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Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period

Published:February 06, 2020DOI:https://doi.org/10.1016/j.jogn.2020.01.001

      Abstract

      Objective

      To determine the prevalence of maternity blues among women in the postpartum period.

      Data Sources

      We conducted our systematic review and meta-analysis by searching the literature for relevant articles published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through December 11, 2019, using the keywords prevalence, incidence, maternity blues, and baby blues.

      Study Selection

      From 336 articles initially screened, we included 26 articles in the systematic review and meta-analysis.

      Data Extraction

      Two independent reviewers used a standardized form to extract data from eligible articles. We evaluated the quality of individual studies and the overall evidence according to Hoy et al.’s risk of bias tool.

      Data Synthesis

      The prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence interval [32.3, 45.6]; I2 = 96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.

      Conclusion

      Considering the great prevalence of maternity blues in women after childbirth, paying attention to the key symptoms of maternity blues and implementing educational programs for health care providers and mothers after childbirth are essential.

      Keywords

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      References

        • Adewuya A.O.
        The maternity blues in western Nigerian women: Prevalence and risk factors.
        American Journal of Obstetrics and Gynecology. 2005; 193: 1522-1525https://doi.org/10.1016/j.ajog.2005.02.085
        • Alvarado-Esquivel C.
        • Sifuentes-Alvarez A.
        • Salas-Martinez C.
        • Martínez-García S.
        Validation of the Edinburgh Postpartum Depression Scale in a population of puerperal women in Mexico.
        Clinical Practice and Epidemiology in Mental Health. 2006; 2: 33https://doi.org/10.1186/1745-0179-2-33
        • Alves S.
        • Fonseca A.
        • Canavarro M.C.
        • Pereira M.
        Preliminary psychometric testing of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in Portuguese women.
        Maternal and Child Health Journal. 2018; 22: 571-578https://doi.org/10.1007/s10995-017-2426-5
        • Badr H.A.
        • Zauszniewski J.A.
        Kangaroo care and postpartum depression: The role of oxytocin.
        International Journal of Nursing Sciences. 2017; 4: 179-183https://doi.org/10.1016/j.ijnss.2017.01.001
        • Bruno A.
        • Lagana A.S.
        • Leonardi V.
        • Greco D.
        • Merlino M.
        • Vitale S.G.
        • Muscatello M.R.A.
        Inside-out: The role of anger experience and expression in the development of postpartum mood disorders.
        Journal of Maternal-Fetal & Neonatal Medicine. 2018; 31: 3033-3038https://doi.org/10.1080/14767058.2017.1362554
        • Bydlowski S.
        • Lalanne C.
        • Golse B.
        • Vaivre-Douret L.
        Postpartum blues: A marker of early neonatal organization?.
        Infant Mental Health Journal. 2013; 34: 508-515https://doi.org/10.1002/imhj.21410
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale.
        British Journal of Psychiatry. 1987; 150: 782-786https://doi.org/10.1192/bjp.150.6.782
        • Dell D.L.
        • Halford J.J.
        Dementia presenting as postpartum depression.
        Obstetrics & Gynecology. 2002; 99: 925-928https://doi.org/10.1016/s0029-7844(01)01713-6
        • Doornbos B.
        • Fekkes D.
        • Tanke M.A.
        • de Jonge P.
        • Korf J.
        Sequential serotonin and noradrenalin associated processes involved in postpartum blues.
        Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2008; 32: 1320-1325https://doi.org/10.1016/j.pnpbp.2008.04.010
        • Edhborg M.
        Comparisons of different instruments to measure blues and to predict depressive symptoms 2 months postpartum: A study of new mothers and fathers.
        Scandinavian Journal of Caring Sciences. 2008; 22: 186-195https://doi.org/10.1111/j.1471-6712.2007.00512.x
        • Ehlert U.
        • Patalla U.
        • Kirschbaum C.
        • Piedmont E.
        • Hellhammer D.
        Postpartum blues: Salivary cortisol and psychological factors.
