Physiological and hematological predictors of early postpartum depressive symptoms in women after childbirth

The early postpartum period is a critical window of biological and psychological vulnerability. Postpartum blues (PPB), characterized by affective lability and irritability in the first days after delivery, is highly prevalent and may represent an early indicator of later postpartum depression. Emerging evidence suggests that PPB reflects underlying susceptibility shaped by neuroendocrine changes, immune activation, and obstetric stressors. Identifying objective and clinically accessible markers—particularly routine hematological and obstetric parameters—may improve early risk stratification. This study aimed to examine the associations between maternal clinical, laboratory, obstetric, and neonatal factors and early postpartum depressive symptom severity.

Methods: This retrospective cohort study analyzed clinical data from 691 women who delivered at Koç University Hospital. Data were obtained from integrated maternal records, including demographic characteristics, obstetric history, and laboratory parameters. Early postpartum emotional distress was assessed using the Edinburgh Postnatal Depression Scale (EPDS) within the first postpartum week. Only participants with complete EPDS scores and linked maternal–neonatal data were included. Analyses examined associations between EPDS scores and clinical variables, including age, obstetric comorbidities, delivery mode, and inflammatory markers (NLR: Neutrophil-to-Lymphocyte Ratio, MLR: Monocyte-to-Lymphocyte Ratio, PLR: Platelet-to-Lymphocyte Ratio, SII: Systemic Immune-Inflammation Index, SIRI: Systemic Inflammation Response Index, PIV: Pan-Immune-Inflammation Value). Participants were categorized using an EPDS cut-off ≥13. Group differences were assessed using chi-square and Mann–Whitney U tests, while correlations were analyzed with Spearman’s test (p < 0.05), based on the Normality tests (Kolmogorov–Smirnov and Shapiro–Wilk).

Results: The mean age of the sample was 32.63 years (SD = 4.69). The mean EPDS score was 6.83 (SD = 5.03). Based on the EPDS cut-off (≥13), 14.5% of participants (n = 100) were classified as depressive, while 85.5% (n = 591) were classified as non-depressive. Descriptive analyses of inflammatory markers showed that mean prepartum neutrophil-to-lymphocyte ratio (NLR) was 4.15 (SD = 2.46), and post-partum NLR was 6.91 (SD = 3.91). Other inflammatory indices (MLR, PLR, SII, SIRI, and PIV) demonstrated wide variability both before and after delivery. Groups showed no significant differences in most inflammatory markers, age, or BMI (all p > .05). However, a statistically significant difference was observed in prepartum monocyte-to-lymphocyte ratio (MLR), which was lower in the depressive group compared to the non-depressive group (U = 25350.00, Z = −2.28, p = .023). No significant differences were found between groups in prepartum NLR (p = .061), PLR (p = .930), SII (p = .847), SIRI (p = .210), or PIV (p = .747). Similarly, post-partum inflammatory markers (NLR, MLR, PLR, SII, SIRI, PIV) and hemoglobin change (ΔHb) did not differ significantly between groups (all p > .05).

Conclusion: The findings suggest a limited association between peripheral inflammatory markers and early postpartum depressive symptoms, with only a modest difference in prepartum MLR. Single time-point measures may not capture this complexity. Future studies should focus on symptom-level dimensions, longitudinal inflammatory changes, and infant health outcomes’ effects. The layered impact of age and BMI should also be considered.

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