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Faisal-Cury A, Tabb K, Matijasevich A. Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:12-21. [PMID: 32725101 PMCID: PMC7861178 DOI: 10.1590/1516-4446-2019-0764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth. METHODS Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates. RESULTS The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression. CONCLUSIONS Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Karen Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Cao S, Jones M, Tooth L, Mishra GD. History of premenstrual syndrome and development of postpartum depression: A systematic review and meta-analysis. J Psychiatr Res 2020; 121:82-90. [PMID: 31783236 DOI: 10.1016/j.jpsychires.2019.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/29/2019] [Accepted: 11/16/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is thought to be a risk factor for postpartum depression (PPD), but results from studies examining the association have been mixed. OBJECTIVES To estimate the association between pre-pregnancy history of PMS and development of PPD and evaluate the risk of bias of included evidence. SEARCH STRATEGY PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang Data, and reference lists of relevant papers were searched. SELECTION CRITERIA Observational studies that collected pre-pregnancy history of PMS and measured PPD status between one week and one year after delivery were included. DATA COLLECTION AND ANALYSIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence interval (CI). Small study effect was analysed by funnel plot. Risk of bias was assessed using the Risk of Bias Instrument for Non-Randomized Studies of Exposures (ROBINS-E). MAIN RESULTS Our meta-analysis included 19 studies. Overall, women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68). However, the quality of evidence was low: five studies had moderate risk, eleven studies had serious risk, and three studies had critical risk of bias. CONCLUSIONS Current evidence supports a significant association between history of PMS and development of PPD. Well-designed prospective studies are needed to further investigate this relationship.
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Affiliation(s)
- Sifan Cao
- Faculty of Medicine, School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, Queensland, Australia.
| | - Mark Jones
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Leigh Tooth
- Faculty of Medicine, School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Faculty of Medicine, School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, Queensland, Australia
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Abstract
Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased, no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients' preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal depression.
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Affiliation(s)
- Sara L Johansen
- Stanford University School of Medicine, Stanford, CA 94305-5119, USA
| | - Thalia K Robakis
- Stanford University School of Medicine, Stanford, CA 94305-5119, USA
| | | | - Natalie L Rasgon
- Stanford University School of Medicine, Stanford, CA 94305-5119, USA
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Kepple AL, Lee EE, Haq N, Rubinow DR, Schmidt PJ. History of postpartum depression in a clinic-based sample of women with premenstrual dysphoric disorder. J Clin Psychiatry 2016; 77:e415-20. [PMID: 27035701 PMCID: PMC6328311 DOI: 10.4088/jcp.15m09779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Overlapping comorbidities between premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD) suggest that these disorders represent a continuum of vulnerability with shared pathophysiology. We report the past histories of PPD (and other Axis I psychiatric illnesses) in a clinic-based sample of women meeting criteria for PMDD. METHODS 215 women, ages 19 to 51 years, who attended the National Institute of Mental Health Mood Disorders Clinic between 1988 and 2013 seeking treatment for PMDD and in whom we confirmed the diagnosis of PMDD (DSM-IV), were identified. All were administered the Structured Clinical Interview for DSM-III-R or -IV. The frequency of PPD (major or minor) was established in the subgroup of women (n = 137) who had delivered at least 1 child. RESULTS Ninety-three women (43.3%) had a past history of a mood disorder (ie, either major [n = 67; 31.2%] or minor [n = 10; 4.7%] depression or PPD [n = 16; 7.4%; 11.7% of parous women]). Nine of the 16 women with PMDD and a past PPD had either a past major depressive episode (MDE) or subsyndromal anxiety disorder. Thirty-three women (15.3%) had a past history of an Axis I anxiety disorder. A total of 40 women (18.6%) met criteria for past alcohol or drug abuse, 3 (1.4%) met criteria for bulimia nervosa, and 2 (0.9%) met criteria for anorexia nervosa. CONCLUSIONS Our data demonstrate that PMDD and PPD do not frequently co-occur. These data do not suggest that PMDD and PPD share similar pathophysiology beyond being ovarian-steroid-triggered mood disorders. The high comorbidity of past MDE could contribute to the increased risk both for future MDE and for PPD in some women with PMDD.
