Skip to main content Accessibility help
Hostname: page-component-747cfc64b6-dwt4q Total loading time: 0.677 Render date: 2021-06-14T03:00:15.439Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women

Published online by Cambridge University Press:  23 January 2017

S. Meltzer-Brody
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
M. L. Maegbaek
National Center for Register-based Research, Aarhus University, Aarhus, Denmark
S. E. Medland
Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
W. C. Miller
Department of Epidemiology, The Ohio State University, Columbus, OH, USA
P. Sullivan
Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
T. Munk-Olsen
National Center for Register-based Research, Aarhus University, Aarhus, Denmark



Childbirth is a potent trigger for the onset of psychiatric illness in women including postpartum depression (PPD) and postpartum psychosis (PP). Medical complications occurring during pregnancy and/or childbirth have been linked to postpartum psychiatric illness and sociodemographic factors. We evaluated if pregnancy and obstetrical predictors have similar effects on different types of postpartum psychiatric disorders.


A population-based cohort study using Danish registers was conducted in 392 458 primiparous women with a singleton delivery between 1995 and 2012 and no previous psychiatric history. The main outcome was first-onset postpartum psychiatric episodes. Incidence rate ratios (IRRs) were calculated for any psychiatric contact in four quarters for the first year postpartum.


PPD and postpartum acute stress reactions were associated with pregnancy and obstetrical complications. For PPD, hyperemesis gravidarum [IRR 2.69, 95% confidence interval (CI) 1.93–3.73], gestational hypertension (IRR 1.84, 95% CI 1.33–2.55), pre-eclampsia (IRR 1.45, 95% CI 1.14–1.84) and Cesarean section (C-section) (IRR 1.32, 95% CI 1.13–1.53) were associated with increased risk. For postpartum acute stress, hyperemesis gravidarum (IRR 1.93, 95% CI 1.38–2.71), preterm birth (IRR 1.51, 95% CI 1.30–1.75), gestational diabetes (IRR 1.42, 95% CI 1.03–1.97) and C-section (IRR 1.36, 95% CI 1.20–1.55) were associated with increased risk. In contrast, risk of PP was not associated with pregnancy or obstetrical complications.


Pregnancy and obstetrical complications can increase the risk for PPD and acute stress reactions but not PP. Identification of postpartum women requiring secondary care is needed to develop targeted approaches for screening and treatment. Future work should focus on understanding the contributions of psychological stressors and underlying biology on the development of postpartum psychiatric illness.

Original Articles
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below.


This work was previously presented as an oral podium talk at The 12th World Congress of Biological Psychiatry, Athens, Greece, 16 June 2015 and at The Perinatal Mental Health Conference in Chicago, November 2015.


Anderson, PK (1993). Statistical Models Based on Counting Processes. Springer-Verlag: New York.CrossRefGoogle Scholar
Ayers, S, Rados, SN, Balouch, S (2015). Narratives of traumatic birth: quality and changes over time. Psychological Trauma 7, 234242.CrossRefGoogle ScholarPubMed
Barakat, S, Martinez, D, Thomas, M, Handley, M (2014). What do we know about gestational diabetes mellitus and risk for postpartum depression among ethnically diverse low-income women in the USA? Archives of Women's Mental Health 17, 587592.CrossRefGoogle ScholarPubMed
Barroso, NE, Hartley, CM, Bagner, DM, Pettit, JW (2015). The effect of preterm birth on infant negative affect and maternal postpartum depressive symptoms: a preliminary examination in an underrepresented minority sample. Infant Behavior and Development 39, 159165.CrossRefGoogle Scholar
