International journal of behavioral medicine, 2026
Screening Using the Edinburgh Postnatal Depression Scale at Delivery Discharge as a Predictor of Postpartum Depression
Kelly B. Zafman, Melissa L. Riegel , Markolline Forkpa
Jessie Chittams , Sindhu K. Srinivas
Author affiliations (3)
Department of Obstetrics and Gynecology, Perelman School of Medicine, Division of Maternal Fetal Medicine, University of Pennsylvania, Philadelphia, PA, USA. Kelly.zafman@pennmedicine.upenn.edu.
Department of Obstetrics and Gynecology, Perelman School of Medicine, Division of Maternal Fetal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Biostatistics Analysis Core, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
The objective of this study was to determine if Edinburgh Postnatal Depression Scale (EPDS) scores at delivery discharge are predictive of EPDS scores at 2-6 weeks postpartum.
Method
This was a retrospective cohort study of all patients who delivered at an urban academic medical center from 6/2021 to 6/2022. Universal EPDS screening was implemented for all patients prior to discharge; a score of ≥ 9 was considered at risk for postpartum depression. Patients were re-screened at 2-6 weeks postpartum. The primary outcome was mean EPDS score at 2-6 weeks postpartum.
Results
One thousand six hundred three patients were included; 219 (13.7%) scored ≥ 9 at delivery discharge and 37 (2.3%) endorsed self-harm at delivery discharge. Mean EPDS score at the postpartum visit was significantly higher for patients who had an elevated EPDS at delivery discharge compared to those with a low-risk score (7.9 vs. 2.7, p < 0.001). Of patients who had an EPDS ≥ 9 at delivery discharge, 42.0% (92/219) continued to score ≥ 9 postpartum. Most patients who scored < 9 at delivery discharge continued to score low at 2-6 weeks postpartum (1270/1384, negative predictive value 91.8%). A small proportion of patients who had a low score at delivery discharge scored ≥ 9 at the postpartum visit (114/1384, 8.2%).
Conclusion
EPDS screening at delivery discharge is feasible and identifies patients at risk of postpartum depression. Interventions should target patients with an elevated EPDS score at delivery discharge, as many patients will continue to score high at their postpartum visit. Rescreening at the postpartum visit remains important, as there are patients who will not be captured immediately postpartum.
Very few studies describe the obstetric and neonatal outcome of spontaneous pregnancies in women with irregular menstrual cycles. However, menstrual cycle irregularities are common and may be associated with increased risk, and women who develop pregnancy complications more frequently recollect irregular menstrual cycles before the time of conception in case-control studies. This retrospective cohort study compares obstetric and neonatal outcomes in spontaneous singleton pregnancies in 3440 primiparous Danish women stratified according to menstrual cycle regularity. All pregnancies delivered after 22 weeks of gestation and had a nuchal translucency examination at Copenhagen University Hospital Hvidovre between 1 January 2009 and 31 December 2010. Menstrual cycle irregularity was defined as more than 7 days' deviation between self-reported and ultrasound examination-based gestational age. Outcome measures were gestational diabetes, hypertension, preeclampsia, preterm premature rupture of membranes, preterm birth, prolonged pregnancy, birthweight, umbilical artery pH <7.1, APGAR <7 after 5 min, admission to neonatal intensive care unit and stillbirth. Women with more than 7 days' deviation between self-reported and ultrasound examination-based gestational age were compared with women with a deviation of 7 days or less. Irregular menstrual cycle before conception increases the risk of preeclampsia (7.9% vs. 5.2%, p < 0.05) and low birthweight (6.0% vs. 3.6%, p < 0.05) in spontaneous pregnancies, but reduces the risk of prolonged pregnancy (1.4% vs. 4.7%, p < 0.001). Irregular menstrual cycle before conception is associated with increased risk of adverse obstetric and neonatal outcome.
Contraception/ComparisonDMPA Side EffectsBMI ChangesRetrospective Cohort
Weight gain is a frequent reason for discontinuing the contraceptive with depot-medroxyprogesterone acetate (DMPA). This 3-year retrospective cohort study assessed body mass index (BMI; kg/m(2)) variations in 379 current or past DMPA users compared to TCu380A intrauterine device (IUD) users matched for age and BMI, categorized into G1 (normal weight), G2 (overweight) or G3 (obese) according to baseline BMI. Variations in weight and BMI were evaluated using analysis of variance. BMI increased progressively in all groups but significantly more in G1 and G2 DMPA users compared to nonusers and according to duration of use. In the G3 subgroup, weight trends were similar in the DMPA and IUD users. Normal and overweight women increased BMI with DMPA use; however, obese women did not increase weight. Weight increase in DMPA users could be associated with metabolic alterations related to duration of use in normal and overweight women and to alterations already present in obese women. Prospective studies are required to determine triggering factors. DMPA use or=30.
The purpose of this study was to evaluate the efficacy of the Edinburgh Postnatal Depression Scale versus routine clinical evaluation to detect postpartum depression among a low-income inner-city population and to evaluate risk factors associated with a positive score on the Edinburgh Postnatal Depression Scale. On the basis of the day of the month, all English-speaking patients who were seen for their postpartum visit were assigned either to routine clinical evaluation for postpartum depression or routine clinical evaluation plus the use of the 10-question Edinburgh Postnatal Depression Scale. During the 7-week study period, 72 women 35 women in the routine evaluation group and 37 women in the Edinburgh Postnatal Depression Scale group. Women who completed the Edinburgh Postnatal Depression Scale were significantly more likely than those in the routine evaluation group to be identified as 11 of 37 women (30%) versus 0 of 35 women (P <.001). A failed attempt at breast-feeding was associated with an increased risk of a score of > or =10 on the Edinburgh Postnatal Depression Scale (relative risk, 3.78; 95% CI, 1.03-13.89). The Edinburgh Postnatal Depression Scale appears to be a valuable and efficient tool for the identification of patients who are at risk for postpartum depression.