Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism

Even though most pregnancies and deliveries are uncomplicated, still fifteen percent of all women in developed countries suffer pregnancy-related complications. The aim of this thesis was to explore the associations between perinatal complications and perinatal maternal health, with emphasis on postpartum depressive symptoms (PPDS) and neuroticism taking into account potential confounding or mediating factors such as history of depression, antenatal depressive symptoms and delivery experience. In the first study (n=446), the association between heavy postpartum haemorrhage and PPDS at six weeks postpartum was delineated by using path-analysis in order to provide insight into the complex mediating roles of several consequences of postpartum haemorrhage. There was no direct association between postpartum haemorrhage and PPDS, only an indirect one via anaemia at discharge and negative delivery experience. The second study (n=3888) examined the association of mode of delivery with PPDS at 6 weeks postpartum. The results indicate that the association between elective caesarean section and PPDS is highly confounded by history of depression and fear of delivery, while emergency caesarean section and vacuum extraction increase odds for PPDS by leading to postpartum complications and negative delivery experience. The third study (n=1503) investigated the association between the use of epidural analgesia during delivery and PPDS. A positive association in the crude analysis was no longer present after adjustment for sociodemographic, psychosocial and obstetrical variables, indicating that pain relief through epidural analgesia is not likely to affect risk for PPDS. In the last study (n=1969), the association between neuroticism and perinatal complications was explored. Neuroticism was not associated with adverse perinatal outcomes, except for gestational diabetes mellitus. The association, however, became statistically non-significant after adjusting for psychiatric morbidity. In summary, the current studies do no find evidence for a direct association between perinatal complications and postpartum depressive symptoms or neuroticism. However, several important mediators have been identified, among which postpartum anaemia and negative delivery experience deserve special attention. Also, earlier psychiatric history needs to be addressed as an important confounder