Bay, B, Mortensen, EL, Hvidtjorn, D, Kesmodel, US (2013). Fertility treatment and risk of childhood and adolescent mental disorders: register based cohort study. British Medical Journal 347, f3978.CrossRefGoogle ScholarPubMed
Benros, ME, Waltoft, BL, Nordentoft, M, Ostergaard, SD, Eaton, WW, Krogh, J, Mortensen, PB (2013). Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study. Journal of the American Medical Association: Psychiatry 70, 812820.Google ScholarPubMed
Bergink, V, Bouvy, PF, Vervoort, JS, Koorengevel, KM, Steegers, EA, Kushner, SA (2012). Prevention of postpartum psychosis and mania in women at high risk. American Journal of Psychiatry 169, 609615.CrossRefGoogle ScholarPubMed
Bijlenga, D, Koopmans, CM, Birnie, E, Mol, BW, van der Post, JA, Bloemenkamp, KW, Scheepers, HC, Willekes, C, Kwee, A, Heres, MH, Van Beek, E, Van Meir, CA, Van Huizen, ME, Van Pampus, MG, Bonsel, GJ (2011). Health-related quality of life after induction of labor versus expectant monitoring in gestational hypertension or preeclampsia at term. Hypertension in Pregnancy: Official Journal of the International Society for the Study of Hypertension in Pregnancy 30, 260274.CrossRefGoogle ScholarPubMed
Blackmore, ER, Jones, I, Doshi, M, Haque, S, Holder, R, Brockington, I, Craddock, N (2006). Obstetric variables associated with bipolar affective puerperal psychosis. British Journal of Psychiatry: The Journal of Mental Science 188, 3236.CrossRefGoogle ScholarPubMed
Blackmore, ER, Rubinow, DR, O'Connor, TG, Liu, X, Tang, W, Craddock, N, Jones, I (2013). Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disorders 15, 394404.CrossRefGoogle ScholarPubMed
Blom, EA, Jansen, PW, Verhulst, FC, Hofman, A, Raat, H, Jaddoe, VW, Coolman, M, Steegers, EA, Tiemeier, H (2010). Perinatal complications increase the risk of postpartum depression. The Generation R Study. British Journal of Obstetrics and Gynaecology 117, 13901398.CrossRefGoogle ScholarPubMed
Bock, C, Bukh, JD, Vinberg, M, Gether, U, Kessing, LV (2009). Validity of the diagnosis of a single depressive episode in a case register. Clinical Practice and Epidemiology in Mental Health 5, 4.CrossRefGoogle Scholar
Buyukkayaci Duman, N, Ozcan, O, Bostanci, MO (2015). Hyperemesis gravidarum affects maternal sanity, thyroid hormones and fetal health: a prospective case control study. Archives of Gynecology and Obstetrics 292, 307312.CrossRefGoogle ScholarPubMed
Carter, JD, Mulder, RT, Bartram, AF, Darlow, BA (2005). Infants in a neonatal intensive care unit: parental response. Archives of Disease in Childhood: Fetal and Neonatal Edition 90, F109F1013.CrossRefGoogle Scholar
Chandra, KM, Magee, LM, Koren, GM (2002). Discordance between physical symptoms versus perception of severity by women with nausea and vomiting in pregnancy (NVP). BioMed Central Pregnancy Childbirth 2, 5.CrossRefGoogle Scholar
Cox, JL, Holden, JM, Sagovsky, R (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry: the Journal of Mental Science 150, 782786.CrossRefGoogle ScholarPubMed
Davis, L, Edwards, H, Mohay, H, Wollin, J (2003). The impact of very premature birth on the psychological health of mothers. Early Human Development 73, 6170.CrossRefGoogle ScholarPubMed
Delnord, M, Blondel, B, Zeitlin, J (2015). What contributes to disparities in the preterm birth rate in European countries? Current Opinion in Obstetrics and Gynecology 27, 133142.CrossRefGoogle Scholar
DeSisto, CL, Kim, SY, Sharma, AJ (2014). Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Preventing Chronic Disease 11, E104.CrossRefGoogle ScholarPubMed
Di Florio, A, Forty, L, Gordon-Smith, K, Heron, J, Jones, L, Craddock, N, Jones, I (2013). Perinatal episodes across the mood disorder spectrum. Journal of the American Medical Association: Psychiatry 70, 168175.Google ScholarPubMed
