title: Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression.
abstract: OBJECTIVE
  To explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history.
  
  
  METHODS
  A nested cohort study (n = 446), based on two population-based cohorts in Uppsala, Sweden. Exposed individuals were defined as having a bleeding of ≥1000 ml (n = 196) at delivery, and non-exposed individuals as having bleeding of <650 ml (n = 250). Logistic regression models with PPD symptoms (Edinburgh Postnatal Depression scale (EPDS) score ≥ 12) as the outcome variable and PPH, anaemia, experience of delivery, mood during pregnancy and other confounders as exposure variables were undertaken. Path analysis using Structural Equation Modeling was also conducted.
  
  
  RESULTS
  There was no association between PPH and PPD symptoms. A positive association was shown between anaemia at discharge from the maternity ward and the development of PPD symptoms, even after controlling for plausible confounders (OR = 2.29, 95%CI = 1.15-4.58). Path analysis revealed significant roles for anaemia at discharge, negative self-reported delivery experience, depressed mood during pregnancy and postpartum stressors in increasing the risk for PPD.
  
  
  CONCLUSIONS
  This study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH.
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Patricia
authors.initials: P
authors.lastname: Eckerdal
authors.affiliation: Department of Biostatistics, Harokopio University, Athens, Greece.
authors.forename: Natasa
authors.initials: N
authors.lastname: Kollia
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Löfblad
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hellgren
authors.affiliation: Department of Child Psychiatry, Turku University Hospital, Turku, Finland.|FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Institute of Clinical Medicine, University of Turku, Turku, Finland.
authors.forename: Linnea
authors.initials: L
authors.lastname: Karlsson
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Högberg
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Wikström
authors.affiliation: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
authors.forename: Alkistis
authors.initials: A
authors.lastname: Skalkidou
mesh_terms: D000328:Adult; D000740:Anemia / Q000523:psychology; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D036861:Delivery, Obstetric / Q000523:psychology; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000523:psychology; D011247:Pregnancy / Q000523:psychology; D011248:Pregnancy Complications / Q000523:psychology; D011272:Pregnancy, Multiple / Q000523:psychology; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult