{{redirect|Baby blues|other uses|Baby Blues (disambiguation){{!}}Baby Blues}} {{Infobox medical condition (new) | name = Postpartum blues | synonyms = Baby blues, maternity blues | image = | width = | alt = | caption = | pronounce = | field = [[Psychiatry]], [[obstetrics and gynecology]] | symptoms =Tearfulness, mood swings, irritability, anxiety, fatigue, difficulty sleeping or eating | complications = | onset =Within a few days of childbirth | duration =Up to 2 weeks | types = | causes = | risks = | diagnosis = | differential =[[Postpartum depression]], postpartum anxiety, [[postpartum psychosis]] | prevention = | treatment =Supportive | medication =No medication indicated | prognosis =Self-limited | frequency =Up to 85% | deaths = }} {{Pregnancy and mental health}} '''Postpartum blues''', also known as '''baby blues''' and '''maternity blues''', is a very common but self-limited condition that begins shortly after childbirth and can present with a variety of [[symptoms]] such as [[Mood swing|mood swings]], [[irritability]], and [[tearfulness]].<ref>{{Cite web|title=Postpartum Depression|url=https://medlineplus.gov/postpartumdepression.html|access-date=2020-10-29|website=medlineplus.gov|archive-date=2016-07-27|archive-url=https://web.archive.org/web/20160727211033/https://medlineplus.gov/postpartumdepression.html|url-status=live}}</ref><ref>{{Cite web|title=Baby blues after pregnancy|url=https://www.marchofdimes.org/pregnancy/baby-blues-after-pregnancy.aspx|access-date=2020-10-29|website=www.marchofdimes.org|language=en|archive-date=2017-02-19|archive-url=https://web.archive.org/web/20170219220308/https://www.marchofdimes.org/pregnancy/baby-blues-after-pregnancy.aspx|url-status=live}}</ref> Mothers may experience negative mood symptoms mixed with intense periods of [[joy]]. Up to 85% of new mothers are affected by postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two weeks in duration. Treatment is supportive, including ensuring adequate sleep and emotional support. If symptoms are severe enough to affect daily functioning or last longer than two weeks, the individual should be evaluated for related postpartum psychiatric conditions, such as [[postpartum depression]] and postpartum anxiety. It is unclear whether the condition can be prevented, however education and reassurance are important to help alleviate patient distress. {{TOC limit}}
==Signs and symptoms== Symptoms of postpartum blues can vary significantly from one individual to another, and from one pregnancy to the next. Many symptoms of postpartum blues overlap both with normal symptoms experienced by new parents and with [[postpartum depression]]. Individuals with postpartum blues have symptoms that are milder and less disruptive to their daily functioning compared to those with postpartum depression. Symptoms of postpartum blues include, but are not limited to:<ref name=":04" /><ref name=":0">{{cite web|url= https://www.acog.org/Patients/FAQs/Postpartum-Depression|title= Postpartum Depression|work= American College of Obstetricians and Gynecologists (ACOG)|access-date= 2019-10-13|archive-date= 2014-07-14|archive-url= https://web.archive.org/web/20140714130901/https://www.acog.org/Patients/FAQs/Postpartum-Depression|url-status= live}}</ref>
* Tearfulness or crying "for no reason" * Mood swings * Irritability * Anxiety * Questioning one's ability to care for the baby * Difficulty making choices * Loss of appetite * Fatigue * Difficulty sleeping * Difficulty concentrating * Negative mood symptoms interspersed with positive symptoms<ref name=":1" />
=== Onset === Symptoms appear within 4 weeks of delivery and can last for years. (49)
=== Duration === Postpartum blues may last a few days up to two weeks.<ref name=":22">{{cite web |title=Baby blues after pregnancy |url=https://www.marchofdimes.org/pregnancy/baby-blues-after-pregnancy.aspx |url-status=live |archive-url=https://web.archive.org/web/20170219220308/https://www.marchofdimes.org/pregnancy/baby-blues-after-pregnancy.aspx |archive-date=2017-02-19 |access-date=2019-10-01 |work=March of Dimes |language=en}}</ref><ref name=":33">{{cite web|url=http://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Understanding-Motherhood-and-Mood-Baby-Blues-and-Beyond.aspx|title=Depression During & After Pregnancy: You Are Not Alone|work=HealthyChildren.org|publisher=American Academy of Pediatrics|access-date=2019-10-13|archive-date=2009-12-31|archive-url=https://web.archive.org/web/20091231002606/http://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Understanding-Motherhood-and-Mood-Baby-Blues-and-Beyond.aspx|url-status=live}}</ref> If symptoms last more than two weeks, evaluation for postpartum depression is recommended by the [[American Psychiatric Association]].<ref>{{Cite book|title=Diagnostic and statistical manual of mental disorders: DSM-5.|author=(([[American Psychiatric Association]] DSM-5 Task Force)) |year=2013|publisher=American Psychiatric Association |isbn=978-0-89042-559-6|oclc=847226928}}</ref>
==Causes== The causes of postpartum blues have not been clearly established. Most hypotheses regarding the etiology of postpartum blues and postpartum depression center on the intersection of the significant biological and psychosocial changes that occur with childbirth.
