Postpartum Haemorrhage Is Associated with an Increased Risk of Postnatal Depression

Sarfaroj Khan 


April 01, 2021


Why this matters

  • In clinical practice, vigilance in women exposed to PPH needs to be raised and assessment for PND and PTSD should form an integral part of the follow-up given the associated increased risk following PPH.

Study design

  • A retrospective open cohort study of 42,327 women from linked primary care (The Health Improvement Network) and secondary care (Hospital Episode Statistics) databases (1990-2018).

  • Of these, 14,109 women who had a PPH during index delivery were matched to 28,218 women unexposed to PPH.

  • Primary outcome: PND following PPH; secondary outcomes: PTSD, severe mental illness and anxiety.

  • Funding: None.

Key results

  • Women exposed to PPH vs those unexposed were at an increased risk of developing PND (adjusted HR [aHR], 1.10; 95% CI, 1.01-1.21; P=.037).

  • Women exposed to PPH vs those unexposed had an increased risk of PTSD (aHR, 1.17; 95% CI, 0.73-1.89; P=.511), although this was not statistically significant.

  • In the first year of follow-up after childbirth, women with PPH vs those without were at an increased risk of PTSD (aHR, 3.44; 95% CI, 1.31-9.03).

  • No significant difference was seen between women with PPH and those without in the overall risk of:

    • severe mental illness (aHR, 0.65; 95% CI, 0.40-1.08; P=.095);

    • depression (aHR, 0.94; 95% CI, 0.87-1.01; P=.103); and

    • anxiety (aHR, 0.99; 95% CI, 0.90-1.09; P=.881).


  • Retrospective design.


Parry-Smith W, Okoth K, Subramanian A, Gokhale KM, Chandan JS, Humpston C, Coomarasamy A, Nirantharakumar K, Šumilo D. Postpartum haemorrhage and risk of mental ill health: A population-based longitudinal study using linked primary and secondary care databases. J Psychiatr Res. 2021;137:419-425. doi: 10.1016/j.jpsychires.2021.03.022. PMID: 33774536.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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