A Single Menstrual Pain Question at Routine Antenatal Visits Flags Risk of Postpartum Depressive Symptoms: A Retrospective Cohort Study

Abstract

Introduction

Postpartum depression (PPD) is a common and serious condition, and early identification of patients who are at risk during pregnancy is a clinical priority. Premenstrual mood disorders and dysmenorrhea have been associated with PPD, but routine diagnostic ascertainment is not always feasible. We evaluated whether a single yes/no question about menstrual pain can flag women at higher risk of PPD.

Methods

This single-center, retrospective cohort study was performed at a tertiary perinatal unit. Menstrual pain was routinely documented during antenatal care and operationalized as a binary exposure (yes/no). The primary outcome was an Edinburgh Postnatal Depression Scale score greater than or equal to 9 at one month postpartum. We estimated adjusted odds ratios (aORs) using multivariable logistic regression, adjusting for maternal age, body mass index, infertility treatment, parity, number of fetuses, current smoking during pregnancy, and a history of mental illness. Adjusted risks were obtained by marginal standardization. The primary analysis used complete cases, with multiple imputation using 50 imputations as a sensitivity analysis.

Results

Among 5096 women, the crude risk of PPD was 5.3% in women without menstrual pain and 7.4% in those with menstrual pain. Menstrual pain was associated with PPD (aOR, 1.39; 95% CI, 1.09-1.77), and the results were similar with multiple imputation. The adjusted risk was 5.5% without menstrual pain and 7.2% with menstrual pain (absolute risk difference of 1.7 percentage points and a risk ratio of 1.3).

Discussion

A single yes/no question about menstrual pain identified women who were pregnant and at elevated risk of PPD. Given its minimal burden and high feasibility in midwifery workflows, this screen may support early psychosocial follow-up.