Di Florio, A, Jones, L, Forty, L, Gordon-Smith, K, Blackmore, ER, Heron, J, Craddock, N, Jones, I (2014). Mood disorders and parity – a clue to the aetiology of the postpartum trigger. Journal of Affective Disorders 152–154, 334339.CrossRefGoogle ScholarPubMed
Ferrara, A, Hedderson, MM, Albright, CL, Brown, SD, Ehrlich, SF, Caan, BJ, Sternfeld, B, Gordon, NP, Schmittdiel, JA, Gunderson, EP, Mevi, AA, Tsai, AL, Ching, J, Crites, Y, Quesenberry, CP Jr. (2014). A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study. BioMed Central Pregnancy Childbirth 14, 21.CrossRefGoogle ScholarPubMed
Flynn, HA, Davis, M, Marcus, SM, Cunningham, R, Blow, FC (2004). Rates of maternal depression in pediatric emergency department and relationship to child service utilization. General Hospital Psychiatry 26, 316322.CrossRefGoogle ScholarPubMed
Frank, L (2000). Epidemiology. When an entire country is a cohort. Science 287, 23982399.CrossRefGoogle ScholarPubMed
Garthus-Niegel, S, Ayers, S, von Soest, T, Torgersen, L, Eberhard-Gran, M (2014). Maintaining factors of posttraumatic stress symptoms following childbirth: a population-based, two-year follow-up study. Journal of Affective Disorders 172C, 146152.Google Scholar
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology 106, 10711083.CrossRefGoogle ScholarPubMed
Gaynes, BN, Gavin, N, Meltzer-Brody, S, Lohr, KN, Swinson, T, Gartlehner, G, Brody, S, Miller, WC (2005). Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment (Summary), no. 119, 18.Google Scholar
Grigoriadis, S, VonderPorten, EH, Mamisashvili, L, Tomlinson, G, Dennis, CL, Koren, G, Steiner, M, Mousmanis, P, Cheung, A, Radford, K, Martinovic, J, Ross, LE (2013). The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. Journal of Clinical Psychiatry 74, e321e341.CrossRefGoogle ScholarPubMed
Hannah, ME, Whyte, H, Hannah, WJ, Hewson, S, Amankwah, K, Cheng, M, Gafni, A, Guselle, P, Helewa, M, Hodnett, ED, Hutton, E, Kung, R, McKay, D, Ross, S, Saigal, S, Willan, A; Term Breech Trial Collaborative Group (2004). Maternal outcomes at 2 years after planned Cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. American Journal of Obstetrics and Gynecology 191, 917927.CrossRefGoogle ScholarPubMed
Helle, N, Barkmann, C, Bartz-Seel, J, Diehl, T, Ehrhardt, S, Hendel, A, Nestoriuc, Y, Schulte-Markwort, M, von der Wense, A, Bindt, C (2015). Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: cross-sectional results from a controlled multicentre cohort study. Journal of Affective Disorders 180, 154161.CrossRefGoogle ScholarPubMed
Henrichs, J, Schenk, JJ, Roza, SJ, van den Berg, MP, Schmidt, HG, Steegers, EA, Hofman, A, Jaddoe, VW, Verhulst, FC, Tiemeier, H (2010). Maternal psychological distress and fetal growth trajectories: the Generation R Study. Psychological Medicine 40, 633643.CrossRefGoogle ScholarPubMed
Hoedjes, M, Berks, D, Vogel, I, Franx, A, Bangma, M, Darlington, AS, Visser, W, Duvekot, JJ, Habbema, JD, Steegers, EA, Raat, H (2011). Postpartum depression after mild and severe preeclampsia. Journal of Women's Health 20, 15351542.CrossRefGoogle ScholarPubMed
Horgan, MJ (2015). Management of the late preterm infant: not quite ready for prime time. Pediatric Clinics of North America 62, 439451.CrossRefGoogle ScholarPubMed
Houston, KA, Kaimal, AJ, Nakagawa, S, Gregorich, SE, Yee, LM, Kuppermann, M (2015). Mode of delivery and postpartum depression: the role of patient preferences. American Journal of Obstetrics and Gynecology 212, 229.e1229.e7.CrossRefGoogle ScholarPubMed
Howard, LM, Molyneaux, E, Dennis, CL, Rochat, T, Stein, A, Milgrom, J (2014). Non-psychotic mental disorders in the perinatal period. Lancet 384, 17751788.CrossRefGoogle ScholarPubMed
