Risk Factors for Postpartum Depression
Postpartum depression is associated with various risk factors, some of which can be mitigated while others cannot. This blog article will explore these specific risk factors and offer research-backed strategies to address them, based on the review article ‘Postpartum risk factors: A narrative review.’ Understanding psychological, obstetric, biological, social, and lifestyle factors is crucial for preemptive intervention.
Psychological Risk Factors
Depression and anxiety stand out as the most significant indicators of Postpartum Depression (PPD). Women with a history of these conditions face a heightened risk of PPD compared to those without such experiences. Moreover, the likelihood of developing PPD increases for women experiencing premenstrual syndrome (PMS). One theory suggests that severe PMS may be linked to variations in serotonin transport systems, a neurotransmitter crucial for regulating mood, happiness, and contentment. Genetic differences, particularly in serotonin polymorphisms, may contribute to tryptophan depletion, potentially triggering postpartum depression.
Several other psychological factors also contribute to PPD susceptibility. These include harboring negative sentiments toward pregnancy, encountering multiple stressful life events, and having a history of sexual abuse. Intriguingly, difficulties accepting the baby’s gender or possessing low self-esteem are additional predisposing factors for postpartum depression.
Obstetric Risk Factors
While the overall research remains inconclusive, certain studies shed light on the association between the number of children a woman has and postpartum depression (PPD). Women with at least one prior child face a slightly elevated risk of developing PPD. Moreover, there’s evidence indicating a potential link between having two or more children and PPD. However, another study suggests that women who are having their first child are more susceptible to PPD. Despite these seemingly contradictory findings, they imply that the number of children may not directly correlate with PPD risk. Rather, it suggests that the increased responsibilities following childbirth could be a more significant predictor of PPD; hence, more children may imply more responsibilities, potentially elevating the likelihood of developing PPD.
High-risk pregnancies also contribute to PPD. Women requiring hospitalization during pregnancy or undergoing emergency cesarean sections are at higher risk. Additionally, complications like meconium passage, umbilical cord prolapse, and obstetric hemorrhages elevate the likelihood of PPD. Mothers of low birth weight infants (<1500 grams) face a 4 to 18 times greater risk of developing PPD.
A mismatch between pregnancy and delivery expectations and reality heightens the PPD risk. For instance, women hoping for natural childbirth but undergoing cesarean sections are at increased risk. To mitigate this, reducing stress during pregnancy, especially nearing delivery, is advisable. Moreover, attending in-person childbirth classes, receiving epidurals during childbirth, and breastfeeding postpartum decrease PPD risk. Interestingly, breastfeeding for at least three months correlates with lower Edinburgh Postnatal Depression Scale scores compared to non-breastfeeding mothers. Another study suggests that breastfeeding for four months is associated with reduced postpartum depression levels.
Low hemoglobin concentration levels also link to PPD. A low mean corpuscular hemoglobin concentration (MCHC), indicating insufficient hemoglobin in red blood cells, potentially indicates iron-deficiency anemia. Women with low MCHC levels (<120 g/L) on day seven post-delivery exhibit higher PPD symptoms by day 28 after childbirth.
Biological Risk Factors
Age is a factor associated with the likelihood of experiencing postpartum depression (PPD), with younger mothers being at a higher risk. Research indicates that women aged 13 to 19 have the highest risk of developing PPD, while those between 31 and 35 years old have the lowest risk. Another study corroborates this, suggesting that older mothers at the time of delivery are less likely to develop postpartum depression. This correlation between a mother’s age and the timing of childbirth may be linked to her self-efficacy, which refers to one’s belief in their ability to achieve specific goals or tasks. Women with higher reported self-efficacy tend to have a lower risk of postpartum depression.
Glucose metabolism disorders during pregnancy pose another risk factor for PPD. Women with higher blood glucose levels, such as those with gestational diabetes, following a glucose challenge test with 50 g of glucose, are at an increased risk of developing PPD. Fortunately, gestational diabetes typically resolves naturally after delivery and can be managed during pregnancy.
Serotonin and tryptophan levels play a crucial role in understanding postpartum depression. Low serotonin levels are associated with depression, memory issues, and low mood. Tryptophan is essential for serotonin production and healthy sleep, and while the body cannot produce tryptophan, it can be obtained through a balanced diet. Foods rich in tryptophan include salmon, poultry, eggs, spinach, seeds, milk, soy, and nuts. Consuming these foods alongside carbohydrates may enhance tryptophan absorption, thereby increasing serotonin levels indirectly. While there are no foods that directly boost serotonin levels, focusing on a diet rich in tryptophan can elevate serotonin levels.