=== Psychosocial causes === [[Pregnancy]] and [[Postpartum period|postpartum]] are significant life events that increase a woman's vulnerability for postpartum blues. Even with a [[planned pregnancy]], it is normal to have feelings of doubt or regret, and it takes time to adjust to having a newborn. Feelings commonly reported by new parents and lifestyle changes that may contribute to developing early postpartum mood symptoms include:<ref name=":0" /><ref name=":3" /><ref name=":4" />
* Fatigue after labor and delivery * Caring for a newborn that requires 24/7 attention * [[Sleep deprivation]] * Lack of support from family and friends * Marital or relationship strain * Changes in home and work routines * Financial stress * Unrealistic expectations of self * Societal or cultural pressure to "bounce back" quickly after [[pregnancy]] and [[childbirth]] * Overwhelmed and questioning ability to care for baby * Anger, loss, or guilt, especially for parents of premature or sick [[Infant|infants]]
=== Risk factors === Most risk factors studied have not clearly and consistently demonstrated an association with postpartum blues. These include sociodemographic factors, such as age and marital status, and obstetric factors, such as delivery complications or low birth weight.<ref name=":14">{{cite journal | vauthors = O'Hara MW, Schlechte JA, Lewis DA, Wright EJ | title = Prospective study of postpartum blues. Biologic and psychosocial factors | journal = Archives of General Psychiatry | volume = 48 | issue = 9 | pages = 801–6 | date = September 1991 | pmid = 1929770 | doi = 10.1001/archpsyc.1991.01810330025004 }}</ref><ref name=":5" /><ref name=":04" />
Factors most consistently shown to be predictive of postpartum blues are personal and family history of depression.<ref name=":14" /> This is of particular interest given of the bidirectional relationship between postpartum blues and postpartum depression: a history of postpartum depression appears to be a [[risk factor]] for developing postpartum blues, and postpartum blues confers a higher risk of developing subsequent postpartum depression.