        Journal of Psychosomatic Research. 1990; 34: 319-325https://doi.org/10.1016/0022-3999(90)90088-l
        • Faisal-Cury A.
        • Menezes P.R.
        • Tedesco J.J.A.
        • Kahalle S.
        • Zugaib M.
        Maternity “blues”: Prevalence and risk factors.
        Spanish Journal of Psychology. 2008; 11: 593-599https://doi.org/10.1017/s1138741600004595
        • Fiala A.
        • Švancara J.
        • Klánová J.
        • Kašpárek T.
        Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study.
        BMC Psychiatry. 2017; 17: 104https://doi.org/10.1186/s12888-017-1261-y
        • Gautam P.
        • Bhatia M.
        • Rathi A.
        • Kaur J.
        Sheehan’s syndrome with psychosis: A rare case presentation.
        Delhi Psychiatry Journal. 2014; 17: 211-213
        • Gelaye B.
        • Rondon M.B.
        • Araya R.
        • Williams M.A.
        Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries.
        Lancet Psychiatry. 2016; 3: 973-982https://doi.org/10.1016/S2215-0366(16)30284-X
        • Gerli S.
        • Fraternale F.
        • Lucarini E.
        • Chiaraluce S.
        • Tortorella A.
        • Bini V.
        • Favilli A.
        Obstetric and psychosocial risk factors associated with maternity blues.
        Journal of Maternal-Fetal & Neonatal Medicine. Advance online publication. 2019; (https://doi.org/10.1080/14767058.2019.1630818)
        • Glangeaud-Freudenthal N.M.C.
        • Crost M.
        • Kaminski M.
        Severe post-delivery blues: Associated factors.
        Archives of Women’s Mental Health. 1999; 2: 37-44https://doi.org/10.1007/s007370050033
        • Gonidakis F.
        • Rabavilas A.D.
        • Varsou E.
        • Kreatsas G.
        • Christodoulou G.N.
        Maternity blues in Athens, Greece: A study during the first 3 days after delivery.
        Journal of Affective Disorders. 2007; 99: 107-115https://doi.org/10.1016/j.jad.2006.08.028
        • Goyal D.
        • Gay C.
        • Lee K.A.
        How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?.
        Women’s Health Issues. 2010; 20: 96-104https://doi.org/10.1016/j.whi.2009.11.003
        • Hahn-Holbrook J.
        • Cornwell-Hinrichs T.
        • Anaya I.
        Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries.
        Frontiers in Psychiatry. 2018; 8: 248https://doi.org/10.3389/fpsyt.2017.00248
        • Harris B.
        ‘Maternity blues’ in East African clinic attenders.
        Archives of General Psychiatry. 1981; 38: 1293-1295https://doi.org/10.1001/archpsyc.1981.01780360109013
        • Hau F.W.
        • Levy V.A.
        The maternity blues and Hong Kong Chinese women: An exploratory study.
        Journal of Affective Disorders. 2003; 75: 197-203https://doi.org/10.1016/s0165-0327(02)00039-3
        • Henshaw C.
        • Foreman D.
        • Cox J.
        Postnatal blues: A risk factor for postnatal depression.
        Journal of Psychosomatic Obstetrics & Gynecology. 2004; 25: 267-272https://doi.org/10.1080/01674820400024414
      1. Cochrane handbook for systematic reviews of interventions. Vol. 4. John Wiley & Sons, Hoboken, NJ2011
        • Hoy D.
        • Brooks P.
        • Woolf A.
        • Blyth F.
        • March L.
        • Bain C.
        • Buchbinder R.
        Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement.
        Journal of Clinical Epidemiology. 2012; 65: 934-939https://doi.org/10.1016/j.jclinepi.2011.11.014
        • Ishikawa N.
        • Goto S.
        • Murase S.
        • Kanai A.
        • Masuda T.
        • Aleksic B.
        • Ozaki N.
        Prospective study of maternal depressive symptomatology among Japanese women.
        Journal of Psychosomatic Research. 2011; 71: 264-269https://doi.org/10.1016/j.jpsychores.2011.02.001
        • Kariman N.
        • Karimi S.
        • Shiadeh M.N.
        • Shams J.
        • Nasiri N.
        The relation between maternity blues and postpartum anxiety among Iranian pregnant women.
        Biosciences Biotechnology Research Asia. 2016; 13: 429-434https://doi.org/10.13005/bbra/2050
        • Kieviet N.
        • Dolman K.M.
        • Honig A.
        The use of psychotropic medication during pregnancy: How about the newborn?.
        Neuropsychiatric Disease and Treatment. 2013; 9: 1257https://doi.org/10.2147/NDT.S36394