Oxytocin, a hormone involved in regulating emotions and social interactions, also affects postpartum depression. Higher oxytocin levels in mid-pregnancy are associated with PPD within the first two weeks after delivery. However, oxytocin also activates serotonin receptors, which reduces stress and boosts mood. Breastfeeding naturally increases oxytocin levels, as oxytocin plays a role in milk production.
Estrogen, another hormone, impacts postpartum depression by influencing serotonin receptor function. Upon delivery, estrogen levels drop due to the removal of the placenta, contributing to postpartum depression and sleep disturbances. Therefore, it is crucial to explore other methods to increase serotonin production to counteract the inevitable decrease in estrogen levels.
Corticotropin-releasing hormone (CRH), produced in the hypothalamus and placenta during pregnancy, is also involved in postpartum depression. After delivery, the expulsion of the placenta causes a significant decrease in CRH and estrogen levels, rendering women susceptible to postpartum depression for the first 12 weeks after childbirth.
Social Risk Factors
Social support encompasses emotional, financial, informational, and empathetic relationships. Among all environmental factors, diminished social support poses the greatest risk for postpartum depression. Therefore, having robust social support networks is crucial in combating postpartum depression. Research indicates that spousal support during the postpartum period is linked to decreased postpartum depression. Additionally, low income and lower educational attainment, specifically less than a high school degree, are risk factors for postpartum depression. Conversely, higher employment status correlates with lower levels of PPD.
Lifestyle Risk Factors
Several lifestyle factors influence postpartum depression, including dietary patterns, sleep, exercise, and physical activity. A research study demonstrated a potential reduction in postpartum depression by up to 50% through a diet rich in vegetables, fruits, legumes, seafood, dairy products, and olive oil.
Vitamin B6 supports serotonin production from tryptophan, thus aiding in depression reduction. Foods abundant in vitamin B6 include seafood, beef liver, potatoes, and other starchy vegetables. Across 23 countries, increasing seafood intake was associated with decreased postpartum depression, likely due to elevated levels of docosahexaenoic acid, known to correlate with reduced depression levels.
Two critical micronutrients in postpartum depression are zinc and selenium. Zinc functions similarly to an antidepressant by enhancing serotonin reuptake, and its deficiency is linked to postpartum depression. Foods rich in zinc include red meat, grains, and fish. Selenium deficiency may lead to thyroid dysfunction, another contributor to postpartum depression, with Brazil nuts, seafood, and organ meats being selenium-rich foods.
Sleep plays a pivotal role in postpartum depression, as evidenced by research linking low sleep levels to PPD. High levels of fatigue and post-delivery depression elevate the risk of postpartum depression. Chronic sleep deprivation affects various physiological processes, including glucose metabolism and inflammatory responses, both of which are linked to postpartum depression. Acute sleep deprivation heightens immune responses and generates inflammatory markers like interleukin-6 and tumor necrosis factor, further exacerbating PPD risk.
Exercise and physical activity have shown to significantly alleviate depression symptoms, comparable to medicinal benefits in some studies. Moderate physical activity in the third trimester of pregnancy has demonstrated reduced postpartum depression scale scores at least six weeks post-delivery. Exercise is believed to elevate endogenous opioids and endorphins, positively impacting mental health. Thus, incorporating exercise into one’s lifestyle can be protective against developing postpartum depression.
While certain factors may increase the likelihood of developing postpartum depression, there are proactive steps you can take to mitigate this risk. Adopting a well-balanced diet rich in seafood, vegetables, fruits, nuts, and seeds can positively influence mood, thus reducing the risk of postpartum depression. Incorporating regular exercise into your lifestyle and relying on your social support network to ensure adequate sleep can further reduce this risk. If these measures do not effectively prevent or alleviate depressive symptoms, it’s essential to seek assistance and consult with your doctor, as well as potentially a therapist specializing in maternal mental health for pregnancy and postpartum care.
Sources:
Research Article “Postpartum depression risk factors: A narrative review”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561681/
Medical News Today: https://www.medicalnewstoday.com/articles/322416#serotonin-vs-tryptophan