of the 43 articles that
remained, 26 met the eligibility criteria. Of the 17
excluded articles, six were reviews, three were
published in languages other than English, six
did not have full text, one had an unrelated tool,
and one did not meet the minimum quality
requirements for inclusion (see Figure 1).
Study Characteristics
The 26 eligible studies included a total of 5,667
participants whose ages ranged from 18 to 39
years. Most studies were conducted in Asia
(n¼10) and Europe (n¼12); only one study was
conducted in the United States (n¼1). Most of
the Asian studies were conducted in Japan
(n¼7). Most of the studies were descriptive
cross-sectional (n¼21), and convenience sam-
pling was used for data collection. The instrument
used to measure maternity blues in most studies
(n¼13) was the Stein scale (Stein, 1980). The
sample size of the included studies that used the
Stein scale was 2,623 participants. All of the
included studies had suitable quality in terms of
methods and a low risk of bias. In most studies
(n¼16), researchers assessed maternity blues
during the first week postpartum. Moreover, anx-
iety and postpartum depression, considered to
be associated disorders, were reported in one
and seven studies, respectively (see
Supplemental Table S1).
Tools
The most commonly used tools in the 26 studies
were the Stein scale (n¼13) and the Kennerley
and Gath Blues Scale (n¼8). Other tools
included the Pitt scale (Pop et al., 1995), Zung
Self-Rating Depression Scale (ZSDS; Nagata
et al., 2000), Middlesex Hospital Questionnaire
Figure 1. Preferred ReportingItems for SystematicReviews andMeta-Analyses (PRISMA) flow diagram of study selection process.
Rezaie-Keikhaie, K. et al. REVIEW
JOGNN 2020; Vol. 49, Issue 2 129
(MHQ; Harris, 1981), Edinburgh Postnatal
Depression Scale (EPDS; Cox, Holden, &
Sagovsky, 1987), and Maternity Blues Scale
(MBS; Pop et al., 2015). All of the tools were
validated. The number of items and scoring sys-
tem based on the type of tool were as follows: Pitt
(12 items, score range ¼1–26), Stein (24 items,
score range ¼1–48), Kennerley and Gath Blues
Scale (28 items, score range ¼1–28), MHQ (48
items, score range ¼1–8), ZSDS (20 items, score
range ¼1–100), EPDS (10 items, score range ¼
1–30), and MBS (16 items, score range ¼1–100).
Prevalence of Maternity Blues
The prevalence of maternity blues reported in the
26 studies was 13.7% to 76.0%. Based on the
results of the random-effects model, the overall
prevalence of maternity blues in 5,667 women
was 39.0% (95% CI [32.3, 45.6], I
2
¼96.6%).
Subgroup analysis for the diagnosis of hetero-
geneity was performed based on the instrument
used for maternity blues assessment and the
country where the study was conducted. Mater-
nity blues had a lesser pooled prevalence with
the Stein scale (33.6%) and Kennerley and Gath
Blues Scale (40.1%) than with the other
instruments (50.9%). The prevalence of maternity
blues when measured with the other instruments
was 76.1% with the MHQ, 40.6% with the Pitt,
66.7% with the ZSDS, 29.4% with the EPDS, and
43.1% with the MBS (see Figure 2). The preva-
lence of maternity blues in Africa was greater
than in other continents. Among women in Africa
and Asia, the prevalence of maternity blues was
49.6% (95% CI [31.7, 67.5]) and 33.1% (95% CI
[20.1, 46.0]), respectively (see Figure 3).
One study was conducted in a low-income
country, four studies were conducted in middle-
income countries, and 21 studies were conduct-
ed in high-income countries. Subgroup analysis
based on income status showed that the preva-
lence of maternity blues was greater in low- and
middle-income countries than in high-income
countries. Hence, the pooled prevalence of ma-
ternity blues was 76.0% (95% CI [61.8, 86.9]),
40.8% (95% CI [28.4, 53.3]; I
2
¼95.3%), and
38.4% (95% CI [30.0, 46.7]; I
2
¼97.0%) in low-,
middle-, and high-income countries, respectively.
Prevalence of Maternity Blues by Tools
The pooled prevalence of maternity blues based
on the random-effects model for the two main
measurement tools (Stein scale and Kennerley
and Gath Blues Scale) in 21 studies with 4,597
Heterogeneity between groups: p = 0.174
Overall (I^2 = 96.634%, p = 0.000);
Stein, G.
Henshaw, C.
Ishikawa, N.
Takahashi, Y.
Edhborg, M.
Faisal-Cury, A.
Ehlert, U.
Okano, T.
Subtotal (I^2 = 96.746%, p = 0.000)
Bruno, A.
Watanabe, M.
Reck, C.
Harris, B.
Doornbos, B.
kariman, N.
Moslemi, L.
* Kennerley & Gath Blues Scale
Gonidakis, F.
Subtotal (I^2 = 95.779%, p = 0.000)
Glangeaud-Freudenthal, N.M.C.
Hau, F.W.L.
Nagata, M.
Murata, A.
Sakumoto, K.
Zanardo, V.
First
Gerli, S.
Pop, V. J.
Subtotal (I^2 = 94.808%, p = 0.000)
Adewuya, A.O.
author
* Stein scale
Sutter, A.