Jones, I, Chandra, PS, Dazzan, P, Howard, LM (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384, 17891799.CrossRefGoogle ScholarPubMed
Khashan, AS, Abel, KM, McNamee, R, Pedersen, MG, Webb, RT, Baker, PN, Kenny, LC, Mortensen, PB (2008). Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events. Archives of General Psychiatry 65, 146152.CrossRefGoogle Scholar
Kumar, R, Marks, M, Platz, C, Yoshida, K (1995). Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions. Journal of Affective Disorders 33, 1122.CrossRefGoogle ScholarPubMed
Kurki, T, Hiilesmaa, V, Raitasalo, R, Mattila, H, Ylikorkala, O (2000). Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics and Gynecology 95, 487490.Google ScholarPubMed
Leffert, LR (2015). What's new in obstetric anesthesia? Focus on preeclampsia. International Journal of Obstetric Anesthesia 24, 264271.CrossRefGoogle ScholarPubMed
Li, J, Laursen, TM, Precht, DH, Olsen, J, Mortensen, PB (2005). Hospitalization for mental illness among parents after the death of a child. New England Journal of Medicine 352, 11901196.CrossRefGoogle ScholarPubMed
Lindahl, V, Pearson, JL, Colpe, L (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women's Mental Health 8, 7787.CrossRefGoogle ScholarPubMed
Lynge, E, Sandegaard, JL, Rebolj, M (2011). The Danish National Patient Register. Scandinavian Journal of Public Health 39, 3033.CrossRefGoogle ScholarPubMed
Marmorstein, NR, Malone, SM, Iacono, WG (2004). Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. American Journal of Psychiatry 161, 15881594.CrossRefGoogle ScholarPubMed
Mazzotta, P, Stewart, DE, Koren, G, Magee, LA (2001). Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy. Journal of Psychosomatic Obstetrics and Gynaecology 22, 712.CrossRefGoogle ScholarPubMed
McGrath, JJ, Eyles, DW, Pedersen, CB, Anderson, C, Ko, P, Burne, TH, Norgaard-Pedersen, B, Hougaard, DM, Mortensen, PB (2010). Neonatal vitamin D status and risk of schizophrenia: a population-based case–control study. Archives of General Psychiatry 67, 889894.CrossRefGoogle ScholarPubMed
McNeil, TF (1988). Women with nonorganic psychosis: psychiatric and demographic characteristics of cases with versus without postpartum psychotic episodes. Acta Psychiatrica Scandinavica 78, 603609.CrossRefGoogle ScholarPubMed
Meltzer-Brody, S, Boschloo, L, Jones, I, Sullivan, PF, Penninx, BW (2013). The EPDS-Lifetime: assessment of lifetime prevalence and risk factors for perinatal depression in a large cohort of depressed women. Archives of Women's Mental Health 16, 465473.CrossRefGoogle Scholar
Meltzer-Brody, S, Stuebe, A (2014). The long-term psychiatric and medical prognosis of perinatal mental illness. Best Practice and Research. Clinical Obstetrics and Gynaecology 28, 4960.CrossRefGoogle ScholarPubMed
Meyer, EC, Coll, CT, Lester, BM, Boukydis, CF, McDonough, SM, Oh, W (1994). Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants. Pediatrics 93, 241246.Google ScholarPubMed
Miles, MS, Holditch-Davis, D, Burchinal, P, Nelson, D (1999). Distress and growth outcomes in mothers of medically fragile infants. Nursing Research 48, 129140.CrossRefGoogle ScholarPubMed
Miles, MS, Holditch-Davis, D, Schwartz, TA, Scher, M (2007). Depressive symptoms in mothers of prematurely born infants. Journal of Developmental and Behavioral Pediatrics 28, 3644.CrossRefGoogle ScholarPubMed
Mors, O, Perto, GP, Mortensen, PB (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39, 5457.CrossRefGoogle ScholarPubMed
Mortensen, PB, Pedersen, CB, Westergaard, T, Wohlfahrt, J, Ewald, H, Mors, O, Andersen, PK, Melbye, M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603608.CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Jones, I, Laursen, TM (2014). Birth order and postpartum psychiatric disorders. Bipolar Disorders 16, 300307.CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Laursen, TM, Meltzer-Brody, S, Mortensen, PB, Jones, I (2011 a). Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Archives of General Psychiatry 69, 428434.Google ScholarPubMed
