Association Between Post-Partum Anaemia and Depressive Symptoms at Two Months After Vaginal Delivery: A Secondary Analysis of the TRAAP Trial

Abstract

Objective

To assess the association between maternal haemoglobinaemia in the immediate post-partum period and PPD symptoms 2 months after vaginal delivery.

Design

Ancillary cohort study of the TRAAP trial, a multicentre trial.

Setting

In France, 2015–2016.

Population

Women with a singleton pregnancy and vaginal delivery ≥ 35 weeks. We excluded women with known psychiatric conditions and those who were non-respondent to the Edinburgh Post-partum Depression Scale (EPDS) questionnaire.

Methods

The exposure was immediate post-partum haemoglobinemia (systematically collected in TRAAP trial) as a continuous variable.

Main Outcome

PPD symptoms at 2 months post-partum, defined as an EPDS score ≥ 11. We also differentiated two levels of PPD symptom severity: moderate (11 ≤ EPDS < 13) and severe (EPDS ≥ 13) depressive symptoms.

Results

Amongst the 2672 women included, 1115 (43.6%) had post-partum anaemia (haemoglobin < 11 g/dL) in the immediate post-partum and 369 (13.8%) had PPD symptoms at 2 months. The relation between haemoglobin and PPD symptoms was linear. In the multivariable analysis, each 1 g/dL increase in haemoglobin level was associated with a 9% decrease in the risk of post-partum depression symptoms (adjusted Relative Risk 0.91; 95% CI 0.82–0.997). Post-partum haemoglobin was specifically associated with moderate depressive symptoms (adjusted Relative Risk 0.84; 95% CI, 0.72–0.98) but not with severe depressive symptoms (aRR 0.95; 95% CI, 0.84–1.07).

Conclusions

In women with vaginal delivery, each 1 g/dL increase in haemoglobin level was associated with a 9% decrease in the risk of post-partum depression symptoms.