* Other instruments
1980
2004
2011
2014
2008
2008
1990
1992
2018
2008
2009
1981
2008
2016
2012
2007
1999
2002
2000
1998
2002
2019
2019
1995
2005
Year
1997
United kingdom
United kingdom
Japan
Japan
Sweden
Brazil
Germany
Japan
Italy
Japan
Germany
East africa
Netherland
Iran
Iran
Greece
France
Hong Kong
Japan
Japan
Japan
Italy
Italy
Netherland
Nigeria
Country
France
0.390 (0.323, 0.456)
0.757 (0.588, 0.882)
0.500 (0.430, 0.570)
0.215 (0.177, 0.257)
0.150 (0.086, 0.235)
0.374 (0.302, 0.451)
0.321 (0.236, 0.416)
0.414 (0.298, 0.538)
0.255 (0.139, 0.403)
0.509 (0.343, 0.675)
0.355 (0.266, 0.451)
0.153 (0.110, 0.206)
0.552 (0.518, 0.586)
0.760 (0.618, 0.869)
0.308 (0.143, 0.518)
0.442 (0.381, 0.504)
0.551 (0.504, 0.598)
0.445 (0.396, 0.495)
0.336 (0.252, 0.421)
0.137 (0.077, 0.220)
0.443 (0.337, 0.553)
0.667 (0.619, 0.712)
0.153 (0.092, 0.234)
0.271 (0.207, 0.342)
0.431 (0.339, 0.526)
0.294 (0.231, 0.363)
0.406 (0.349, 0.465)
0.401 (0.299, 0.503)
0.313 (0.272, 0.355)
ES (95% CI)
0.510 (0.410, 0.609)
100.00
3.48
3.92
4.03
3.91
3.90
3.83
3.64
3.58
19.36
3.81
4.01
4.05
3.62
3.17
3.96
4.01
4.00
50.08
3.93
3.72
4.01
3.93
3.94
3.81
%
3.94
3.97
30.56
4.03
Weight
3.77
0.390 (0.323, 0.456)
0.757 (0.588, 0.882)
0.500 (0.430, 0.570)
0.215 (0.177, 0.257)
0.150 (0.086, 0.235)
0.374 (0.302, 0.451)
0.321 (0.236, 0.416)
0.414 (0.298, 0.538)
0.255 (0.139, 0.403)
0.509 (0.343, 0.675)
0.355 (0.266, 0.451)
0.153 (0.110, 0.206)
0.552 (0.518, 0.586)
0.760 (0.618, 0.869)
0.308 (0.143, 0.518)
0.442 (0.381, 0.504)
0.551 (0.504, 0.598)
0.445 (0.396, 0.495)
0.336 (0.252, 0.421)
0.137 (0.077, 0.220)
0.443 (0.337, 0.553)
0.667 (0.619, 0.712)
0.153 (0.092, 0.234)
0.271 (0.207, 0.342)
0.431 (0.339, 0.526)
0.294 (0.231, 0.363)
0.406 (0.349, 0.465)
0.401 (0.299, 0.503)
0.313 (0.272, 0.355)
ES (95% CI)
0.510 (0.410, 0.609)
100.00
3.48
3.92
4.03
3.91
3.90
3.83
3.64
3.58
19.36
3.81
4.01
4.05
3.62
3.17
3.96
4.01
4.00
50.08
3.93
3.72
4.01
3.93
3.94
3.81
%
3.94
3.97
30.56
4.03
Weight
3.77
0.25 .5 .75 1
Figure 2. Pooled analyses and subgroup analyses by type of instrument for estimation of maternity blues prevalence in the
world. CI ¼confidence interval; ES ¼effect size.
Across studies, the prevalence of maternity blues was
39%.
Prevalence of the Maternity Blues in the Postpartum PeriodREVIEW
130 JOGNN, 49, 127–136; 2020.https://doi.org/10.1016/j.jogn.2020.01.001 http://jognn.org
participants was 36.1% (95% CI [29.1, 43.1];
I
2
¼96.2%). Based on these two main measure-
ment tools, the prevalence of maternity blues in
Europe was greater than on other continents.
Moreover, the prevalence of maternity blues in
middle-income countries was greater than in
high-income countries (see Table 1).
Three studies based on other instruments were
conducted in The Netherlands (Pitt), Japan (ZSDS),
Tanzania (MHQ), and Italy (EPDS and MBS). Sub-
group prevalence of maternity blues based on
these tools showed greater pooled prevalence than
prevalence determined with the other instruments
(MHQ, Pitt, ZSDS, EPDS, and MBS) and for the
Kennerley and Gath Blues Scale. Hence, we
repeated the meta-analysis and subgroup analyses
separately based on the tools used.
Metaregression
The results of the univariate random-effects met-
aregression analyses showed that the publication
year significantly contributed to the heterogeneity
of prevalence, with coefficients of –0.66%
(95% CI [–1.3, -0.01]) and R
2
of 11.3%. The in-
struments used to measure maternity blues did
not significantly explain variation in prevalence
(p¼.060). Moreover, income status was not
significantly associated with the prevalence of
maternity blues (p¼.685). Although the mean
age of participants had an indirect association
with maternity blues prevalence, the effect size
variation was not significant (p¼.131; see
Table 2 and Figure 4).
Discussion
We conducted a systematic review and meta-
analysis to investigate the prevalence of mater-
nity blues. Maternity blues is considered the most
common psychological disorder in the early
weeks after childbirth. We included 26 studies
published between 1980 and 2019 involving
5,667 participants in our meta-analysis. The
prevalence of maternity blues across these
studies was 39.0% (13.7%–76%). We also found
that the prevalence of maternity blues was
greater in African and European countries than in
Asian countries and the United States.
Additionally, the prevalence of maternity blues
was greater in low- and middle-income countries
than in high-income countries. This finding was
consistent with those of previous studies that
women with poor economic status experienced
greater levels of postpartum depression and
Heterogeneity between groups: p = 0.198
Overall (I^2 = 96.634%, p = 0.000);
Subtotal (I^2 = .%, p = .)
Sakumoto, K.
Glangeaud-Freudenthal, N.M.C.
author
Reck, C.
Subtotal (I^2 = 93.814%, p = 0.000)
Doornbos, B.
kariman, N.
Gerli, S.
Hau, F.W.L.
* America
Subtotal (I^2 = 98.053%, p = 0.000)
Bruno, A.
Harris, B.
Okano, T.
Murata, A.
Nagata, M.
Adewuya, A.O.
Pop, V. J.
Watanabe, M.
Sutter, A.
* Africa
Takahashi, Y.
* Asia
Ehlert, U.
Faisal-Cury, A.
Ishikawa, N.
Henshaw, C.
Edhborg, M.
Gonidakis, F.
Stein, G.
Moslemi, L.
Zanardo, V.
* Europe
First
2002
1999
Year
2009
2008
2016
2019
2002
2018
1981
1992
1998
2000
2005
1995
2008
1997
2014
1990
2008
2011
2004
2008
2007
1980
2012
2019
Japan
France
Country
Germany
Netherland
Iran
Italy
Hong Kong
Italy
East africa
Japan
Japan
Japan
Nigeria
Netherland
Japan
France
Japan
Germany
Brazil
Japan
United kingdom
Sweden
Greece
United kingdom
Iran
Italy
0.390 (0.323, 0.456)
0.496 (0.317, 0.675)
0.271 (0.207, 0.342)
0.137 (0.077, 0.220)
ES (95% CI)
0.552 (0.518, 0.586)
0.418 (0.333, 0.503)
0.308 (0.143, 0.518)
0.442 (0.381, 0.504)
0.294 (0.231, 0.363)
0.443 (0.337, 0.553)
0.331 (0.201, 0.460)
0.355 (0.266, 0.451)
0.760 (0.618, 0.869)
0.255 (0.139, 0.403)
0.153 (0.092, 0.234)
0.667 (0.619, 0.712)
0.313 (0.272, 0.355)
0.406 (0.349, 0.465)
0.153 (0.110, 0.206)
0.510 (0.410, 0.609)
0.150 (0.086, 0.235)
0.414 (0.298, 0.538)
0.321 (0.236, 0.416)
0.215 (0.177, 0.257)
0.500 (0.430, 0.570)
0.374 (0.302, 0.451)
0.445 (0.396, 0.495)
0.757 (0.588, 0.882)
0.551 (0.504, 0.598)
0.431 (0.339, 0.526)
100.00
11.66
3.94
3.93
Weight
4.05
45.40
3.17
3.96
3.94
3.72
39.12
3.81
3.62
3.58
3.93
4.01
4.03
3.97
4.01
3.77
3.91
3.64
3.83
4.03
3.92
3.90
4.00
3.48
4.01
3.81
%
0.390 (0.323, 0.456)
0.496 (0.317, 0.675)
0.271 (0.207, 0.342)
0.137 (0.077, 0.220)
ES (95% CI)
0.552 (0.518, 0.586)
0.418 (0.333, 0.503)
0.308 (0.143, 0.518)
0.442 (0.381, 0.504)
0.294 (0.231, 0.363)
0.443 (0.337, 0.553)
0.331 (0.201, 0.460)
0.355 (0.266, 0.451)
0.760 (0.618, 0.869)
0.255 (0.139, 0.403)
0.153 (0.092, 0.234)
0.667 (0.619, 0.712)
0.313 (0.272, 0.355)
0.406 (0.349, 0.465)
0.153 (0.110, 0.206)
0.510 (0.410, 0.609)
0.150 (0.086, 0.235)
0.414 (0.298, 0.538)
0.321 (0.236, 0.416)
0.215 (0.177, 0.257)
0.500 (0.430, 0.570)
0.374 (0.302, 0.451)
0.445 (0.396, 0.495)
0.757 (0.588, 0.882)
0.551 (0.504, 0.598)
0.431 (0.339, 0.526)
100.00
11.66
3.94
3.93
Weight
4.05
45.40
3.17
3.96
3.94
3.72
39.12
3.81
3.62
3.58
3.93
4.01
4.03
3.97
4.01
3.77
3.91
3.64
3.83
4.03
3.92
3.90
4.00
3.48
4.01
3.81
%
0.25 .5 .75 1
Figure 3. Pooled analyses and subgroup analyses by continent of study conducted for estimation the maternity blues
prevalence in the world. CI ¼confidence interval; ES ¼effect size.
Rezaie-Keikhaie, K. et al. REVIEW
JOGNN 2020; Vol. 49, Issue 2 131
maternity blues (Hahn-Holbrook, Cornwell-
Hinrichs, & Anaya, 2018; Manjunath, Giriyappa,
& Rajanna, 2011; Shivalli & Gururaj, 2015).
Because it was observed by researchers that
mothers with newborn daughters experience
more maternity blues (Manjunath et al., 2011),
factors that may contribute to the increased
prevalence of maternity blues in less-developed
countries include the lesser importance associ-
ated with female newborns in these countries and
the lack of emotional and social support
(Alvarado-Esquivel, Sifuentes-Alvarez, Salas-
Martinez, & Martı
´nez-Garcı
´a, 2006; Goyal, Gay, &
Lee, 2010; Manjunath et al., 2011). Moreover, in
terms of policy making, the lack of necessary
infrastructure to better manage maternity blues
and provide support for women until it resolves,
such as shortage of health care personnel,
insufficient mental health screening services for
mothers, and low awareness about use of social
support services in countries with low income
levels, is the primary factor affecting the resolu-
tion of maternity blues (Gelaye, Rondon, Araya, &
Williams, 2016; Patel et al., 2007; World Health
Organization, 2008). Moreover, this difference in
the prevalence of maternity blues among
countries might be related to differences in cul-
tural backgrounds and their lifestyles (Alves,
Fonseca, Canavarro, & Pereira, 2018; Fiala,
Svancara, Kla
´nova
´,&Ka
spa
´rek, 2017; Shi, Ren,
Li, & Dai, 2018).
The most commonly used tools to measure ma-
ternity blues were the Stein scale and the Ken-
nerley and Gath Blues Scale, which were used in
13 and 8 studies, respectively. A greater preva-
lence in maternity blues was found using the
Kennerley and Gath Blues Scale than the Stein
scale. This difference may arise from the different
symptoms measured by the two tools. Because
maternity blues causes a variety of emotional and
psychological symptoms and each tool may
examine a slightly different domain of symptoms,
there may be variations in the prevalence of ma-
ternity blues depending on the measurement tool
(Manjunath et al., 2011). This difference can also
be caused by the study population, demographic
characteristics (residence, educational attain-
ment, and age), and time elapsed between data
collection and when the participants gave birth.
