title: Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother-child cohort in Crete, Greece.
abstract: Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum.
  
  
  
  A total of 1037 women who enrolled in the Rhea mother-child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders.
  
  
  
  The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother.
  
  
  
  We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.
authors.affiliation: Department of Social Medicine,Faculty of Medicine,University of Crete,Heraklion,Greece.
authors.forename: K
authors.initials: K
authors.lastname: Koutra
authors.affiliation: Department of Health Sciences Research,Mayo Clinic,Rochester, MN,USA.
authors.forename: M
authors.initials: M
authors.lastname: Vassilaki
authors.affiliation: Department of Social Medicine,Faculty of Medicine,University of Crete,Heraklion,Greece.
authors.forename: V
authors.initials: V
authors.lastname: Georgiou
authors.affiliation: Department of Social Medicine,Faculty of Medicine,University of Crete,Heraklion,Greece.
authors.forename: A
authors.initials: A
authors.lastname: Koutis
authors.affiliation: Department of Psychiatry and Behavioral Sciences,Faculty of Medicine,University of Crete,Heraklion,Greece.
authors.forename: P
authors.initials: P
authors.lastname: Bitsios
authors.affiliation: National School of Public Health,Athens,Greece.
authors.forename: M
authors.initials: M
authors.lastname: Kogevinas
authors.affiliation: Department of Social Medicine,Faculty of Medicine,University of Crete,Heraklion,Greece.
authors.forename: L
authors.initials: L
authors.lastname: Chatzi
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D009035:Mothers / Q000523:psychology*; D011159:Population Surveillance; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011295:Prenatal Care; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Perinatal; postpartum complications; postpartum depression; pregnancy