***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Unplanned , adverse events during labor or delivery may generate a negative response during the early postpartum period , result ing in disruption of usual functioning and mood . High levels of maternal depressive symptoms are associated with parenting , infant attachment , behavioral problems and cognition ( Beck 2002 ) . The purpose of this study was to examine the relationship of adverse events in labor or delivery and depressive symptoms , functional status and infant care at 2-weeks postpartum . The secondary aim was to explore the role of  social support  as a possible moderator in the relationship between adverse birth events and maternal outcomes . A secondary analysis of data ( n = 123 ) was performed using data collected in a prospect i ve , observational study examining the effects of antidepressant use during pregnancy .  Adverse events did not significantly predict depressive symptoms ( odds ratio = 1.34 , p = .536 ) , functional status ( R2 change = .001 , p = .66 ) , or infant care ( R2 change = .004 , p = .48 ) at 2-weeks postpartum when controlling for depression during pregnancy , antidepressant use at delivery , education level , age , and parity . Social support had significant effects on depressive symptoms ( p = .02 ) , functional status ( p = .014 ) , and infant care ( p < .001 ) but did not moderate the effect of adverse events when predicting depressive symptoms ( odds ratio = 1.01 , p = .045 ) , functional status ( R2 change = .009 , p = .056 ) and infant care ( R2 change < .001 , p = .92 ) . Adverse events did not predict maternal outcomes at 2-weeks postpartum . Social support was related to depressive symptoms , functional status and infant care , but did not moderate the effects of adverse events BACKGROUND Postpartum depression is a mental disorder that occurs after birth and has negative consequences for the mother , infant , and family . The objective of this secondary analysis was to examine whether pregnancy intention was associated with  postpartum depression among first-time mothers . METHODS The First Baby Study is a prospect i ve cohort study of women aged 18 - 35 having a first singleton birth in Pennsylvania . Baseline data were collected during the third trimester . Postpartum depressive symptoms were measured at 1-month postpartum using the Edinburgh Postnatal Depression Scale .  Logistic regression was performed to examine the association between unintended pregnancy and postpartum depression , controlling for prepregnancy anxiety/depression and sociodemographic data . RESULTS Of 2972 first-time mothers , 83.4 % were white , 70.7 % were married , and 56.9 % were college educated . Nine hundred fifty-two women ( 32.0 % ) reported their pregnancy was unintended and 151 ( 5.1 % ) met the threshold for postpartum depression . The prevalence of postpartum depression was higher in women with unintended pregnancies compared to women with intended pregnancies ( 6.7 % vs. 4.3 % , p<0.01 ) . However , after controlling for confounders , unintended pregnancy was no longer associated with postpartum depression ( adjusted OR 1.41 ; 95 % CI 0.91 - 2.18 ) . Variables independently associated with postpartum depression included prepregnancy anxiety/depression , Asian race , and Hispanic ethnicity . CONCLUSION Pregnancy intention was not independently associated with postpartum depression among first time mothers in Pennsylvania BACKGROUND : Childbearing years in the women ’s life are associated with the highest risk of depression . In this study depression in third trimester of pregnancy and after delivery was studied . Depressive symptom score and the proportion of mothers above a threshold were compared to indicate probable depressive disorder at each stage . METHODS : This prospect i ve cohort study was conducted in rural areas of Isfahan province of Iran from September 2007 to January 2008 . Subjects were all in their third trimester and followed up from the beginning of the study to 6 - 8 weeks postpartum . At all , 2156 pregnant women completed the self report question naires but 258 were excluded because they were incomplete and final analysis was done with 1898 sample s. At the final stage the sample size was decreased to 1291 . RESULTS : The prevalence of depression based on BDI score greater than 20 in last trimester of pregnancy , was 22.8 % and rate of depression based on EPD score greater than 12 between 6 to 8 weeks after delivery , was 26.3 % . Incidence of Post Partum Depression ( PPD ) in 6 to 8 weeks after delivery in those who were not clinical ly depressed during pregnancy was 20.1 % . Results showed that history of depression , unplanned pregnancy , being housewife and having 3 or more children had significant relation with ante partum depression . CONCLUSIONS : Two main risk factors for post partum depression are previous history of depression and depression during current pregnancy . It is important to assess these variables during pregnancy in order to facilitate timely identification of women at risk BACKGROUND We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale ( EPDS ) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong . METHOD A prospect i ve cohort of 145 women completed the EPDS , the 12-item General Health Question naire ( GHQ ) and the Beck Depression Inventory ( BDI ) six weeks after giving birth . They were then assessed with the  Structured Clinical Interview for DSM-III-R , non-patient version ( SCID-NP ) to establish psychiatric diagnosis . The criterion validity of EPDS was tested against this clinical diagnosis , and the concurrent validity against the GHQ and BDI scores was also evaluated . The internal consistency of the scales was measured by Cronbach 's alpha coefficient . RESULTS The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population . At six weeks postpartum , 5.5 % of the study population suffered from major depression . CONCLUSIONS The Chinese EPDS will be useful for screening for postnatal depression This study aim ed at estimating the prevalence of postpartum depression ( PPD ) according to postpartum periods and sub-groups in public primary health care setting s in Rio de Janeiro , Brazil . A cross-sectional survey was carried out in five primary health care units and included 811 participants r and omly selected among mothers of children up to five postpartum months . Women were classified as depressed and given scores on Edinburgh Postnatal Depression Scale ( EPDS ) above 11 . The overall estimate of PPD was 24.3 % ( 95 % CI , 21.4–27.4 ) . However , estimates were not homogeneous during the first 5 months postpartum ( p value = 0.002 ) . There was a peak of depressive symptoms around 3 months postpartum , when 128 women ( 37.5 % , 95 % CI , 29.1–46.5 ) disclosed scores above 11 on EPDS . Regarding the magnitude of PPD according to some maternal and partners ' characteristics , it was consistently higher among women with low schooling , without a steady partner , and whose partners misused alcohol or used illicit drugs . The prevalence of PPD among women attending primary health care units in Rio de Janeiro seems to be higher than general estimates of 10–15 % , especially among mothers with low schooling and that receive little ( if any ) support from partners . Also , the “ burden ” of PPD may be even higher around 3 months postpartum . These results are particularly relevant for public health policies . Evaluation of maternal mental health should be extended at least until 3 to 4 months postpartum , and mothers presenting a high-risk profile deserve special attention The aim of this prospect i ve study was to determine the relationship between anaemia during pregnancy and postpartum depression . Two hundred eighty-one non-anaemic mothers with singleton and low-risk pregnancy and no history of antidepressant-use  were studied . Demographic and reproductive data at week 20 were obtained . Mothers were followed up and haemoglobin ( Hb ) was checked at delivery . Iranian version of  Edinburgh Postpartum Depression Scale  ( EPDS ) was completed 4 - 6 weeks after delivery . Mean age of the mothers was 26.6±4 years . The prevalence of postpartum depression according to EPDS was 5.5 % . Binary logistic regression analysis showed that Hb < 11 g/dL at delivery would increase the chance of postpartum depression ( OR 4.64 ; 95 % CI 1.33 - 16.08 ) . The results show that diagnosis and treatment of physiologic factors , especially anaemia , would reduce the risk of postpartum depression BACKGROUND Maternal depression during the peripartum period has an incidence of about 13 % . Individuals with specific genetic predispositions are more vulnerable to stressful life events suggesting that exploration of gene-environmental pathways might facilitate the identification of risk factors for peripartum depression . The aim of this study was to evaluate the influence of stressful life events in combination with the serotonin transporter gene 5-HTTLPR polymorphism on peripartum depressive symptoms . METHODS In a non-psychiatric cohort of 419 Caucasians , the severity of depression was assessed prospect ively during pregnancy ( 3rd trimester ) and the postpartum period ( 2 - 3 days and 6 - 8 months ) using the  Edinburgh Postnatal Depression Scale . Satisfaction with the partner and exposure to negative life events were evaluated using self-report question naires and the genotype of the 5-HTTLPR was assessed . Repeated measures generalized linear models were used to investigate the gene-environment interaction on depressive symptoms across late pregnancy and the postpartum period . RESULTS The 5-HTTLPR S-allele carrier status predicted late postpartum depressive symptom severity only in the presence of negative life events . This interaction was not observed for depressive symptoms during the 3rd trimester or the early postpartum . In addition , S-allele carrier status increased the negative effects of dissatisfaction with the current partner on depressive symptoms in the late postpartum period . CONCLUSIONS In this non-psychiatric cohort , the 5-HTTLPR interacts with both lifetime and current stressors to influence depressive symptoms in the late post partum period . These findings could have clinical implication s by allowing identification of women at higher risk for developing postpartum depressive symptoms Background Depression and anxiety are important mood changes in childbearing women . However , changes in depression and anxiety over time in women who undergo an elective cesarean section ( CS )  have not yet been eluci date d. We aim ed to characterize the trajectories of depressive and anxiety symptoms , and patterns of co-occurrence , and examined the associated predictors of depression and anxiety courses . Methods A prospect i ve longitudinal study of childbearing women ( N = 139 ) who underwent a CS was conducted .  Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory  , in the third trimester and at 1 day , 1 week , and 1 and 6 months postpartum . Results Group-based modeling identified three distinct trajectories of depressive symptoms : group 1 ( low , 30.9 % ) , group 2 ( mild , 41.7 % ) , and group 3 ( high , 27.3 % ) . Four group trajectories of anxiety symptoms were identified : group 1 ( low , 19.4 % ) , group 2 ( mild , 44.6 % ) , group 3 ( high , 28.8 % ) , and group 4 ( very high , 7.2 % ) . Mild symptoms of both depression and anxiety were the most common joint trajectory . Depression trajectories were significantly related to anxiety trajectories ( p<0.001 ) . Predictors of the joint trajectory included the pre-pregnant body mass index ( odds ratio ( OR ) : 2.42 , 95 % confidence interval ( CI ) : 1.1∼6.3 ) and a poor sleep score ( OR : 3.2 , 95 % CI : 1.4∼7.3 ) in the third trimester . Conclusions Distinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified . Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS BACKGROUND Previous studies showed an inverse association between folate intake and depression . However , epidemiological evidence for folate intake and postpartum depression is unavailable . This prospect i ve study examined the relationship of dietary consumption of folate and B vitamins during pregnancy with the risk of postpartum depression . METHODS Study subjects were 865 Japanese women . Dietary data were obtained during pregnancy from a vali date d self-administered diet history question naire . Postpartum depression was defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 9 or higher between 2 and 9 months postpartum . Adjustment was made for age , gestation , parity , cigarette smoking , alcohol intake , family structure , family income , education , changes in diet in the previous 1 month , season when data at baseline were collected , body mass index , time of delivery before the second survey , medical problems in pregnancy , baby 's sex , and baby 's birth weight . RESULTS Postpartum depression developed in 121 subjects ( 14.0 % ) 2 to 9 months postpartum . There was no measurable association between intake of folate , cobalamin , or pyridoxine and the risk of postpartum depression 
    Output:
    
Interpretation The global prevalence of PPD is greater than previously thought and varies dramatically by nation .
Disparities in wealth ine quality and maternal-child-health factors explain much of the national variation in PPD prevalence