Association between Immediate Postnatal Anaemia and Risk of Developing Postpartum Depression at the Aga Khan University Hospital: A Cohort Study

Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Wangira Musana

Second Supervisor/Advisor

Dr. Mwaniki Mukaindo


Obstetrics and Gynaecology (East Africa)


Introduction: Postpartum depression has significant burden on obstetric psychopathology. While risk factors for the same have been extensively studied, most of this studies have focused on the role of psychosocial factors. Data on the role of physiological variables such as anaemia and role of obstetric complications in postpartum depression is now emerging. There are still gaps in literature regarding the same in developing countries and in Africa.

Primary Objective: To determine the association between low postnatal hemoglobin and postpartum depression

Secondary Objective: To determine the association between obstetric complication specifically postpartum hemorrhage, operative delivery and NICU/NHDU admission and postpartum depression.

Materials and methods: Study design: prospective cohort study

Procedure: Using a cutoff of 11 grams/deciliter, 90 anemic and 90 non anemic women without a prior history of depression were recruited on the second postnatal day. The Edinburgh Postpartum Depression scale was administered at the six week postnatal visit and a score of 13 was used to determine those at risk of postpartum depression.

Results: Using logistic regression analysis, we did not find a statistically significant association between postnatal anemia and postpartum depression. (Adjusted odds ratio 1.25, CI 0.51-3.05, p 0.6290). There was also no significant association between mode of delivery (OR 1.10 CI 0.46-2.60 p=0.8337) nor postpartum hemorrhage (OR 1.45 CI 0.60-3.54 p=0.4092) and postpartum depression. Admission to the neonatal unit (Adjusted OR 6.14 CI 1.09-34.42 p=0.039) and not taking antenatal iron supplements (Adjusted OR 2.83 CI 1.15-6.93 p=0.023) were significantly associated with postpartum depression.

Conclusion: Postnatal anemia, postpartum hemorrhage and mode of delivery are not associated with postpartum depression. NICU/NHDU admission and not taking antenatal iron are associated with postpartum depression though this was not hypothesized a priori and may therefore be a chance finding.

Recommendations: We recommend a prospective cohort study looking at the association of postnatal anemia, iron stores and postpartum depression. We also recommend a study looking at the association between adverse perinatal outcome (NICU/NHDU admission), operative delivery and postpartum depression.

This document is available in the relevant AKU library