title: Maternal morbidities and postpartum depression: an analysis using the 2007 and 2008 Pregnancy Risk Assessment Monitoring System.
abstract: OBJECTIVE
  Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis.
  
  
  METHODS
  Data from the 2007 and 2008 Pregnancy Risk Assessment Monitoring System were analyzed from 23 states and 1 city (n = 61,733 pregnancies); 13 antenatal morbidities were included. To determine whether antenatal morbidity predictors of PPD would differ based on PPD symptoms versus a diagnosis, each of the 13 antenatal morbidities were examined in separate logistic regression models with each PPD outcome. For each objective, two samples were examined: 1) Women from all states and 2) women from Alaska and Maine, the two states that included both PPD symptoms and PPD diagnosis measures in their questionnaires. Control variables included demographic and sociodemographic variables, pregnancy variables, antenatal and postpartum health behaviors, and birth outcomes.
  
  
  RESULTS
  Having vaginal bleeding (odds ratio [OR], 1.42; OR, 1.76), kidney/bladder infection (OR, 1.59; OR, 1.63), nausea (OR, 1.50; OR, 1.80), preterm labor (OR, 1.54; OR, 1.51), or being on bed rest (OR, 1.34; OR, 1.56) associated with both PPD symptoms and PPD diagnosis, respectively. Being in a car accident associated with PPD symptoms only (OR, 1.65), whereas having hypertension (OR, 1.94) or a blood transfusion (OR, 2.98) was associated with PPD diagnosis only. Among women from Alaska or Maine, having preterm labor (OR, 2.54, 2.11) or nausea (OR, 2.15, 1.60) was associated with both PPD symptoms and PPD diagnosis, respectively. Having vaginal bleeding (OR, 1.65), kidney/bladder infection (OR, 1.74), a blood transfusion (OR, 3.30), or being on bed rest (OR, 1.87) was associated with PPD symptoms only, whereas having diabetes before pregnancy (OR, 5.65) was associated with PPD diagnosis only.
  
  
  CONCLUSIONS
  The findings of this exploratory study revealed differences in the antenatal morbidities that were associated with PPD symptoms versus diagnosis in both samples, and can assist prenatal care providers in prioritizing and screening for these morbidities that are associated with PPD during pregnancy. Additional research is warranted to confirm the results of this study in other samples and populations. Developing strategies to 1) improve general awareness of PPD and the appropriate antenatal morbidity risk factors to focus on in clinical settings, and 2) increase screening for the antenatal morbidities determined to be predictors of PPD in this study are warranted in preventing PPD.
authors: Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado. Electronic address: ssunda@phhp.ufl.edu.
authors: Swathy
authors: S
authors: Sundaram
authors: Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.
authors: Jeffrey S
authors: JS
authors: Harman
authors: Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.
authors: Robert L
authors: RL
authors: Cook
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000413:Alaska; D001510:Bed Rest; D019052:Depression, Postpartum / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006262:Health; D006301:Health Services Needs and Demand; D006801:Humans; D007239:Infections / Q000150:complications; D016015:Logistic Models; D008281:Maine; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D055815:Young Adult