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New Risk Factors for Postpartum Depression Revealed

Findings could help obstetricians help women avoid the debilitating condition

FRIDAY, Feb. 1, 2002 (HealthDayNews) -- Pregnant women who visit their obstetrician or prenatal care clinic more often than usual and also take the greatest amount of sick leave during their pregnancy are prime candidates for postpartum depression, new research finds.

Knowing these new risk factors could help obstetricians protect new mothers from the potentially life-threatening condition, say Swedish researchers, who report their findings in the February issue of the Journal of The American College of Obstetricians and Gynecologists.

The new study was the first to utilize both short- and long-term medical and psychological histories to identify risk factors for postpartum depression, a condition that often results in feelings of overwhelming sadness and inability to cope that can last up to six months or more after giving birth.

"Our studies show that women at high risk [for postpartum depression] can be identified during pregnancy," the researchers write. They add that doctors could play an important preventive role by being on the lookout for women prone to this problem.

For psychiatrist Dr. Shari Lusskin, who specializes in reproductive medicine, the new research raises some interesting possibilities for preventive care.

"If there are problems that appear before pregnancy that can be corroborated with a higher risk of postpartum depression, then yes, obstetricians can be of great value, in not only determining which women are at higher risk, but by helping to steer them in the direction of appropriate treatment even before the depression sets in," says Lusskin.

This could not only help reduce the number of women who suffer greatly with postpartum depression, it could even reduce the number of tragedies linked to this condition, adds Lusskin, an associate clinical professor of psychiatry at New York University Medical Center in New York City.

Women who experience postpartum depression often report feeling overwhelmed by even the simplest chores of new motherhood. In worst case scenarios, a woman's despair can cause her to take her life or the lives of loved ones.

Last year, Texas mother Andrea Yates was accused of drowning her five children after a severe bout of postpartum depression left her feeling helpless to care for them. And singer Marie Osmond made headlines several years ago when she admitted that postpartum depression drove her to near-suicidal behavior.

Although doctors aren't certain what causes this condition, or why some women get it while others escape it, Lusskin says one theory links the problem to the wild hormonal fluctuations that occur after pregnancy.

"Just like some women are more susceptible to mood swings or other symptoms occurring during their monthly cycle, some women may be genetically susceptible to, or in some other way more affected by, the hormonal changes that occur after giving birth," says Lusskin.

The Swedish researchers say they aren't certain if hormones are the reason behind the extra sick leave or increased doctor visits. But, they do say that "the possibilities of genetic vulnerability and hormonal changes warrant further investigation to reach a more thorough understanding."

The study involved 394 women, including 132 diagnosed with postpartum depression and 264 without any depressive symptoms. Relying on medical records, the researchers gathered a wide variety of data about each woman.

This included age, marital status, occupation, number of induced abortions, number of miscarriages and any incidence of ectopic pregnancy. The researchers also looked for a history of psychiatric disorder, infertility or obstetrical complications, as well as any chronic diseases.

The researchers also recorded the total number of prenatal care visits made by each women to her doctor or midwife, as well as any incidence of pregnancy complications, and they tallied the total number of sick leave days taken during the pregnancy.

When the women had more than one child, researchers also gathered data about previous pregnancies, including the number of doctor visits during those pregnancies, and the rate of depression following childbirth. Such information had never before been used in a postpartum depression study.

The result: Those women who had the most doctor visits during their current pregnancy and also took the most sick-leave days were also the most likely to develop postpartum depression.

The risk was also elevated in women who had experienced at least two abortions, or women who had a history of obstetric complications.

Complications during the current pregnancy, including premature labor, along with psychiatric disorders also were considered possible indicators of future postpartum depression.

"These are all factors that a good obstetrician should be aware of," Lusskin says. "So if the study proves true, then it's possible that doctors can play a key role in singling out those women who are more likely to suffer after giving birth, and try to prevent at least some of those problems from occurring."

Postpartum depression is often treated using antidepressants, counseling or sometimes hormone and/or vitamin therapy. Preventive treatments, Lusskin says, can include the use of medications as well as therapy.

What To Do

Could you -- or someone you love -- be suffering from postpartum depression? Visit Postpartum Support Internationalto find out more.

For more information, visit The BabyCenter.

And check out The Women's Health Information Center for a fact sheet on postpartum depression and information on treatment.

SOURCES: Interviews with Shari Lusskin, M.D., associate clinical professor of psychiatry, New York University Medical Center, New York City; February 2002 Journal of the American College of Obstetricians and Gynecologists
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