Implications
Timely detection and treatment of the symptoms
of maternity blues can help reduce the burden of
these symptoms. Untreated symptoms of mater-
nity blues can have negative consequences on
the health of women and their infants, including
Table 1: Pooled Prevalence of Maternity Blues in Continents and Income Status
Subgroups by Tools
Characteristic
Stein Scale Kennerley–Gath Blues Scale Two Main Tools
a
n
Effect Size, %
[95% CI] I
2
n
Effect Size
(95% CI) I
2
n
Effect Size, %
(95% CI) I
2
Continent
Asia 9 29.2 [18.4, 40.1] 96.6 0 9 29.2 [18.4, 40.1] 96.6
America 1 32.1 [23.6, 41.6] NA 0 1 32.1 [23.6, 41.6] NA
Europe 2 55.5 [46.6, 64.4] NA 7 39.3 [26.7, 52.0] 95.5 9 43.3 [32.1, 54.5] 94.8
Africa 1 31.3 [27.2, 35.5] NA 1 44.5 [39.6, 49.5] NA 2 36.7 [33.6, 39.8] NA
Income status
Middle 4 40.8 [28.4, 53.3] 95.3 0 4 40.8 [28.4, 53.3] 95.3
High 9 29.9 [21.4, 38.5] 92.4 8 40.1 [29.9, 50.3] 94.8 17 35.0 [26.5, 43.4] 96.4
Overall pooled
effect size
13 33.6 [25.2, 42.1] 95.8 8 40.1 [29.9, 50.3] 94.8 21 36.1 [29.1, 43.1] 96.2
Note. CI ¼confidence interval; I
2
index ¼degree of heterogeneity; NA ¼not applicable.
a
The two main tools are the Stein scale and Kennerley–Gath Blues scale.
Results indicate that attention to symptoms of maternity
blues after childbirth is crucial in combination with
physical care.
Prevalence of the Maternity Blues in the Postpartum PeriodREVIEW
132 JOGNN, 49, 127–136; 2020.https://doi.org/10.1016/j.jogn.2020.01.001 http://jognn.org
the children’s cognitive growth (Kieviet, Dolman,
& Honig, 2013). Disagreement among special-
ists about approaches to the diagnosis of mater-
nity blues is an important barrier to
comprehensive management of maternity blues,
and this led to the great heterogeneity in preva-
lence in our study (Gonidakis, Rabavilas, Varsou,
Kreatsas, & Christodoulou, 2007; Ntaouti et al.,
2018). This can be attributed to the lack of a
specific definition of maternity blues based on
international standards. Although instances of
maternity blues present with postpartum changes
in mood, no specific diagnostic criteria have been
established (Gonidakis et al., 2007; Ntaouti et al.,
2018). Additionally, some rare medical disorders
such as frontotemporal dementia, frontal lobe
tuberculoma, and Sheehan syndrome may be
associated with some symptoms similar to those
of maternity blues (Dell & Halford, 2002; Gautam,
Bhatia, Rathi, & Kaur, 2014; Stavrou & Sgouros,
2002). Despite the variety of maternity blues
assessment tools, Vitale et al. (2016) found that
the use of mood-affecting drugs and antide-
pressants, along with appropriate precautions,
such as family support, can help in the treatment
of the symptoms of maternity blues.
Table 2: Univariate Metaregression for Prevalence of Maternity Blues
Variable Coefficient, % Standard Error 95% CI for Coefficient pAdjusted R
2
Mean age –2.1 1.3 [–4.9, 0.68] .131 7.0
Publication year –0.66 0.32 [–1.3, –0.01] .047 11.3
Type of instrument
a
8.2 4.2 [–0.36, 16.8] .060 12.1
Income status
b
–2.7 6.7 [–16.8, 11.2] .685 3.7
Note. CI ¼confidence interval.
a
Type of instrument: 1 ¼Stein scale, 2 ¼Kennerley–Gath Blues Scale, 3 ¼other tools.
b
Income status: 1 ¼low, 2 ¼middle, 3 ¼high.
Figure 4. Metaregression of the prevalence of maternity blues based on four variables: (a) publication year of study, (b)
instruments, (c) income status, and (d) mean age in years.
Rezaie-Keikhaie, K. et al. REVIEW
JOGNN 2020; Vol. 49, Issue 2 133
Limitations
There were several limitations to our review.
Among the most important challenges was that
the time at which the symptoms of maternity blues
were measured was diverse across the studies,
resulting in the inability to determine the preva-
lence of maternity blues based on time since
childbirth. The use of different maternity blues
measurement tools in various studies was another
important limitation that led to a broad range of
prevalence rates and substantially increased the
heterogeneity. To decrease the heterogeneity, we
assessed the prevalence of maternity blues
based on subgroups, including the type of scale
used and the continents where the studies were
conducted. Finally, all studies were cross-
sectional observational designs, and the esti-
mated prevalence in the United States was
determined based on one study.
Conclusion
Our findings suggest a relatively high prevalence
of maternity blues among women during the
postpartum period. Our findings also indicate that
attention to symptoms of maternity blues after
childbirth is crucial in combination with physical
care. The attention paid to psychological di-
mensions of the postpartum period can be
improved through educational programs
designed for women and their families before and
after childbirth. Furthermore, our results suggest
that health care professionals, including mid-
wives, nurses, and physicians, play a vital role in
identifying the occurrence and severity of mater-
nity blues through essential psychosocial care
and mental health support.
Supplementary Material
Note: To access the supplementary material that
accompanies this article, visit the online version
of the Journal of Obstetric, Gynecologic, &
Neonatal Nursing at http://jognn.org and at
https://doi.org/10.1016/j.jogn.2020.01.001.
