Vol. 38, No. 18

3-14-2006
By: Holly Wagner

Persistent fatigue may predict postpartum depression

Persistent fatigue immediately following birth may be the best predictor of postpartum depression, a new study suggests.

Women who said they still felt extremely fatigued two weeks after having a baby were more likely to suffer from postpartum depression a month after giving birth.

"All mothers are tired right after having a baby —it helps them get the rest that they need to recover and heal from the physical and mental stressors of childbirth," said Elizabeth Corwin, the study's lead author and an associate professor of nursing at Ohio State. "But for most women, fatigue steadily fades within the first two weeks of giving birth."

What is unusual — and detrimental — is a fatigue that persists, the researchers said. In this study, fatigue — not stress or a history of depression — was the best indicator of which women went on to develop postpartum depression. "For these women, the constant fatigue came first, and depression followed," Corwin said.

The study appears in a recent issue of the Journal of Obstetric, Gynecological and Neonatal Nursing. Corwin and her colleagues recruited 31 pregnant women who were near the end of their third trimester. Each woman carried her baby to full term and delivered vaginally without complications.

A researcher met each woman at her home when she was between 36 and 38 weeks pregnant. The participants were asked to complete questionnaires on fatigue, stress and both symptoms and history of depression. They also were asked to provide a saliva sample that the researchers used to measure levels of cortisol, a hormone related to stress.

Each woman was asked to call one of the researchers as soon as possible after giving birth. At that point, the researcher arranged to visit the woman about seven days after she delivered. The researcher also visited that same woman two weeks and four weeks after delivery.

At each postpartum visit, the women filled out the same questionnaires on depressive symptoms, stress and feelings of fatigue and also provided saliva samples. By the end of the fourth week, 11 of the 31 women in the study showed symptoms of depression —seven of whom had a family history of depression. Of these seven, four also had a personal history of depression. And 10 of the 11 women (91 percent) who showed symptoms of postpartum depression during the fourth and final week of the study also had reported higher-than-normal levels of fatigue two weeks earlier.

"A personal history of depression is an excellent way to predict which women are at risk for postpartum depression," said Corwin. "Still, using that as the sole screening tool would have left seven of the women undiagnosed.

"Likewise, a family history of depression is a risk factor," she continued. "But by using family history alone, we would have missed four women who went on to develop signs of depression."

While these women reported they also felt more stressed than normal, elevated stress levels weren't enough to predict which women would ultimately develop postpartum depression. Most of the women in the study reported higher-than-usual levels of stress during the first month after having their babies.

Also, cortisol levels were highest for all of the women in the study at the end of their pregnancies and steadily declined during the month after they gave birth. This ruled out using cortisol as an indicator of difference in stress between women who went on to develop depression and those who did not.

It's estimated that 12 percent of women develop major depression within a year of giving birth, while about 19 percent develop minor forms of the illness.

Postpartum depression is detrimental on many levels. For one, it interrupts maternal-infant bonding, which may have negative effects on infant behavioral and cognitive development. It also can affect a mother's self-esteem and her relationship with her partner and other children.

There currently is no standard way to screen for postpartum depression. A mother at risk of developing the illness often goes undiagnosed until several weeks after her baby is born. Treatment typically includes counseling or anti-depressants or a combination of both.

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