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Lidegaard, O, Mortensen, PB (2011 b). Induced first-trimester abortion and risk of mental disorder. New England Journal of Medicine 364, 332339.CrossRefGoogle Scholar
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Mors, O, Mortensen, PB (2006). New parents and mental disorders: a population-based register study. Journal of the American Medical Association 296, 25822589.CrossRefGoogle ScholarPubMed
Nicklas, JM, Miller, LJ, Zera, CA, Davis, RB, Levkoff, SE, Seely, EW (2013). Factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes mellitus. Maternal and Child Health Journal 17, 16651672.CrossRefGoogle ScholarPubMed
O'Hara, MW, McCabe, JE (2013). Postpartum depression: current status and future directions. Annual Review of Clinical Psychology 9, 379407.CrossRefGoogle ScholarPubMed
O'Hara, MW, Swain, AM (1996). Rates and risk of postpartum depression – a meta-analysis. International Review of Psychiatry 8, 3754.CrossRefGoogle Scholar
Paffenbarger, RS (1982). Epidemiological Aspects of Mental Illness Associated with Childbearing, In Motherhood and Mental Illness. Academic Press: London.Google Scholar
Palladino, CL, Singh, V, Campbell, J, Flynn, H, Gold, KJ (2011). Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstetrics and Gynecology 118, 10561063.CrossRefGoogle ScholarPubMed
Pedersen, CB (2011). The Danish Civil Registration System. Scandinavian Journal of Public Health 39, 2225.CrossRefGoogle ScholarPubMed
Poehlmann, J, Schwichtenberg, AJ, Bolt, D, Dilworth-Bart, J (2009). Predictors of depressive symptom trajectories in mothers of preterm or low birth weight infants. Journal of Family Psychology 23, 690704.CrossRefGoogle ScholarPubMed
Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (2015). Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2, 5967.CrossRefGoogle ScholarPubMed
Poursharif, B, Korst, LM, Fejzo, MS, MacGibbon, KW, Romero, R, Goodwin, TM (2008). The psychosocial burden of hyperemesis gravidarum. Journal of Perinatology 28, 176181.CrossRefGoogle ScholarPubMed
Poursharif, B, Korst, LM, MacGibbon, KW, Fejzo, MS, Romero, R, Goodwin, TM (2007). Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception 76, 451455.CrossRefGoogle Scholar
Qiu, C, Williams, MA, Calderon-Margalit, R, Cripe, SM, Sorensen, TK (2009). Preeclampsia risk in relation to maternal mood and anxiety disorders diagnosed before or during early pregnancy. American Journal of Hypertension 22, 397402.CrossRefGoogle ScholarPubMed
Rigó, J Jr., Kecskeméti, A, Molvarec, A, Lefkovics, E, Szita, B, Baji, I (2015). [233-POS]: postpartum depression and anxiety in hypertensive disorders of pregnancy. Pregnancy Hypertension 5, 117118.Google Scholar
Robillard, PY, Dekker, G, Chaouat, G, Hulsey, TC, Saftlas, A (2011). Epidemiological studies on primipaternity and immunology in preeclampsia – a statement after twelve years of workshops. Journal of Reproductive Immunology 89, 104117.CrossRefGoogle ScholarPubMed
Sentilhes, L, Gromez, A, Clavier, E, Resch, B, Descamps, P, Marpeau, L (2011). Long-term psychological impact of severe postpartum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica 90, 615620.CrossRefGoogle ScholarPubMed
Shaw, RJ, Deblois, T, Ikuta, L, Ginzburg, K, Fleisher, B, Koopman, C (2006). Acute stress disorder among parents of infants in the neonatal intensive care nursery. Psychosomatics 47, 206212.CrossRefGoogle ScholarPubMed