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Doğum genellikle bir kadının hayatındaki en unutulmaz ve acı verici deneyimlerden biri olarak kabul edilmektedir (Kolan ve ark., 2020). Doğum ağrısı karmaşık ve çok boyutlu bir olaydır ve fizyolojik bir süreç olarak en şiddetli ağrılardan biri olarak bilinmektedir (Shaterian ve ark., 2021). Normal, müdahale edilmeyen vajinal doğum, sezaryene göre daha güvenli ve annenin hastanede kalış süresini kısaltan fizyolojik bir süreçtir. Ancak doğum sırasındaki ağrı ve kaygı bu fizyolojik süreci olumsuz etkileyebilmektedir. Doğum ağrısı kadınlarda sezaryen oranını artıran önemli bir faktördür. Ayrıca doğum deneyiminin olmaması kadınların doğum sırasında kaygı ve korku yaşamalarını arttıran bir faktördür (Yüksel ve ark. 2017). Doğum ağrısı bireysel bir deneyim olmasına rağmen, doğum ağrısının doğum ilerledikçe daha yoğun hale geldiği bilinmektedir (Hu ve ark., 2021). Doğumun ikinci evresinde ağrı daha yoğundur ve karnın alt kısmında yerleşmiştir (Yüksel ve ark. 2017). Uluslararası Ağrı Araştırmaları Derneği (IASP), ağrının genellikle uyum sağlayıcı bir role sahip olduğunu ancak işlevsel durum, sosyal ve psikolojik iyilik hali üzerinde olumsuz etkileri olabileceğini belirtektedir. Williams ve Craig ağrıyı “duyusal, duygusal, bilişsel ve sosyal bileşenlerle gerçek veya potansiyel doku hasarı ile ilişkili rahatsız edici bir deneyim” olarak tanımlamaktadır (Raja ve ark. 2020). Doğum ağrısının yoğun hissedilmesi anne adayında uterus kan akımını azaltma, kalp debisini artırma, oksijen tüketimini arttırma ve ciddi solunum alkalozuna yol açma gibi olumsuz etkilere yol açabilmektedir (Hu ve ark., 2021). Bu fizyolojik değişiklikler, fetüse giden oksijen miktarını etkilemekte ve fetal hipoksemi ve metabolik asidoza neden olmaktadır. Ayrıca doğumda ağrısının yoğun hissedilmesi, travma sonrası stres bozukluğu için hazırlayıcı bir faktördür ve olumsuz bir doğum sonrası deneyimine neden olmaktadır (Taheri ve ark. 2018). Doğum sırasında aşırı ağrı, korkuyu artırarak kadını ağrıya karşı daha duyarlı hale getirmekte ve korku-gerginlik-acı döngüsü kavramı ortaya çıkmaktadır. Bu döngüyü kırmak, olumlu bir doğum deneyimine sahip olmak için gereklidir Ayrıca korku, stres hormonlarının salınmasına neden olan kortizolün dolaşımda salınmasına neden olur. Yüksek bir kortizol seviyesi, uterin arter kan akışında azalmaya neden olur, bu da kasılmaların yavaşlamasına veya durmasına sebep olur. Rahim kasılmalarının etkinliğindeki düşüş, doğumun süresini uzatmaktadır. Uzun bir doğum, bebek ve anne için komplikasyonları artırabilir (Çiçek ve Başar. 2017). 96Bununlabirlikte doğum ağrısına uyumlanma, annelerin doğum sürecinden daha fazla memnun olmalarını sağlamaktadır(Geltore ve Angelo, 2020). Bu nedenle, doğum ağrısının yoğunluğunu ve süresini güvenli bir aralığa indirmek için uygun ağrıya uyumlanma yöntemlerini benimsemek esastır. Dünya Sağlık Örgütü’de doğumun ilk aşamasında doğum ağrısını azaltacak ve böylece kadınların doğum deneyimini iyileştirecek önlemler alınmasını tavsiye etmektedir (WHO, 2018). Yaşanan ağrılı süreç, gebe ve ebenin birlikte yol alması gereken bir süreçtir. Ebeler, doğum sürecinde gebe ile pozitif iletişim sağlayarak bireyselleştirilmiş bakım sağlamalı ve gebenin doğum ağrısıyla uyumlanabilmesine destek olmalıdır (Kaçar, 2020). Doğum ağrısını gidermek için farmakolojik ve farmakolojik olmayan yöntemler kullanılmaktadır. Bu yöntemlerin amacı anneye ve bebeğe herhangi bir zarar vermeden ağrının giderilmesi ve anneye konforlu bir doğum deneyimi yaşatılmasıdır. Farmakolojik olmayan ağrı giderme yöntemleri herhangi bir ilaç kullanılmadan kadının gevşemesine odaklanan, ağrısını en az algılamasını sağlayan yöntemlerdir. Farmakolojik olmayan yöntemler genellikle maliyet etkin ve girişimsel olmadığı için genellikle farmakolojik tedavilere tercih edilir (Young ve ark., 2021). Farmakolojik olmayan yöntemlerin uygulanması doğum sürecinde anne ve bebeğe önemli yararlar sağlamaktadır. Bunun yanı sıra bu yöntemlerin kullanılması bireyselleştirilmiş, kadın merkezli bakımın alınmasını gerektirmektedir. Çünkü tüm farmakolojik olmayan yöntemlerin kullanılması ebe liderliğinde kadın merkezli bir bakım felsefesi ile sunulabilmektedir. Farmakolojik olmayan yöntemlerin uygulandığı ebelik bakım modeli kadının fiziksel, zihinsel ve ruhsal boyutlara sahip bir bütün olarak görüldüğü “bütünsellik” kavramını benimsemektedir (Bertone ve Dekker, 2021). Son on yılda giderek daha popüler hale gelen farmakolojik olmayan yöntemlerin kullanımının yaygınlık oranlarını gösteren çalışmalar %1 ile %87 arasında değiştiğini bildirmektedir. Son yıllarda doğum ağrısına uyumlanmada kullanılan farmakolojik olmayan başlıca yöntemler; nefes teknikleri, refakatçi eşliğinde doğum, suda doğum, yoga, hareket özgürlüğü, aromaterapidir (Bertone ve Dekker, 2021). Doğum korkusu, stres hormonlarının salınmasına neden olan kortizolün dolaşımda salınmasına neden olur. Yükselen kortizol seviyesi, uterin arter kan akışında azalmaya neden olur, bu da kasılmaların yavaşlamasına veya durmasına sebep olur. Rahim kasılmalarının etkinliğindeki düşüş, doğumun süresini uzatmaktadır.
