Perinatal depression (PND) is a common mental condition that emerges during pregnancy or in the postpartum period. Specific background characteristics of mothers may explain why the onset of depression occurs at a particular stage of the perinatal period, according to study results published in the Journal of Neuroscience Research.

Researchers obtained data from the BASIC cohort in Sweden (N=4,073; n=2466) and created 4 categories of PND trajectory: onset of depression during pregnancy (209; 8.5%), early-onset postpartum depression (270; 10.9%), late-onset postpartum depression (132; 5.4%), and chronic depression (361; 14.6%). These groups were compared with healthy controls (1494; 60.6%). Distinct trajectories of PND have been suggested, although no single method for their determination has been adopted. Examining different trajectories may be valuable, as it is thought that each may have unique consequences for the mother and her family.

The background and lifestyle-related characteristics of younger age, lower educational attainment, unemployment, and using snuff before pregnancy were associated with 2 trajectories: onset of depression during pregnancy and chronic depression. In contrast, smoking before pregnancy, migraine, premenstrual mood symptoms, intimate partner violence, and interpersonal trauma were significantly associated with all PND trajectories compared with controls. Lack of sleep in early pregnancy was significantly associated with the onset of depression during pregnancy and in the early postpartum period and with chronic depression, but not with onset during the late postpartum period.

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Pregnancy-related characteristics including negative delivery expectations and having experienced symphysiolysis or nausea during pregnancy were associated with all PND trajectories compared with the healthy trajectory. Women who experienced other complications of pregnancy had greater odds of developing specifically early postpartum and chronic depression. An unplanned pregnancy and severe fear of delivery were associated with onset of depression during pregnancy and in the early postpartum period, as was chronic depression. Nulliparity was associated with early-onset postpartum depression.

Characteristics related to delivery such as a having undergone a delivery with instrumentation or a negative delivery experience were associated with early postpartum onset and chronic depression.

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Postpartum-related characteristics, such as being a single parent, having a partner who did not help with the infant, and not breastfeeding, were associated with all PND trajectories. Infant colic, lack of sleep, no partner support with household, and bonding difficulties were significantly associated with early postpartum onset, late postpartum onset, and chronic depression. Women with partners who suffered from poor mental health reported more early-onset postpartum and chronic depression.

“In conclusion, a broad range of background‐ and lifestyle‐, pregnancy‐, delivery‐, and postpartum‐related characteristics were found to be associated with different PND trajectories to varying degrees and may be amenable to intervention,” the investigators stated. “As an extension of this research, patients with risk of pregnancy onset or even chronic PND might be identified early on.”


Wikman A, Axfors C, Iliadis SI, Cox J, Fransson E, Skalkidou A. Characteristics of women with different perinatal depression trajectories [published online February 5, 2019]. J Neurosci Res. doi:10.1002/jnr.24390