        • Manjunath N.G.
        • Giriyappa V.
        • Rajanna
        Postpartum blue is common in socially and economically insecure mothers.
        Indian Journal of Community Medicine. 2011; 36: 231-233https://doi.org/10.4103/0970-0218.86527
        • McGowan J.
        • Sampson M.
        • Salzwedel D.M.
        • Cogo E.
        • Foerster V.
        • Lefebvre C.
        PRESS peer review of electronic search strategies: 2015 guideline statement.
        Journal of Clinical Epidemiology. 2016; 75: 40-46https://doi.org/10.1016/j.jclinepi.2016.01.021
        • Meilina A.R.
        • Nasrudin A.
        Relationship between childbirth duration and postpartum blues.
        Indian Journal of Public Health Research & Development. 2019; 10: 955-959https://doi.org/10.5958/0976-5506.2019.00830.1
        • Mirhosseini H.
        • Moosavipoor S.A.
        • Nazari M.A.
        • Dehghan A.
        • Mirhosseini S.
        • Bidaki R.
        • Yazdian-anari P.
        Cognitive behavioral development in children following maternal postpartum depression: A review article.
        Electronic Physician. 2015; 7: 1673https://doi.org/10.19082/1673
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        PLoS Medicine. 2009; 6e1000097https://doi.org/10.1371/journal.pmed.1000097
        • Moslemi L.
        • Tabari M.G.
        • Montazeri S.
        • Tadayon M.
        The frequency and several effective factors on baby blues.
        HealthMED. 2012; 6 (Retrieved from): 4004-4008
        • Murata A.
        • Nadaoka T.
        • Morioka Y.
        • Oiji A.
        • Saito H.
        Prevalence and background factors of maternity blues.
        Gynecological and Obstetric Investigation. 1998; 46: 99-104https://doi.org/10.1159/000010011
        • Nagata M.
        • Nagai S.
        • Sobajima H.
        • Ando T.
        • Nishide Y.
        • Honjo S.
        Maternity blues and attachment to children in mothers of full-term normal infants.
        Acta Psychiatrica Scandinavica. 2000; 101: 209-217https://doi.org/10.1034/j.1600-0447.2000.101003209.x
        • Norhayati M.
        • Hazlina N.N.
        • Asrenee A.
        • Emilin W.W.
        Magnitude and risk factors for postpartum symptoms: A literature review.
        Journal of Affective Disorders. 2015; 175: 34-52https://doi.org/10.1016/j.jad.2014.12.041
        • Ntaouti E.
        • Gonidakis F.
        • Nikaina E.
        • Varelas D.
        • Creatsas G.
        • Chrousos G.
        • Siahanidou T.
        Maternity blues: Risk factors in Greek population and validity of the Greek version of Kennerley and Gath’s blues questionnaire.
        Journal of Maternal-Fetal & Neonatal Medicine. Advance online publication. 2018; (https://doi.org/10.1080/14767058.2018.1548594)
        • O’Hara M.W.
        • McCabe J.E.
        Postpartum depression: Current status and future directions.
        Annual Review of Clinical Psychology. 2013; 9: 379-407https://doi.org/10.1146/annurev-clinpsy-050212-185612
        • Okano T.
        • Nomura J.
        Endocrine study of the maternity blues.
        Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1992; 16: 921-932https://doi.org/10.1016/0278-5846(92)90110-z
        • Patel V.
        • Araya R.
        • Chatterjee S.
        • Chisholm D.
        • Cohen A.
        • De Silva M.
        • Van Ommeren M.
        Treatment and prevention of mental disorders in low-income and middle-income countries.
        Lancet. 2007; 370: 991-1005https://doi.org/10.1016/S0140-6736(07)61240-9
        • Pop V.J.
        • Truijens S.E.
        • Spek V.
        • Wijnen H.A.
        • Van Son M.J.
        • Bergink V.
        A new concept of maternity blues: Is there a subgroup of women with rapid cycling mood symptoms?.
        Journal of Affective Disorders. 2015; 177: 74-79https://doi.org/10.1016/j.jad.2015.02.015
        • Pop V.J.
        • Wijnen H.A.
        • Vanmontfort M.
        • Essed G.G.
        • Degeus C.A.
        • Vanson M.M.
        • Komproe I.H.
        Blues and depression during early puerperium: Home versus hospital deliveries.
        British Journal of Obstetrics & Gynaecology. 1995; 102: 701-706https://doi.org/10.1111/j.1471-0528.1995.tb11426.x
        • Rai S.
        • Pathak A.
        • Sharma I.
        Postpartum psychiatric disorders: Early diagnosis and management.