Thesis
La santé mentale des femmes en période périnatale est une priorité de santé publique. Première cause de décès maternel en France, les pathologies mentales et notamment la dépression postnatale (DPN) ont aussi des effets sur la santé de la mère, du père et le développement de l’enfant. A l’heure où la promotion pour la santé (PPS) est devenue la clé de voute d’un système visant à gommer les inégalités sociales de santé, peu de travaux scientifiques se sont intéressés aux interventions anténatales de PPS que sont l’Entretien Prénatal Précoce (EPP) et la Préparation à la Naissance et à la Parentalité (PNP). Répondent-elles à leurs objectifs de dépistage et de prévention en termes de santé mentale et de qualité de vie (QV) ? Sont-elles les seules stratégies d’intervention mobilisables et sont-elles adaptées ?Pour répondre à ces questions, nous avons étudié au sein d’un échantillon de mères représentatif de la population française (Étude Longitudinale Française depuis l’Enfance-E.L.F.E.) : (1) les facteurs sociodémographiques et de santé associés à la pratique de l’EPP et/ou de la PNP (2) les liens entre la pratique de l’EPP et/ou de la PNP et les symptômes dépressifs postnataux (SDPN) à 2 mois post-partum évalué par l’ Edinburgh Post Natal Scale (EPDS) (3) les facteurs sociodémographiques, économiques, de santé de la mère, psychologiques, de santé de l’ enfant, et liés au soutien social associés à la QV physique et mentale des mères à 1 an post-partum évaluée par le SF-12.Pour atteindre ces objectifs nous avons mené trois études. Les résultats de notre première étude (n=14595 femmes sans jumeaux, vivant en couple et sans données manquantes) ont permis de montrer que l’EPP et la PNP concernaient préférentiellement des populations de femmes de bon niveau sociodémographique quand les femmes les plus vulnérables sur ce plan ne bénéficiaient pas plus souvent d’un EPP et accédaient moins fréquemment à la PNP. Les résultats de la deuxième étude (n=16411 femmes sans jumeaux et sans données manquantes sur la variable principale) ont permis de montrer que ces mesures anténatales concernaient une minorité de femmes (35 % avaient eu à la fois un EPP et une PNP, 26 % n'avaient eu aucune mesure préventive pendant la grossesse). Lorsque l’EPP et la PNP étaient associés, le taux de femmes présentant des SDPN légers à 2 mois post-partum (EPDS>10) étaient plus faible que lorsqu’elles étaient pratiquées séparément ou non faites. Il n’y avait pas d’association avec la présence de symptômes dépressifs cliniquement significatif à 2 mois post-partum (EPDS>12). Les résultats de la troisième étude (n=11514 femmes sans jumeaux et sans données manquantes pour la variable principale) ont permis de montrer que les facteurs influençant la QV des mères à 1 an post-partum sont nombreux et multidimensionnels et surtout souvent présents et identifiables avant et/ou pendant la grossesse. Il n’existait pas d’association entre le fait d’avoir bénéficié de l’EPP et/ou la PNP et la QV à 1 an post-partum.Nos résultats soulignent que les stratégies de PPS et de prévention que sont l’EPP et la PNP ne pourront, en l’état, être une réponse univoque à la problématique de la prévention en santé mentale périnatale. Intégrées dans un système de prévention et de soins gradués et coordonnés de l’anté au postnatal, ces interventions pourront répondre aux besoins spécifiques des femmes et des coparents. Si elles intègrent une vision écosystémique et se déclinent dans cette approche populationnelle, elles pourront être à la base d’un parcours de PPS à la hauteur du défi des «1000 premiers jours ».
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Background: Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. Subjects and methods: A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein's Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan's Experiences in Close Relationship Scale, as well as demographic and obstetric data. Results: The prevalence of maternity blues in our study was 19.9%. Higher result on Stein's Maternity Blues Scale was associated with anxious attachment style (r=0.425, p<0.01), oxytocin (r=0.308, p<0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p<.01). Conclusions: This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population.
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Background: In terms of maternal morbidity and mortality, the puerperium is just as significant as pregnancy and childbirth. Nearly half of all maternal deaths occur in the time after delivery. Methods: This review is based on pertinent articles in English and German from the years 2000- 2020 that were retrieved by a selective search in MEDLINE and EMBASE, as well as on the available guidelines in English and German and on German-language textbooks of obstetrics. Results: The most common and severe complications are, in the post-placental phase, bleeding and disturbances of uterine involution; in the first seven days after delivery, infection (e.g., endomyometritis, which occurs after 1.6% [0.9; 2.5] of all births) and hypertension-related conditions. Thromboembolism, incontinence and disorders of the pelvic floor, mental disease, and endocrine disturbances can arise at any time during the puerperium. In an Australian study, the incidence of embolism was 0.45 per 1000 births, with 61.3% arising exclusively after delivery. Conclusion: Basic familiarity with the most common and severe diseases in the puerperium is important for non-gynecologists as well, among other things because highly acute, lifethreatening complications can arise that demand urgent intervention.
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Background: Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. Subjects and methods: A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein's Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan's Experiences in Close Relationship Scale, as well as demographic and obstetric data. Results: The prevalence of maternity blues in our study was 19.9%. Higher result on Stein's Maternity Blues Scale was associated with anxious attachment style (r=0.425, p<0.01), oxytocin (r=0.308, p<0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p<0.01). Conclusions: This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population.
