Association between perinatal anemia and postpartum depression: A prospective cohort study of Japanese women.

Objective: To clarify the association between postpartum depression (PPD) and anemia in each stage of pregnancy as well as in the postpartum period.

Methods: A prospective cohort study was conducted between May 2010 and November 2013 at a tertiary hospital in Japan. In total, 1128 women were assessed using the Edinburgh Postpartum Depression Scale (EPDS) at postpartum week 4 and a blood test was performed in the second trimester (24-28 weeks of gestation), third trimester (35-36 weeks of gestation), and postpartum week 1. The primary outcome was PPD, defined as an EPDS score of 9 or higher. Multivariate logistic regression analysis was used to elucidate the association between anemia and PPD for each period. Additionally, trend analysis was conducted to determine if there was a linear association between maternal hemoglobin concentration and PPD.

Results: Postpartum anemia was significantly associated with increased PPD risk (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.26) whereas anemia in the second and third trimesters was not. Similarly, a significant inverse association was observed between the quintiles of maternal hemoglobin levels in the puerperium and the PPD risk (P value for trend 0.004).

Conclusion: Postpartum anemia was associated with an increased risk of PPD.