        Indian Journal of Psychiatry. 2015; 57: 216-221https://doi.org/10.4103/0019-5545.161481
        • Reck C.
        • Stehle E.
        • Reinig K.
        • Mundt C.
        Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the first three months postpartum.
        Journal of Affective Disorders. 2009; 113: 77-87https://doi.org/10.1016/j.jad.2008.05.003
        • Sakumoto K.
        • Masamoto H.
        • Kanazawa K.
        Post-partum maternity ‘blues’ as a reflection of newborn nursing care in Japan.
        International Journal of Gynecology & Obstetrics. 2002; 78: 25-30https://doi.org/10.1016/S0020-7292(02)00091-7
        • Shi P.
        • Ren H.
        • Li H.
        • Dai Q.
        Maternal depression and suicide at immediate prenatal and early postpartum periods and psychosocial risk factors.
        Psychiatry Research. 2018; 261: 298-306https://doi.org/10.1016/j.psychres.2017.12.085
        • Shivalli S.
        • Gururaj N.
        Postnatal depression among rural women in South India: Do socio-demographic, obstetric and pregnancy outcome have a role to play?.
        PLoS One. 2015; 10e0122079https://doi.org/10.1371/journal.pone.0122079
        • Stavrou P.
        • Sgouros S.
        Frontal lobe tuberculoma masquerading as postnatal depression.
        British Journal of Neurosurgery. 2002; 16: 74https://doi.org/10.1080/02688690120114278
        • Stein G.S.
        The pattern of mental change and body weight change in the first post-partum week.
        Journal of Psychosomatic Research. 1980; 24: 165-171https://doi.org/10.1016/0022-3999(80)90038-0
        • Sutter A.L.
        • Leroy V.
        • Dallay D.
        • Verdoux H.
        • Bourgeois M.
        Post-partum blues and mild depressive symptomatology at days three and five after delivery: A French cross sectional study.
        Journal of Affective Disorders. 1997; 44: 1-4https://doi.org/10.1016/s0165-0327(97)01440-7
        • Takahashi Y.
        • Tamakoshi K.
        Factors associated with early postpartum maternity blues and depression tendency among Japanese mothers with full-term healthy infants.
        Nagoya Journal of Medical Science. 2014; 76: 129-138
        • Vitale S.G.
        • Laganà A.S.
        • Muscatello M.R.A.
        • La Rosa V.L.
        • Currò V.
        • Pandolfo G.
        • Bruno A.
        Psychopharmacotherapy in pregnancy and breastfeeding.
        Obstetrical & Gynecological Survey. 2016; 71: 721-733https://doi.org/10.1097/OGX.0000000000000369
        • Watanabe M.
        • Wada K.
        • Sakata Y.
        • Aratake Y.
        • Kato N.
        • Ohta H.
        • Tanaka K.
        Maternity blues as predictor of postpartum depression: A prospective cohort study among Japanese women.
        Journal of Psychosomatic Obstetrics & Gynecology. 2008; 29: 206-212https://doi.org/10.1080/01674820801990577
        • World Health Organization
        Maternal mental health and child health and development in low and middle income countries.
        (Retrieved from)
        • Zanardo V.
        • Volpe F.
        • de Luca F.
        • Giliberti L.
        • Giustardi A.
        • Parotto M.
        • Soldera G.
        Maternity blues: A risk factor for anhedonia, anxiety, and depression components of Edinburgh Postnatal Depression Scale.
        Journal of Maternal-Fetal & Neonatal Medicine. 2019; 25: 1-7https://doi.org/10.1080/14767058.2019.1593363

      Biography

      Khadije Rezaie-Keikhaie, MD, is an associate professor, Department of Obstetrics and Gynecology, Zabol University of Medical Sciences, Zabol, Iran.

      Biography

      Mohammad Edris Arbabshastan, BSc, MSc, is a lecturer, Department of Nursing, Iranshahr University of Medical Sciences, Iranshahr, Iran.

      Biography

      Hosein Rafiemanesh, BSc, MSc, is a PhD candidate, Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

      Biography

      Mehrbanoo Amirshahi, BSc, MSc, is a lecturer, Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran.

      Biography

      Shokoufeh Mogharabi Ostadkelayeh, BSc, MSc, is an instructor, Faculty of Nursing, Iranshahr Branch, Islamic Azad University, Iranshahr, Iran.

      Biography

      Azizollah Arbabisarjou, BSc, MSc, PhD, is an associate professor, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.