Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences

Abstract

Background: The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history.

Aims: The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD).

Method: Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder.

Results: A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ²(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017).

Conclusions: Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

Keywords: Baby blues; longitudinal study; postpartum depression; premenstrual syndrome; risk factors.

Fig. 1

(a) Distribution of the MBQ scores across the postpartum group, with applied 50th and 90th percentile. (b) Trajectories of baby blues (MBQ score) and premenstrual syndrome (PTSS score) symptoms across the three diagnostic groups (ND, AD and PPD). Frequency distributions between group combinations with different severities of (c) baby blues and PMS, and (d) baby blues and postpartum diagnosis. ND, no depression; AD, adjustment disorder; PPD, postpartum depression; PTSS, Premenstrual Tension Syndrome Scale; MBQ, Maternity Blues Questionnaire; PMS, premenstrual syndrome.