Prevalence of maternal psychological disorders after immediate postpartum hemorrhage: a repeated nested cross-sectional survey in a cohort study.

backgroundPostpartum hemorrhage (PPH) remains a major cause of maternal morbidity worldwide. Few published studies have examined its psychological impact, and the scientific evidence is inadequate. Our principal objective was to assess whether the prevalence of depression at 2 months postpartum was greater among women with immediate PPH (≥ 500 mL) than among women without PPH. The secondary objectives were to describe at 6 and 12 months of the postpartum period the prevalence of depression, the mean depression score and the prevalence and mean scores for anxiety and PTSD at 2, 6 and 12 months postpartum among women with immediate PPH (≥ 500 mL) compared to women without PPH, and according to the type of delivery (cesarean or vaginal delivery).

methodsOur single-center cohort included women who gave birth at ≥ 22 weeks of gestation from April 27, 2017, through April 2, 2019. Self-administered questionnaires at M2, M6, and M12 have been used to assess the prevalence of depression (EPDS score ≥ 11), anxiety (GAD-7 score > 7) and PTSD (IES-R score ≥ 30). The results are expressed as percentages, least square means, and adjusted mean scores, for all deliveries and by type of birth (cesarean or not). The women with and without PPH were compared at each study time point (M2, M6, and M12).

resultsWe included 1,298 participants (PPH: n = 528; No-PPH: n = 770). The prevalence rate of depression was higher in the PPH group than in the No-PPH group among all the deliveries at M2 (24.4 vs. 18.2%; p = 0.03) It was greater at M12, in the case of a vaginal birth, in the No-PPH group than in the PPH group: 15.9% vs. 6.2% (p = 0.03). The adjusted mean score for depression was higher only at M6, for the vaginal births, among the women with no-PPH than among the women with PPH (6.9 vs. 5.5; p = 0.02). The anxiety prevalence and adjusted mean scores did not differ between the PPH and No-PPH groups for all deliveries and regardless of the type of birth at M2, M6 or M12. The prevalence of PTSD was higher at M2 in the PPH group compared to the No-PPH group (12.8% vs. 7.6%, p = 0.02). Among the cesarean births, women with PPH had a greater prevalence of PTSD than women without PPH at two months (15.4% vs. 4.6%; p = 0.02). The adjusted mean scores for PTSD were higher only at M2 and M12 among the cesarean births for women with PPH than for those without PPH: 11.0 vs. 6.5 (p = 0.005) and 10.6 vs. 5.8 (p = 0.02), respectively.

conclusionsPerinatal professionals must bear that these three postpartum psychological outcomes showed high levels of positive screening at all time points.

trial registrationThe study was registered at ClinicalTrials.gov NCT03120208, 27 April 2017.