Preventing postpartum depression through pre-delivery screening and targeted interventions

Omar Felimban; Mona Abdalla; Fadiyah Alharbi; Saif Altuwairqi; Saja Alawami; Zahra Alramel; Majed Alomar; Fatimah Aldarwish; Danah Aldhafeeri

doi:10.18203/2394-6040.ijcmph20254067

Authors

Omar Felimban Department of Obstetrics and Gynecology, Al Thager Hospital, Jeddah, Saudi Arabia
Mona Abdalla Department of Obstetrics and Gynecology, Ministry of Health, Buraydah, Saudi Arabia
Fadiyah Alharbi Department of Obstetrics and Gynecology, Maternity and Children's Hospital, Qassim, Saudi Arabia
Saif Altuwairqi Department of Family Medicine, Ministry of Defense, Riyadh, Saudi Arabia
Saja Alawami College of Medicine, Mansoura University, Mansoura, Egypt
Zahra Alramel College of Medicine, Mansoura University, Mansoura, Egypt
Majed Alomar Alsulimaniah Primary Healthcare Center, Riyadh Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
Fatimah Aldarwish College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
Danah Aldhafeeri Department of Obstetrics and Gynecology, Ministry of Health, Aljahra, Kuwait

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20254067

Keywords:

Postpartum depression, Prevention, Targeted intervention, Risk assessment, Pre-delivery

Abstract

Postpartum depression (PPD) is a prevalent and disabling complication of childbirth with significant consequences for both maternal and infant well-being. Despite its complex etiology involving hormonal, genetic, immune, and psychosocial factors, increasing evidence supports that PPD is highly preventable through early risk identification and targeted antenatal interventions. This review synthesizes current evidence on pre-delivery screening methods and preventive strategies. The Edinburgh postnatal depression scale (EPDS), patient health questionnaire (PHQ-9), and generalized anxiety disorder scale (GAD-7) are still the main tools for screening, but new biological and epigenetic markers, such as inflammatory cytokines and gene methylation profiles, show promise as useful additional tools. Recent advances in machine-learning algorithms have further enhanced risk prediction by integrating psychosocial, clinical, and biological variables with high discriminative accuracy. Preventive interventions, particularly cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), mindfulness-based cognitive therapy, and peer-support programs, demonstrate consistent efficacy in reducing depressive symptom onset when delivered during pregnancy and postpartum. This review aims to explore the underlying pathogenesis and contributing risk factors for PPD. It also seeks to address pre-delivery screening approaches and preventive measures, with the goal of reducing the risk of developing PPD.

Metrics

Metrics Loading ...

References

WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011.

Albert PR. Why is depression more prevalent in women? J Psychiat Neurosci. 2015;40(4):219-21. DOI: https://doi.org/10.1503/jpn.150205

Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants. Cureus. 2023;15(7):e41381. DOI: https://doi.org/10.7759/cureus.41381

Wang Z, Liu J, Shuai H, Zhongxiang C, Xia F, Yang L, et al. Mapping global prevalence of depression among postpartum women. Translational Psychiat. 2021;11(1):543. DOI: https://doi.org/10.1038/s41398-021-01692-1

Agrawal I, Mehendale AM, Malhotra R. Risk Factors of Postpartum Depression. Cureus. 2022;14(10):e30898. DOI: https://doi.org/10.7759/cureus.30898

Chin K, Wendt A, Bennett IM, Bhat A. Suicide and Maternal Mortality. Curr Psychiat Rep. 2022;24(4):239-275. DOI: https://doi.org/10.1007/s11920-022-01334-3

Dimcea DA, Petca RC, Dumitrascu MC, Sandru F, Mehedintu C, Petca A. Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care. Diagnostics (Basel). 2024;14:9. DOI: https://doi.org/10.3390/diagnostics14090865

Vliegen N, Casalin S, Luyten P. The course of postpartum depression: a review of longitudinal studies. Harvard Rev Psychiat. 2014;22(1):1-22. DOI: https://doi.org/10.1097/HRP.0000000000000013

Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women's Health (London, England). 2019;15:1745506519844044. DOI: https://doi.org/10.1177/1745506519844044

Amer SA, Zaitoun NA, Abdelsalam HA, Abdallah A, Mohamed SR, Hassan MA, et al. Exploring predictors and prevalence of postpartum depression among mothers: Multinational study. BMC Publ Health. 2024;24(1):1308. DOI: https://doi.org/10.1186/s12889-024-18502-0

Wu S, Kaplan J, Trautwein ML, Nelson DA, Duong A, Woolaway-Bickel K, et al. Incidence and Predictors of Postpartum Depression Diagnoses among Active-Duty U.S. Army Soldiers. J Women's Health (2002). 2024;33(12):1625-34. DOI: https://doi.org/10.1089/jwh.2023.1010

Li H, Meng H, Dang C, Pengfei L, Jinxing L, Xiao Y, et al. Exploring potential causal relationships between gut microbiota, inflammatory factors, and postpartum depression: a Mendelian randomization analysis. BMC Pregnancy Childbirth. 2025;25(1):177. DOI: https://doi.org/10.1186/s12884-025-07304-w

Singh DR, Sunuwar DR, Adhikari S, Singh S, Karki K. Determining factors for the prevalence of depressive symptoms among postpartum mothers in lowland region in southern Nepal. PLoS One. 2021;16(1):e0245199. DOI: https://doi.org/10.1371/journal.pone.0245199

Nguyen NT, Pengpid S. Proactive approaches to preventing postpartum depression in non-depressive pregnant women: a comprehensive scoping review. Front Global Women's Health. 2025;6:1497740. DOI: https://doi.org/10.3389/fgwh.2025.1497740

Qi W, Wang Y, Wang Y, Sha H, Cong L, Haoyu J, et al. Prediction of postpartum depression in women: development and validation of multiple machine learning models. J Translational Med. 2025;23(1):291. DOI: https://doi.org/10.1186/s12967-025-06289-6

Norhayati MN, Nik Hazlina NH, Asrenee AR, Wan Emilin WMA. Magnitude and risk factors for postpartum symptoms: A literature review. J Affective Disord. 2015;175:34-52. DOI: https://doi.org/10.1016/j.jad.2014.12.041

Matsumura K, Hamazaki K, Tsuchida A, Haruka K, Hidekuni I, Japan Environment and Children’s Study (JECS) Group. Education level and risk of postpartum depression: results from the Japan Environment and Children’s Study (JECS). BMC Psychiat. 2019;19(1):419. DOI: https://doi.org/10.1186/s12888-019-2401-3

Evagorou O, Arvaniti A, Samakouri M. Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions. Psychiatric Quarterly. 2016;87(1):129-54. DOI: https://doi.org/10.1007/s11126-015-9367-1

Elwood J, Murray E, Bell A, Sinclair M, Kernohan WG, Stockdale J. A systematic review investigating if genetic or epigenetic markers are associated with postnatal depression. J Affect Disord. 2019;253:51-62. DOI: https://doi.org/10.1016/j.jad.2019.04.059

Zaidi F, Nigam A, Anjum R, Agarwalla R. Postpartum Depression in Women: A Risk Factor Analysis. J Clin Diagn Res. 2017;11(8):QC13-6. DOI: https://doi.org/10.7860/JCDR/2017/25480.10479

Lodha P, De Sousa A. Neurobiology of Postpartum Depression: Critical Aspects. In. Vol 8: Medknow. 2024:173-6. DOI: https://doi.org/10.4103/aip.aip_101_24

Schiller CE, Walsh E, Eisenlohr-Moul TA, Prim J, Dichter GS, Schiff L, et al. Effects of gonadal steroids on reward circuitry function and anhedonia in women with a history of postpartum depression. J Affect Disord. 2022;314:176-84. DOI: https://doi.org/10.1016/j.jad.2022.06.078

Maguire J. Neuroactive Steroids and GABAergic Involvement in the Neuroendocrine Dysfunction Associated With Major Depressive Disorder and Postpartum Depression. Front Cell Neurosci. 2019;13:83. DOI: https://doi.org/10.3389/fncel.2019.00083