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Background Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. Methods We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6–18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I² = 98%), ranging from 3% (2–5%) in Singapore to 38% (35–41%) in Chile. Nations with significantly higher rates of income inequality (R² = 41%), maternal mortality (R² = 19%), infant mortality (R² = 16%), or women of childbearing age working ≥40 h a week (R² = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. Interpretation The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Introduction Postpartum depression (PPD) is a prevalent condition with a serious impact. The early identification of women at risk for developing PPD allows for primary prevention and the delivery of timely appropriate referrals. This study investigated the validity and reliability of the postnatal version of the Postpartum Depression Predictors Inventory-Revised (PDPI-R), an instrument widely studied internationally, in Portuguese women. Methods The sample consisted of 204 women who participated in an online cross-sectional survey. Participants completed the European Portuguese versions of the PDPI-R, the Edinburgh Postnatal Depression Scale (EPDS), and the Postnatal Negative Thoughts Questionnaire at 1–2 months postpartum. Additionally, ROC analyses were performed to conduct an exploratory analysis of the instruments’ predictive validity. Results The prevalence rates of clinical postpartum depressive symptoms were 27.5 and 14.2% using the cut-off scores of 9 and 12, respectively, on the EPDS. The European Portuguese postnatal version of the PDPI-R demonstrated acceptable reliability and satisfactory construct and convergent validity. When using the EPDS > 9 cut-off score, the exploratory analyses yielded a sensitivity of 76.8% and a specificity of 73.0% with a cut-off score of 5.5 [area under the curve = 0.816]. Discussion These preliminary findings encourage the use of the postnatal version of the PDPI-R as a screening tool to identify Portuguese women at high risk for developing PPD. Subsequent assessments are needed to support the routine application of the PDPI-R both in research and for clinical purposes.
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Background In the postpartum period, certain groups of women are at a higher risk for developing depressive episodes. Several studies have described risk factors for developing postpartum depression (PPD). However, these studies have used limited numbers of participants, and therefore the estimated prevalence of PPD varies greatly. Methods The objective of this study is to identify the main risk factors for developing PPD by using data collected via the Czech version of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). This database provides a representative sample (n = 7589) observed prospectively and a large amount of data on depressive symptoms and on biological, socioeconomic, and environmental factors.The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for incidence of PPD. The affective pathology was examined at three time points: before delivery, 6 weeks after delivery, and 6 months after delivery. ResultsThe prevalence of depressive symptoms before delivery was 12.8%, 6 weeks after delivery 11.8%, and 6 months after delivery 10.1%. The prevalence rates are based on women who completed questionnaires at all three time-points (N = 3233).At all three time points, the main risk factors for developing PPD identified as significant by both univariate and multivariate analysis were personal history of depressive episodes and mothers experiencing psychosocial stressors. Other risk factors occurring in both types of analysis were: family history of depression from expectant mother’s paternal side (prenatal), mothers living without partners (6 weeks postpartum) and feelings of unhappiness about being pregnant (6 months postpartum). Several protective factors were also observed: male child gender (prenatal), primiparous mothers (6 months postpartum), and secondary education (prenatal, only by multivariate analysis).Significant risk factors found solely by univariate analysis were family history of depression in both parents of the expectant mother (prenatal and 6 weeks postpartum), family history of depression from subject’s maternal side (6 months postpartum), unintentional pregnancy (prenatal and 6 weeks postpartum), feelings of unhappiness about being pregnant (prenatal and 6 weeks postpartum), primary education (prenatal and 6 weeks postpartum), mothers who opted not to breastfeed (6 months postpartum) and mothers living without partners (prenatal and 6 months postpartum). Family savings were identified as protective factor (prenatal and 6 months postpartum). Conclusions We identified significant predictors of PPD. These predictors can be easily detected in clinical practice, and systematic screening can lead to identifying potentially at risk mothers. Since the risk is linked with experience of psychosocial stressors it seems that they might benefit from increased psychosocial support to prevent affective pathology.
Article
Aim: To identify risk factors for Maternity Blues (MB) and to evaluate the impact of obstetric factors on MB prevalence. Materials and methods: 194 mothers have completed the Edinburgh Postnatal Depression Scale (EPDS) 2 days after delivery. Bivariate and multivariate logistic regression models were used to identify the predictors of MB. Results: 57 women (29.4%) were positive at screening. Comparing the two groups, no statistically significant difference was found in age (p = 0.536), nationality (p = 0.065) and BMI before pregnancy (p = 0.224). Interestingly, no significant differences were highlighted in terms of assisted reproduction technology or spontaneous pregnancies and the presence of labor analgesia, while MB was significantly more frequent in case of cesarean section (CS) (p = 0.035). Statistical differences have been found in previous CS (p = 0.022), previous voluntary interruption of pregnancy (p = 0.021), number of previous pregnancies (p = 0.007), Apgar 5’ (p = 0.026), lower level of education (p = 0.009) and previous postpartum Depression (PPD) (0.026). A logistic regression analysis was realized according to a multivariate model incorporating all the variables with a p-value ≤ 0.25 in bivariate analysis. In the final model vaginal delivery (OR 0.451, 95% CI [0.224–0.911], p = 0.026) resulted to be MB protective factor, while a lower level of education (OR 3.657, 95% CI [1.482–9.023], p = 0.005) as well as previous PPD (OR 4.714, 95% CI [1.273–17.458], p = 0.020) were identified as independent risk factors. Conclusion: This study showed that a lower education level and a previous PPD resulted to be important risk factors for MB development, while natural delivery was revealed as a protective factor. These results could be used to develop a better and more accurate prevention program after delivery.
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The study aimed to determine relationship between childbirth duration and postpartum blues. The study was using cohort research design to determine relationship between childbirth duration and postpartum blues. The study was conducted in maternity ward of Pangkep district Hospital for two months duration. The study population were all mothers who came to give birth at Pangkep district Hospital during intervention period. The sample sizes were 60 respondents which met the criteria for this study. The data was analysed using SPSS program. The result found 80% of respondents experienced postpartum blues. Most respondents (83.3%) aged between 20 years and 35 years (low risk), while highest parity percentage was in multiparous mothers (70%). There were 63.3% of respondents had low education level and 78.3% had pregnancy planning. The statistical test had obtained of phase I (p=1.000), phase II (p=1.000) and phase III (p= 0.340). © 2019, Indian Journal of Public Health Research and Development. All rights reseved.
