Anemia and Postpartum Depression: The Role of Anemia Phenotype

Abstract

Objective: To evaluate the relationship between anemia and postpartum depressive symptoms in term pregnant women and to examine whether different anemia phenotypes and hematological parameters are associated with postpartum depressive symptoms.

Study Design: This retrospective observational study included 326 term pregnant women who delivered at Torbalı State Hospital between January and December 2025. Hematological parameters were obtained from the complete blood count performed at hospital admission before labor or cesarean section. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at the routine postpartum follow-up visit at 4–6 weeks postpartum. Participants were grouped according to EPDS score as <10 and ≥10. Univariate and multivariable logistic regression analyses were performed to identify factors associated with EPDS ≥10.

Results: Anemia was present in 112 women (34.4%). The median EPDS score was 1.0 (IQR: 0.0–4.0), and 32 women (9.8%) had EPDS scores ≥10. Women with EPDS scores ≥10 had significantly lower hemoglobin levels and higher RDW values than those with EPDS scores <10. Anemia was significantly more frequent among women with EPDS ≥10 (84.4% vs. 28.9%, p<0.001). EPDS score showed a significant negative correlation with hemoglobin level (ρ=-0.221, p<0.001). After adjustment for potential confounders, anemia remained an independent predictor of EPDS ≥10 (adjusted OR 13.95, 95% CI 5.06-38.44, p<0.001).

Conclusion: Anemia was strongly and independently associated with postpartum depressive symptoms in term pregnant women. Evaluation of anemia phenotypes suggests that this relationship may extend beyond simple iron deficiency and may reflect more complex underlying biological mechanisms.