Kamal Muskan Z, Naseer Nida, Khan Abdar A, Khan Zarar A, Hayat Muhammad Azeem, Mahmood Yasir, Danish Tabinda
Department of Community Medicine, Khyber Medical College, Peshawar, Peshawar, PAK.
Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.
Cureus. 2025 Jun 16;17(6):e86156. doi: 10.7759/cureus.86156. eCollection 2025 Jun.
Postpartum psychiatric disorders, including postpartum depression (PPD) and postpartum psychosis (PPP), are major contributors to maternal morbidity and adverse child outcomes globally. While psychosocial risk factors are well established, the potential mechanistic role of obstetric complications in precipitating these conditions remains less clearly delineated.
This study aimed to evaluate the association between specific obstetric complications and the risk of postpartum depression and psychosis within six months after delivery, using a biopsychosocial framework.
We conducted a retrospective, matched case-control study using medical records from Khyber Teaching Hospital, Peshawar (Pakistan), covering deliveries from January 2018 to December 2023. Cases included women aged 18-45 years diagnosed with PPD or PPP within six months postpartum based on DSM-5 criteria. Controls were women who delivered during the same period without psychiatric diagnoses, matched 2:1 by age, parity, and delivery mode. Obstetric complications assessed included preeclampsia/eclampsia, gestational diabetes mellitus (GDM), postpartum hemorrhage, preterm birth, placental abruption, intrauterine growth restriction (IUGR), chorioamnionitis, and cesarean delivery. Conditional logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI).
A total of 220 cases and 440 matched controls were analyzed. Preeclampsia/eclampsia (aOR: 2.30; 95% CI: 1.45-3.64; p<0.001), postpartum hemorrhage (aOR: 2.10; 95% CI: 1.30-3.38; p=0.002), preterm birth (aOR: 1.85; 95% CI: 1.20-2.85; p=0.004), and GDM (aOR: 1.55; 95% CI: 1.00-2.40; p=0.049) were significantly associated with increased risk of postpartum psychiatric disorders. No significant associations were found for placental abruption, IUGR, chorioamnionitis, or cesarean delivery.
Obstetric complications-particularly preeclampsia/eclampsia, postpartum hemorrhage, preterm birth, and gestational diabetes-may act as physiological stressors that interact with underlying vulnerabilities, consistent with stress-diathesis and inflammatory models of psychopathology. These findings support a multifactorial conceptualization of postpartum psychiatric illness and emphasize the importance of integrating obstetric risk profiles into postpartum mental health screenings. In low-resource settings like Pakistan, targeting women with complicated deliveries and known psychosocial risk factors through collaborative, interdisciplinary care models can help prevent chronic maternal mental health conditions and improve developmental outcomes for children.
产后精神障碍，包括产后抑郁症（PPD）和产后精神病（PPP），是全球孕产妇发病和不良儿童结局的主要原因。虽然社会心理风险因素已得到充分证实，但产科并发症在引发这些疾病中的潜在机制作用仍不太明确。
本研究旨在使用生物心理社会框架评估特定产科并发症与产后6个月内产后抑郁症和精神病风险之间的关联。
我们使用巴基斯坦白沙瓦开伯尔教学医院2018年1月至2023年12月的分娩医疗记录进行了一项回顾性匹配病例对照研究。病例包括根据《精神疾病诊断与统计手册》第5版（DSM - 5）标准在产后6个月内被诊断为PPD或PPP的18 - 45岁女性。对照为同期分娩且无精神疾病诊断的女性，按年龄、产次和分娩方式以2:1进行匹配。评估的产科并发症包括先兆子痫/子痫、妊娠期糖尿病（GDM）、产后出血、早产、胎盘早剥、胎儿宫内生长受限（IUGR）、绒毛膜羊膜炎和剖宫产。采用条件逻辑回归计算调整后的优势比（aOR）及95%置信区间（CI）。
共分析了220例病例和440例匹配对照。先兆子痫/子痫（aOR：2.30；95%CI：1.45 - 3.64；p < 0.001）、产后出血（aOR：2.10；95%CI：1.30 - 3.38；p = 0.002）、早产（aOR：1.85；95%CI：1.20 - 2.85；p = 0.004）和GDM（aOR：1.55；95%CI：1.00 - 2.40；p = 0.049）与产后精神障碍风险增加显著相关。未发现胎盘早剥、IUGR、绒毛膜羊膜炎或剖宫产有显著关联。
产科并发症，特别是先兆子痫/子痫、产后出血、早产和妊娠期糖尿病，可能作为生理应激源与潜在易感性相互作用，这与精神病理学的应激 - 素质和炎症模型一致。这些发现支持产后精神疾病的多因素概念化，并强调将产科风险概况纳入产后心理健康筛查的重要性。在巴基斯坦这样的资源匮乏地区，通过协作的跨学科护理模式针对分娩复杂且已知有社会心理风险因素的女性，有助于预防慢性孕产妇心理健康问题并改善儿童的发育结局。