Article
Background: Women undergo adaptive physical and psychological changes during pregnancy, which make them vulnerable to psychological disorders. Methods: This study used a prospective observational design and included concurrent validation analysis of the 16-item Maternity Blues Scale (MBS) Dutch version to determine the direction and magnitude on the Edinburgh Postnatal Depression Scale (EPDS) symptoms, including three factors, anhedonia, anxiety, and depression in 320 puerperae early after childbirth. Results: We found a statistically significant correlation between MBS and EPDS global scores (0.22, p < .001). Moreover, Negative affect was significantly correlated with the EPDS global score (0.23, p < .001), anhedonia (0.12, p < .05), and anxiety (0.25, p < .001); Positive affect with the EPDS global score (0.14, p < .05) and depression (0.13, p < .05); and Depression subscale with EPDS global score (0.15, p < .05), anhedonia (0.12, p < .05), and anxiety (0.12, p < .05), and depression (0.12, p < .05). In addition, the subgroup of women (n = 33, 10.3%) with EPDS > 12 presented significantly higher global MBS score (2.51 ± 0.38 versus 2.26 ± 0.38, p = .01), with negative affect (2.88 ± 0.67 versus 2.62 ± 0.38, p=.04), positive affect (2.52 ± 0.69 versus 2.32 ± 0.38, p = .04), and depression (2.09 ± 0.75 versus 1.82 ± 0.36, p = .02). Conclusion: These findings together suggest that women with higher maternity blues scores may represent a distinct subgroup at increased risk of depression.
Article
Aims: To validate the Greek version of Kennerley and Gath's Blues Questionnaire (BQ) and gather further knowledge on maternity blues (MB) associations with certain clinical and sociodemographic factors in Greek population. Material and methods: 116 postpartum women, who met the inclusion criteria, completed the Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the third day after delivery. Sociodemographic and clinical data were also collected. Results: Fifty women (43.1%) experienced severe MB on the third day postpartum. Lower number of previous births, less years of marriage, and husband's occupation, were found to be associated with MB occurrence. Of them, years of marriage (odds 0.21, p = 0.001) and husband's occupation in private sector (odds 1.21, p = 0.04) were independent predictors of MB in logistic regression analysis. Cronbach's α for the total 28-item Greek version of BQ was 0.85. Cluster analysis in our data showed that the optimal number of clusters of BQ items was 4; these four clusters of items presented similarities with the Bartholomew and Horowitz's four-category model of attachment styles (avoidant - dismissing, preoccupied, secure, avoidant - fearful). Conclusions: The Greek version of Blues Questionnaire is a reliable tool for the detection and measurement of MB. Less years of marriage and the economic insecurity seem to have strong impact on the occurrence of MB. Further investigation is needed to evaluate whether the phenomenon of MB is associated with parental or mother-to-infant bonding disorders.
Article
Maternal depression has been intensively explored; however, less attention has been paid to maternal suicide. No studies to date have observed maternal depression and suicide at immediate prenatal and early postpartum stages. In total, 213 Chinese women were recruited in hospitals after they were admitted for childbirth. All completed a short-term longitudinal survey at perinatal stages. Women reported lower depression scores (6.65) and higher suicidal ideation incidence (11.74%) after childbirth. Prenatal depression raised the possibility of prenatal suicidal ideation, while prenatal depression and suicidal ideation increased postpartum depression and suicidal ideation. At immediate prenatal stage, marital satisfaction protected women from depression, while miscarriage experiences and self-esteem increased the risk. At early postpartum stage, in contrast, being first-time mother, marital satisfaction, and harmony with mother-in-law prevented them from depression. Our study is among the first to confirm that women have decreased depression but increased suicidal ideation at early postpartum, and a causal relationship between them, which are worthy of public attention. Potential protective (marital satisfaction, being first-time mother, and harmony with mother-in-law) or risk factors (miscarriage experiences and self-esteem) of maternal depression and suicidal ideation are identified at perinatal stages. This offers reliable guidance for clinical practice of health care.
Article
Purpose. Among negative emotions, anger has not been studied in as much depth in her connection to postpartum mood disorders. The study aimed to investigate the role of anger as a potential vulnerability factor increasing the risk of Maternity Blues (MB) and Postpartum Depression (PPD). Materials and methods: Pregnant women in their third trimester of pregnancy underwent the following tests: the State Trait Anger Expression Inventory 2 – STAXI-2 (baseline visit), the Blues Questionnaire -BQ (3 and 5 days after delivery), and the Edinburgh Postnatal Depression Scale – Edinburgh Postnatal Depression Scale (EPDS) (3 and 6 months following delivery). Results: One hundred ten subjects were included in this study. The prevalence rate of mothers with MB was about 35%, whereas about 4% of women developed a PPD. Significant positive correlations were found among State anger (SANG), Trait anger (TANG), anger expression out (AXO) and in (AXI) and postpartum depressive disorders, as measured by blues questionnaire (BQ) and EPDS. Conclusions: Anger experience and expression can be considered as vulnerability factors for postpartum mood disorders onset. Particularly, the expression of angry feelings toward other persons or objects in the environment (AXO) predicts the onset of MB, whereas holding in or suppressing angry feelings (AXI) could be a risk factor for subsequent PPD.
Article
Importance: Fifteen percent to 20% of pregnant women suffer from mental disorders, and 86% of them are not treated due to potential teratogenic risks for the fetus. Several drugs seem to be safe during pregnancy but knowledge regarding risks of antenatal exposure to drugs is still limited. Objective: The aim of this article is to provide a review of literature, data, and a clinical guideline concerning the treatment and management of mental disorders during pregnancy and lactation. Evidence acquisition: Bibliographical research was carried out using Medline and Pubmed (from 2005 until 2015) and articles, books and Websites were consulted. Results: Regarding antidepressants, only paroxetine seems to lead to an increased risk of malformations, whereas fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram and venlafaxine do not appear to increase this risk. The use of duloxetine is associated with an increased risk of miscarriage during pregnancy but not with an increased risk of adverse events, such as birth defects. There is no clear evidence of malformation risk associated with the use of antipsychotics, whereas a risk associated with pregnancy and newborn outcome has been detected. All mood stabilizers are associated with risks of birth defects and perinatal complications. Conclusions and relevance: Taking psychoactive drugs is possible during pregnancy, but it is important to consider various effects of the drugs. Future research should focus on prospective and longitudinal studies with an adequate evaluation of confounding variables. This should be followed by long-term studies to obtain accurate measures of child development.