Association between postpartum anaemia and depressive symptoms at two months after vaginal delivery: a secondary analysis of the TRAAP trial
Postpartum depression affects approximately 10 to 25% of women. It can have major consequences for both the mother (such as impaired mother–infant bonding or suicidal ideation) and the child (including developmental delays and behavioral disorders). Better understanding the risk factors for PPD is a key public health priority, in particular modifiable ones.
While many studies have identified psychosocial risk factors (socioeconomic vulnerability, social isolation, psychiatric history), few have explored the role of obstetrical factors. Maternal anaemia, which is common in the postpartum period (affecting up to 50% of women in high-income countries), mainly due to iron deficiency, may contribute to the onset of depressive symptoms through biological mechanisms (such as cerebral hypoxia or iron deficiency affecting neurotransmitter synthesis) or functional mechanisms (fatigue, reduced social activity). However, studies published on this topic are often limited by methodological biases and have produced inconsistent results.
The database of the TRAAP trial (TRAnexamic Acid for Preventing Postpartum Haemorrhage), a multicentre randomized trial conducted in 15 French maternity units between 2015 and 2016, provides an opportunity to explore this question. It includes systematically collected data for all participants on haemoglobin levels and psychological assessment. The objective of this secondary analysis was to evaluate whether maternal haemoglobin level measured within 5 days after vaginal delivery was associated with an increased risk of depressive symptoms two months later.
Key findings
– Among the 2,672 women included, 43.6% had anaemia in the immediate postpartum period (Hb < 11 g/dL). Overall, 13.8% of women showed symptoms of postpartum depression at 2 months postpartum, defined as an EPDS score ≥11 at two months. A linear association was observed between immediate postpartum haemoglobin and depressive symptoms: each 1 g/dL increase in haemoglobin level was associated with a 9% reduction in the risk of PPD (adjusted RR 0.91; 95% CI 0.82–0.997).
– When symptoms were categorized by severity, the association was found only for moderate forms of PPD (EPDS 11–12) and not for severe forms (EPDS ≥13). These results suggest that the impact of anaemia may be more pronounced in moderate PPD, while other psychosocial factors or psychiatric history may play a predominant role in severe cases.
– After stratification by maternal place of birth, the association between anaemia and PPD symptoms was found only among women born in Europe. In women born outside Europe (mainly of African origin), postpartum anaemia was not associated with depressive symptoms. These results may reflect differences in anaemia profiles (more often chronic or non–iron-deficiency related) or in social vulnerability.
Conclusion
These findings highlight the potential value of systematic screening for postpartum anaemia as a lever to improve maternal mental health. If the observed association is confirmed by interventional studies, early correction of anaemia could become a targeted strategy for preventing moderate postpartum depression
By Lola loussert, Catherine Deneux