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Affiliation(s)
- Alyson L. Kepple
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen E. Lee
- Department of Psychiatry, University of Maryland, Baltimore, Maryland
| | - Nazli Haq
- Behavioral Endocrinology Branch, NIMH, Bethesda, Maryland
| | - David R. Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
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Babb JA, Deligiannidis KM, Murgatroyd CA, Nephew BC. Peripartum depression and anxiety as an integrative cross domain target for psychiatric preventative measures. Behav Brain Res 2015; 276:32-44. [PMID: 24709228 PMCID: PMC4185260 DOI: 10.1016/j.bbr.2014.03.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022]
Abstract
Exposure to high levels of early life stress has been identified as a potent risk factor for neurodevelopmental delays in infants, behavioral problems and autism in children, but also for several psychiatric illnesses in adulthood, such as depression, anxiety, autism, and posttraumatic stress disorder. Despite having robust adverse effects on both mother and infant, the pathophysiology of peripartum depression and anxiety are poorly understood. The objective of this review is to highlight the advantages of using an integrated approach addressing several behavioral domains in both animal and clinical studies of peripartum depression and anxiety. It is postulated that a greater focus on integrated cross domain studies will lead to advances in treatments and preventative measures for several disorders associated with peripartum depression and anxiety.
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Affiliation(s)
- Jessica A Babb
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | - Kristina M Deligiannidis
- Departments of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA 01605, USA.
| | | | - Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
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Paschetta E, Berrisford G, Coccia F, Whitmore J, Wood AG, Pretlove S, Ismail KMK. Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol 2014; 210:501-509.e6. [PMID: 24113256 DOI: 10.1016/j.ajog.2013.10.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 01/10/2023]
Abstract
Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.
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Affiliation(s)
- Elena Paschetta
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK
| | - Giles Berrisford
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Floriana Coccia
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Jennifer Whitmore
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Amanda G Wood
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sam Pretlove
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK
| | - Khaled M K Ismail
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK; School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Plaza A, Garcia-Esteve L, Torres A, Ascaso C, Gelabert E, Luisa Imaz M, Navarro P, Valdés M, Martín-Santos R. Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum. Psychiatry Res 2012; 200:329-35. [PMID: 22878032 DOI: 10.1016/j.psychres.2012.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 06/17/2012] [Accepted: 06/21/2012] [Indexed: 01/05/2023]
Abstract
Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24-48h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS≥11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23-12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17-13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24-48h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period.
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Affiliation(s)
- Anna Plaza
- Unit of Perinatal Psychiatry and Gender Research, Hospital Clinic Universitari of Barcelona, IDIBAPS, Barcelona 08028, Spain.
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Gelabert E, Subirà S, García-Esteve L, Navarro P, Plaza A, Cuyàs E, Navinés R, Gratacòs M, Valdés M, Martín-Santos R. Perfectionism dimensions in major postpartum depression. J Affect Disord 2012; 136:17-25. [PMID: 21930303 DOI: 10.1016/j.jad.2011.08.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/12/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression. METHODS One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms). RESULTS The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p<0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors. CONCLUSIONS High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit.