Shlomi Polachek, I, Dulitzky, M, Margolis-Dorfman, L, Simchen, MJ (2016). A simple model for prediction postpartum PTSD in high-risk pregnancies. Archives of Women's Mental Health 19, 483490.CrossRefGoogle ScholarPubMed
Silverstein, M, Feinberg, E, Young, R, Sauder, S (2010). Maternal depression, perceptions of children's social aptitude and reported activity restriction among former very low birthweight infants. Archives of Disease in Childhood 95, 521525.CrossRefGoogle ScholarPubMed
Sit, D, Rothschild, AJ, Wisner, KL (2006). A review of postpartum psychosis. Journal of Women's Health 15, 352368.CrossRefGoogle ScholarPubMed
Smith, R, Smith, JI, Shen, X, Engel, PJ, Bowman, ME, McGrath, SA, Bisits, AM, McElduff, P, Giles, WB, Smith, DW (2009). Patterns of plasma corticotropin-releasing hormone, progesterone, estradiol, and estriol change and the onset of human labor. Journal of Clinical Endocrinology and Metabolism 94, 20662074.CrossRefGoogle ScholarPubMed
Steegers, EA, von Dadelszen, P, Duvekot, JJ, Pijnenborg, R (2010). Pre-eclampsia. Lancet 376, 631644.CrossRefGoogle ScholarPubMed
Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, Howard, LM, Pariante, CM (2014). Effects of perinatal mental disorders on the fetus and child. Lancet 384, 18001819.CrossRefGoogle Scholar
Svensson, E, Lash, TL, Resick, PA, Hansen, JG, Gradus, JL (2015). Validity of reaction to severe stress and adjustment disorder diagnoses in the Danish Psychiatric Central Research Registry. Clinical Epidemiology 7, 235242.CrossRefGoogle ScholarPubMed
Sword, W, Landy, CK, Thabane, L, Watt, S, Krueger, P, Farine, D, Foster, G (2011). Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. British Journal of Obstetrics and Gynaecology 118, 966977.CrossRefGoogle Scholar
Thompson, JF, Roberts, CL, Ellwood, DA (2011). Emotional and physical health outcomes after significant primary post-partum haemorrhage (PPH): a multicentre cohort study. The Australian and New Zealand Journal of Obstetrics and Gynaecology 51, 365371.CrossRefGoogle ScholarPubMed
Uggerby, P, Ostergaard, SD, Roge, R, Correll, CU, Nielsen, J (2013). The validity of the schizophrenia diagnosis in the Danish Psychiatric Central Research Register is good. Danish Medical Journal 60, A4578.Google Scholar
Vanderbilt, D, Bushley, T, Young, R, Frank, DA (2009). Acute posttraumatic stress symptoms among urban mothers with newborns in the neonatal intensive care unit: a preliminary study. Journal of Developmental and Behavioral Pediatrics 30, 5056.CrossRefGoogle ScholarPubMed
Videbech, P, Gouliaev, G (1995). First admission with puerperal psychosis: 7–14 years of follow-up. Acta Psychiatrica Scandinavica 91, 167173.CrossRefGoogle ScholarPubMed
Vollebregt, KC, van der Wal, MF, Wolf, H, Vrijkotte, TG, Boer, K, Bonsel, GJ (2008). Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? British Journal of Obstetrics and Gynaecology 115, 607615.CrossRefGoogle ScholarPubMed
Webb, RT, Abel, KM, Pickles, AR, Appleby, L, King-Hele, SA, Mortensen, PB (2006). Mortality risk among offspring of psychiatric inpatients: a population-based follow-up to early adulthood. American Journal of Psychiatry 163, 21702177.CrossRefGoogle ScholarPubMed
Weisman, O, Granat, A, Gilboa-Schechtman, E, Singer, M, Gordon, I, Azulay, H, Kuint, J, Feldman, R (2010). The experience of labor, maternal perception of the infant, and the mother's postpartum mood in a low-risk community cohort. Archives of Women's Mental Health 13, 505513.CrossRefGoogle Scholar
Wisner, KL, Sit, DK, McShea, MC, Rizzo, DM, Zoretich, RA, Hughes, CL, Eng, HF, Luther, JF, Wisniewski, SR, Costantino, ML, Confer, AL, Moses-Kolko, EL, Famy, CS, Hanusa, BH (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. Journal of the American Medical Association: Psychiatry 70, 490498.Google ScholarPubMed
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *