Emotional Reaction at Pregnancy Recognition and Risk of Postpartum Depressive Symptoms

To examine whether women's emotional reaction when they first recognize their pregnancy is associated with postpartum depressive symptoms and whether risk increases across positive, ambivalent, and negative feelings.

We conducted a retrospective cohort study at a tertiary perinatal center in Japan. At the first prenatal visit, women answered the free-text question, "How did you feel when you found out you were pregnant?" Responses were coded as positive, ambivalent, or negative; unclear descriptions were excluded. All women who delivered at ≥ 22 weeks' gestation between 2018 and 2024 were eligible. Postpartum depressive symptoms at 1 month were assessed using the Edinburgh Postnatal Depression Scale. Multivariable logistic regression with multiple imputation for missing EPDS and covariates estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for age, parity, single status, employment, prior mental illness, infertility treatment, plurality, and prior miscarriage. Complete-case analyses were performed as sensitivity analyses.

Of the 8932 women, 6835 (76.5%) reported positive, 1729 (19.4%) ambivalent, and 368 (4.1%) negative feelings. The PPD prevalence was 3.5%, 6.2%, and 9.0%, respectively. Compared with positive feelings, aORs were 1.69 (95% CI, 1.30-2.19) for ambivalent and 2.56 (95% CI, 1.73-3.79) for negative feelings (P for trend < 0.001). Estimates were similar in complete-case analyses.

Free-text emotional reactions at pregnancy recognition, categorized as positive, ambivalent, or negative, were strongly and progressively associated with postpartum depressive symptoms. Simple assessment of women's feelings when they discover pregnancy may help identify those at increased risk early in the perinatal course.