The effect of experiencing a premature birth on postpartum maternal EPDS scores

Abstract

Premature birth is a global health issue affecting around 15 million infants annually, contributing to perinatal morbidity and mortality. Postpartum depression (PPD) is common after childbirth, impacting maternal and child health long-term. This thesis examines whether a preterm birth before 37+0 weeks of gestation increases PPD risk, measured by the Edinburgh Postnatal Depression Scale (EPDS), while controlling for prenatal depressive symptoms. Data from the PRINCE (Prenatal Identification of Children’s Health) study in Hamburg, Germany were used. A total of 537 mothers without prenatal depressive symptoms (EPDS scores <11) were analyzed. Participants were divided into two groups: 33 mothers with preterm births (Group A) and 504 with non-preterm births (Group B). Six months postpartum, EPDS scores were measured. Results indicated that mothers in the preterm group did not have higher EPDS scores than those in the non-preterm group. The preterm group had a slightly lower mean EPDS score (3.85, SD = 3.08) than the non-preterm group (4.25, SD = 3.71), although this difference was not statistically significant (t(535) = 0.605, p = 0.545). No participants in the preterm group scored above the clinical cutoff of 11, while 38 in the non-preterm group did. Possible explanations include previous studies overestimating PPD risk associated with preterm birth by not controlling for prenatal depressive symptoms. Additionally, the various support systems in Germany may have reduced the psychological impact of preterm birth. Moreover, most preterm births in this study were late preterm (34+0 to 36+6 weeks of gestation), associated with fewer complications and lower stress levels. This study highlights the need to control for confounding factors when examining the relationship between preterm birth and PPD. The findings suggest that among mothers without depressive symptoms in pregnancy, preterm birth alone may not increase PPD risk. This underscores the essential role of midwives in providing postpartum support to all mothers.