Mehta D, Grewen K, Pearson B, Shivangi W, Leanne W, Anjali KH, et al. Genome-wide gene expression changes in postpartum depression point towards an altered immune landscape. Translational Psychiat. 2021;11(1):155. DOI: https://doi.org/10.1038/s41398-021-01270-5

Welcome MO. Cellular mechanisms and molecular signaling pathways in stress-induced anxiety, depression, and blood–brain barrier inflammation and leakage. Inflammopharmacology. 2020;28(3):643-65. DOI: https://doi.org/10.1007/s10787-020-00712-8

Yu Y, Liang HF, Chen J, Zhi-Bin L, Yu-Shuai H, Jia-Xi C, et al. Postpartum Depression: Current Status and Possible Identification Using Biomarkers. Front Psychiatry. 2021;12:620371. DOI: https://doi.org/10.3389/fpsyt.2021.620371

Guintivano J, Byrne EM, Kiewa J, Shuyang Y, Anna EB, Karolina AA, et al. Meta-Analyses of Genome-Wide Association Studies for Postpartum Depression. Am J Psychiat. 2023;180(12):884-95. DOI: https://doi.org/10.1176/appi.ajp.20230053

Chandra JH, Kurniawan C, Puspitasari IM. Genetic Markers Associated with Postpartum Depression: A Review. Neuropsychiatr Dis Treat. 2024;20:281-93. DOI: https://doi.org/10.2147/NDT.S434165

Zhu J, Jin J, Tang J. Inflammatory pathophysiological mechanisms implicated in postpartum depression. Front Pharmacol. 2022;13:955672. DOI: https://doi.org/10.3389/fphar.2022.955672

Wang Y, Yan P, Wang G, Yi L, Jie X, Yujia S, et al. Trajectory on postpartum depression of Chinese women and the risk prediction models: A machine-learning based three-wave follow-up research. J Affect Disord. 2024;365:185-92. DOI: https://doi.org/10.1016/j.jad.2024.08.074

Munk-Olsen T, Liu X, Madsen KB, Mette-Marie ZK, Liselotte VP, Veerle B, et al. Postpartum depression: a developed and validated model predicting individual risk in new mothers. Translational Psychiat. 2022;12(1):419. DOI: https://doi.org/10.1038/s41398-022-02190-8

Tenaw LA, Ngai FW, Bessie C. Effectiveness of Psychosocial Interventions in Preventing Postpartum Depression Among Teenage Mothers-Systematic Review and Meta-analysis of Randomized Controlled Trials. Prev Sci. 2024;25(7):1091-103. DOI: https://doi.org/10.1007/s11121-024-01728-0

Surkan PJ, Malik A, Perin J, Najia A, Armaan R, Ahmed Z, et al. Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial. Nat Med. 2024;30(3):675-82. DOI: https://doi.org/10.1038/s41591-024-02809-x

Werner E, Miller M, Osborne LM, Kuzava S, Monk C. Preventing postpartum depression: review and recommendations. Archives of women's mental health. 2015;18(1):41-60. DOI: https://doi.org/10.1007/s00737-014-0475-y

Force USPST, Curry SJ, Krist AH, Douglas KO, Michael JB, Aaron BC, et al. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(6):580-7. DOI: https://doi.org/10.1001/jama.2019.0007

Fukuzawa RK, Park CG. Role of Intrapartum Social Support in Preventing Postpartum Depression. J Perinatal Educat. 2023;32(2):104-15. DOI: https://doi.org/10.1891/JPE-2022-0003

Paria A, Atallah A, Nourredine M, Gil D, Fanny J, Verena L, et al. Early detection of perinatal depression in couples: a single-center prospective study. Eur Psychiatry. 2024;67(1):e48. DOI: https://doi.org/10.1192/j.eurpsy.2024.1755

Hoorelbeke K, Fried EI, Koster EHW. A comprehensive network analysis of biopsychosocial factors associated with postpartum depression. J Affect Disord. 2025;390:119808. DOI: https://doi.org/10.1016/j.jad.2025.119808