Effect of previous perinatal loss on postpartum depressive symptoms

Background. Women with a history of perinatal loss may be at increased risk of depressive symptoms after the birth of a healthy infant; however, research to date has not been conclusive.

Methods. We enrolled 2854 pregnant women ages 18-36 expecting their first live-born baby. Women with a history of perinatal loss via miscarriage were compared to women without a history of perinatal loss. Probable depression was defined as a score ≥13 on the Edinburgh Postnatal Depression Scale at 1 month postpartum. Logistic regression analysis utilized adjustment for age, use of fertility advice or treatment, and social support or stress.

Results. Overall, women with a history of perinatal loss were not at increased risk for postpartum depression compared to women without previous perinatal loss. However, stratified analysis revealed that for women with the lowest levels of social support (n=1041) previous perinatal loss was associated with increased odds of probable depression (OR=2.06, 95%CI 1.14-3.70) compared to women in the highest two thirds for social support (OR=1.05, 95%CI 0.42-2.64). Likewise, for women in the highest third for psychosocial stress (n=826), perinatal loss was associated with increased odds of probable depression (OR=2.20, 95%CI 1.26-3.85) while this relationship did not exist for those in the two lower thirds (OR=0.78, 95%CI 0.26-2.30).

Conclusions. Our results indicate that a history of perinatal loss may not be an independent risk factor for postpartum depression. However, for women experiencing low social support or high levels of psychosocial stress, a history of perinatal loss increased the risk of probable depression.