Prevalence of maternal psychological disorders after immediate postpartum hemorrhage: a repeated nested cross-sectional survey in a cohort study

Background Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity worldwide. Few published studies have examined its psychological impact, and the scientific evidence is inadequate. Our principal objective was to assess the prevalence of depression at 2, 6, and 12 months postpartum (M2, M6, and M12) among parturients with and without postpartum hemorrhage (PPH). The secondary objectives were to describe the prevalence of anxiety and posttraumatic stress disorder (PTSD) and the mean scores for the 3 psychological disorders. Methods Our single-center cohort included women who gave birth at ≥ 22 weeks of gestation from April 27, 2017, through April 2, 2019. Self-administered questionnaires at M2, M6, and M12 have been used to assess the prevalence of depression (EPDS score ≥ 11), anxiety (GAD-7 score > 7) and PTSD (IES-R score ≥ 30). The results are expressed as percentages, least square means, and adjusted mean scores, by type of birth (cesarean or not). The women with and without PPH were compared at each study time point (M2, M6, and M12). Results We included 1,298 participants (PPH: n = 528; No-PPH: n = 770). The prevalence of depression did not differ between the two groups (PPH vs. no-PPH) at M2 or M6, regardless of the type of birth. It was greater at M12, in the case of a vaginal birth, in the No-PPH group than in the PPH group: 15.9% vs 6.2% ( p  = 0.03). The adjusted mean score for depression was higher only at M6, for the vaginal births, among the women with no-PPH than among the women with PPH (6.9 vs 5.5; p  = 0.02). The anxiety prevalence and adjusted mean scores did not differ between the PPH and No-PPH groups regardless of the type of birth at M2, M6 or M12. Among the cesarean births, women with PPH had a greater prevalence of PTSD than women without PPH at two months (15.4% vs. 4.6%; p  = 0.02). The adjusted mean scores for PTSD were higher only at M2 and M12 among the cesarean births for women with PPH than for those without PPH: 11.0 vs. 6.5 ( p  = 0.005) and 10.6 vs. 5.8 ( p  = 0.02), respectively. Conclusions Perinatal professionals must bear that these three postpartum psychological outcomes showed high levels of positive screening at all time points. In particular, PTSD at M2 and M12, where the adjusted mean score was higher among women with a PPH than among those with no-PPH, in the case of a cesarean section. Trial registration The study was registered at ClinicalTrials.gov NCT03120208, 27 April 2017.