-Bruce Leibert, MD

The Postpartum Blues (PPB) occur during the first ten postpartum days. This transient syndrome consists of fatigue, tearfulness, anxiety, depressed mood, restlessness, irritability, and confusion, occurring in various combinations.

The reported incidence of PPD varies for 5% to 80%a of postpartum women. Factors associated with the risk of developing PPB include poor social supports (1) and stressful life events. (2) PPB is a risk factor for the development of the more severe Postpartum Depression.

My objective was to determine the incidence of PPB in our population and to identify associated factors.

METHODS

Our community hospital is a 500 bed facility in a town of 60,000. This hospital has approximately 250 delivers each month.

Sixty-three women were enrolled in the study during a six week time from. All participants had vaginal deliveries and healthy babies.

On the first postpartum day, the investigator conducted a thirty-five question scripted interview, the patient complete Barnett’s Life Events Scale for Obstetric Groups and the obstetric chart was reviewed for prenatal, perinatal, and postnatal complications.

On postpartum days four and ten, the patient complete Stein’s Maternity Blues Scale by telephonic interview.

Univariate analysis was performed using Chi-square or unpaired test to compare the Stein score to the data collected on demographics, social supports, labor and delivery experiences, psychiatric histories, infant behaviors, and life events.

RESULTS

Sixty of the sixty-three women (95.2%) completed the study. Three of the subjects could not be reached after hospital discharge.

The average age was twenty-three years with two children at home. The subjects’ age, ethnicity, parity, number of living children, and age of the youngest child were not associated with development of PPB.

Fifteen of the sixty patients (25.0%) experienced PPB. The Stein scores ranged from zero to seventeen. Twelve patients had a positive Stein score at day four; three additional patients had a positive score at day ten.

DISCUSSION

The lack of consistent diagnostic criteria for PPB has made it a challenge to study this syndrome. Stein’s self-rating scale incorporated thirteen of the most commonly identified signs and symptoms of PPB, in an attempt to standardize the diagnosis of PPB. This study showed an incidence of 25% using Stein’s score, but the tool was only used on days four and ten postpartum. We may have missed subjects with PPB who had recovered by the time of the telephonic interview.

Our results suggest that a woman’s age, gravidity, parity, marital status, and interval from the last delivery do not influence the development of PPB. Lack of statistical difference between patients who took prenatal classes and those who did not suggests that these classes need to include a discussion on mood management.
Our study reached significance on one variable: infant feeding. Our subjects who perceived that their infants did not suck well on the breast or on the bottle nipple experience PPB more frequently. There was no difference in Stein score between breast-feeding and bottle-feeding in our group.

This result has implications for possible prenatal and early postpartum interventions that might decrease the risk of PPB and PPD. Prenatal classes and physician counseling should include in-depth discussion of feeding techniques and common feeding problems. Individual postnatal attention to infant feeding behavior and maternal feeding technique may improve maternal well-being. Demonstration, encouragement, and reinforcement of proper technique and discussion of normal differences in infant behavior should be the hallmarks of a feeding program.

BIBLIOGRAPHY
1.O’Hara, Michael: Social Support, Life Events, and Depression During Pregnancy and the Puerperium; Arch Gen Psych 1986; 43; 569-573.
2.Paykel, E.S.: Life Events and Social Support in Puerperal Depression; Brit J Psych 1980; 136; 339-346.
3.Nelson, D.B.: A Prospective Study of Postpartum Depression in 17,648 Parturients; Journal of Maternal Fetal Neonatal Medicine 2013; 26; 1155.
4. Miller, E.S.: The Association Between Diabetes and Postpartum Depression; Archives of Women’s Mental Health 2016; 19; 183.

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