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Affiliation(s)
- Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain; Neuropsychopharmacology Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - Susana Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lluisa García-Esteve
- Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain
| | - Purificación Navarro
- Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain
| | - Anna Plaza
- Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain
| | - Elisabet Cuyàs
- Neuropsychopharmacology Programe, IMIM-Parc de Salut Mar, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
| | - Ricard Navinés
- Neuropsychopharmacology Programe, IMIM-Parc de Salut Mar, Barcelona, Spain; Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain; CIBERSAM, Barcelona, Spain
| | - Mònica Gratacòs
- Genes and Disease Program, Center for Genomic Regulation (CRG-UPF), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Manuel Valdés
- Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain
| | - Rocío Martín-Santos
- Neuropsychopharmacology Programe, IMIM-Parc de Salut Mar, Barcelona, Spain; Neuroscience Institute, Hospital Clínic, Universitat de Barcelona (UB), IDIBAPS, Barcelona, Spain; CIBERSAM, Barcelona, Spain.
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Abstract
Cyclical mood disorders characterized by shifting affective states include bipolar disorder, seasonal affective disorder, and premenstrual syndrome/premenstrual dysphoric disorder. In this article, we explore the relationship between these disorders and bring the reader up to date on the advances made in the past year in understanding the relationship between bipolar disorder, seasonality, and premenstrual symptoms.
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Demissie Z, Siega-Riz AM, Evenson KR, Herring AH, Dole N, Gaynes BN. Associations between physical activity and postpartum depressive symptoms. J Womens Health (Larchmt) 2011; 20:1025-34. [PMID: 21668353 PMCID: PMC3130516 DOI: 10.1089/jwh.2010.2091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postpartum women are at increased risk for developing depression, which can contribute to the ill health of the mother and her family. Previous research indicates that mothers who are physically active during leisure experience lower levels of postpartum depressive symptoms than do inactive mothers. The objective of this investigation was to examine the associations between total and domain-specific moderate to vigorous physical activity (MVPA) and depressive symptoms postpartum. METHODS Data were obtained from 550 women who participated in the Pregnancy, Infection, and Nutrition (PIN) Postpartum Study, a prospective cohort of mothers who delivered liveborn infants from October 2002 to December 2005 in North Carolina. Three-month postpartum MVPA was investigated as a predictor of 12-month postpartum depressive symptoms. RESULTS Those who participated in MVPA had two times the odds of developing elevated depressive symptoms at 12 months postpartum than those with no MVPA (odds ratio [OR] 2.00, 95% confidence interval [CI] 0.71-6.75). Different associations were suggested when examining domain-specific MVPA. Those participating in adult and child care and indoor household MVPA at 3 months postpartum had more than double the odds of developing elevated depressive symptoms at 12 months postpartum (OR 2.66, 95% CI 1.03, 8.11 and OR 2.72, 95% CI 0.96-10.18, respectively). Work MVPA conferred a doubling of the odds (OR 1.95, 95% CI 0.46-7.13), but recreational and outdoor household MVPA showed no associations with depressive symptoms. CONCLUSIONS Associations between MVPA and depressive symptoms differed by domain among postpartum women. Future studies of postpartum depressive symptoms should explore reasons for differences in physical activity by domain.
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Affiliation(s)
- Zewditu Demissie
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
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Albacar G, Sans T, Martín-Santos R, García-Esteve L, Guillamat R, Sanjuan J, Cañellas F, Gratacòs M, Cavalle P, Arija V, Gaviria A, Gutiérrez-Zotes A, Vilella E. An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression. J Affect Disord 2011; 131:136-42. [PMID: 21130499 DOI: 10.1016/j.jad.2010.11.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/05/2010] [Accepted: 11/05/2010] [Indexed: 01/01/2023]
Abstract
CONTEXT Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear. OBJECTIVE To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD. DESIGN This was a prospective cohort study of depression-free women studied in the postpartum period. SETTING Women who give birth at obstetric units in several general hospitals in Spain. PARTICIPANTS A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism. MAIN OUTCOME MEASURES We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP. RESULTS Overall, the women in the study had low iron concentrations (8.8 ± 6.9 μmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 μg/L vs. 21.6 ± 13.5 μg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84-7.56; P = 0.0001 for ferritin cutoff value of 7.26 μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD. CONCLUSIONS These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.
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Affiliation(s)
- Glòria Albacar
- Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain
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