Risk of Postpartum Depression and Postpartum Psychosis in Patients With Obstetric Complications: A Case-Control Study

Postpartum psychiatric disorders, including postpartum depression (PPD) and postpartum psychosis (PPP), are major contributors to maternal morbidity and adverse child outcomes globally. While psychosocial risk factors are well established, the potential mechanistic role of obstetric complications in precipitating these conditions remains less clearly delineated.

This study aimed to evaluate the association between specific obstetric complications and the risk of postpartum depression and psychosis within six months after delivery, using a biopsychosocial framework.

We conducted a retrospective, matched case-control study using medical records from Khyber Teaching Hospital, Peshawar (Pakistan), covering deliveries from January 2018 to December 2023. Cases included women aged 18-45 years diagnosed with PPD or PPP within six months postpartum based on DSM-5 criteria. Controls were women who delivered during the same period without psychiatric diagnoses, matched 2:1 by age, parity, and delivery mode. Obstetric complications assessed included preeclampsia/eclampsia, gestational diabetes mellitus (GDM), postpartum hemorrhage, preterm birth, placental abruption, intrauterine growth restriction (IUGR), chorioamnionitis, and cesarean delivery. Conditional logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI).

A total of 220 cases and 440 matched controls were analyzed. Preeclampsia/eclampsia (aOR: 2.30; 95% CI: 1.45-3.64; p<0.001), postpartum hemorrhage (aOR: 2.10; 95% CI: 1.30-3.38; p=0.002), preterm birth (aOR: 1.85; 95% CI: 1.20-2.85; p=0.004), and GDM (aOR: 1.55; 95% CI: 1.00-2.40; p=0.049) were significantly associated with increased risk of postpartum psychiatric disorders. No significant associations were found for placental abruption, IUGR, chorioamnionitis, or cesarean delivery.

Obstetric complications-particularly preeclampsia/eclampsia, postpartum hemorrhage, preterm birth, and gestational diabetes-may act as physiological stressors that interact with underlying vulnerabilities, consistent with stress-diathesis and inflammatory models of psychopathology. These findings support a multifactorial conceptualization of postpartum psychiatric illness and emphasize the importance of integrating obstetric risk profiles into postpartum mental health screenings. In low-resource settings like Pakistan, targeting women with complicated deliveries and known psychosocial risk factors through collaborative, interdisciplinary care models can help prevent chronic maternal mental health conditions and improve developmental outcomes for children.