==Pathophysiology== === Estrogen and progesterone === {{See also|Hormone|label 1=Hormones}}
After delivery of the [[placenta]], [[Mother|mothers]] experience an abrupt decline of [[gonadal hormones]], namely [[estrogen]] and [[progesterone]].<ref name=":04" /><ref name=":1" /><ref name=":9">{{cite journal | vauthors = Miller LJ | title = Postpartum depression | journal = JAMA | volume = 287 | issue = 6 | pages = 762–5 | date = February 2002 | pmid = 11851544 | doi = 10.1001/jama.287.6.762 }}</ref> Major hormonal changes in the early [[postpartum period]] may trigger mood symptoms similarly to how more minor hormonal shifts cause mood swings prior to menstrual periods.<ref name=":11">{{Cite web|url=https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/|title=Postpartum Psychiatric Disorders|last=Health|first=MGH Center for Women's Mental|website=MGH Center for Women's Mental Health|language=en-US|access-date=2019-10-16|archive-date=2008-05-12|archive-url=https://web.archive.org/web/20080512130834/https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/|url-status=live}}</ref><ref>{{Cite journal |last1=Schiller |first1=Crystal Edler |last2=Meltzer-Brody |first2=Samantha |author-link2=Samantha Meltzer-Brody |last3=Rubinow |first3=David R. |date=2015 |title=The role of reproductive hormones in postpartum depression |journal=CNS Spectrums |language=en |volume=20 |issue=1 |pages=48–59 |doi=10.1017/S1092852914000480 |issn=1092-8529 |pmc=4363269 |pmid=25263255}}</ref>{{Hatnote|For additional information on the relationship between estrogen and mental health, see [[Estrogen#Brain and behavior]]}}Studies have not detected a consistent association between hormone concentrations and development of postpartum [[Mood disorder|mood disorders]]. Some investigators believe the discrepant results may be due to variations in sensitivity to hormonal shifts across different subgroups of women. Therefore, development of mood symptoms may be related to a woman's sensitivity, based on [[genetic predisposition]] and psychosocial stressors, to changes in hormones rather than absolute hormonal levels.<ref name=":02">{{Cite journal|last1=Seyfried|first1=L. S.|last2=Marcus|first2=S. M.|date=2003|title=Postpartum mood disorders|journal=International Review of Psychiatry|volume=15|issue=3|pages=231–242|doi=10.1080/0954026031000136857|issn=0954-0261|pmid=15276962|s2cid=25021211}}</ref><ref name=":11" />
=== Other === The association between postpartum blues and a variety of other biological factors, including [[cortisol]] and the [[Hypothalamic–pituitary–adrenal axis|HPA axis]],<ref>{{cite journal | vauthors = O'Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos AS, Pawlby S, Seneviratne G, Taylor A, Moore R | display-authors = 6 | title = Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to the postpartum 'blues' | journal = Journal of Neuroendocrinology | volume = 23 | issue = 11 | pages = 1149–55 | date = November 2011 | pmid = 22004568 | doi = 10.1111/j.1365-2826.2011.02139.x | s2cid = 8199019 | doi-access = free }}</ref> [[tryptophan]], [[prolactin]], [[Thyroid hormones|thyroid hormone]], and others have been assessed over the years with inconclusive results.<ref name=":5">{{cite journal | vauthors = Henshaw C | title = Mood disturbance in the early puerperium: a review | journal = Archives of Women's Mental Health | volume = 6 | pages = S33-42 | date = August 2003 | issue = Suppl 2 | pmid = 14615921 | doi = 10.1007/s00737-003-0004-x | s2cid = 11442944 }}</ref> Prolactin contributes to providing the correct amount of energy to support the mother and the fetus/offspring during pregnancy and [[lactation]], but it also has a homeostatic role.<ref>{{Cite journal |last1=Corona |first1=Giovanni |last2=Rastrelli |first2=Giulia |last3=Comeglio |first3=Paolo |last4=Guaraldi |first4=Federica |last5=Mazzatenta |first5=Diego |last6=Sforza |first6=Alessandra |last7=Vignozzi |first7=Linda |last8=Maggi |first8=Mario |date=2022-11-02 |title=The metabolic role of prolactin: systematic review, meta-analysis and preclinical considerations |url=https://www.tandfonline.com/doi/full/10.1080/17446651.2022.2144829 |journal=Expert Review of Endocrinology & Metabolism |language=en |volume=17 |issue=6 |pages=533–545 |doi=10.1080/17446651.2022.2144829 |issn=1744-6651|url-access=subscription }}</ref>
Emerging research has suggested a potential association between the [[Human gastrointestinal microbiota|gut microbiome]] and perinatal mood and anxiety disorders.<ref>{{cite journal | vauthors = Redpath N, Rackers HS, Kimmel MC | title = The Relationship Between Perinatal Mental Health and Stress: a Review of the Microbiome | journal = Current Psychiatry Reports | volume = 21 | issue = 3 | article-number = 18 | date = March 2019 | pmid = 30826885 | doi = 10.1007/s11920-019-0998-z | s2cid = 73461103 }}</ref><ref>{{cite journal | vauthors = Rackers HS, Thomas S, Williamson K, Posey R, Kimmel MC | title = Emerging literature in the Microbiota-Brain Axis and Perinatal Mood and Anxiety Disorders | journal = Psychoneuroendocrinology | volume = 95 | pages = 86–96 | date = September 2018 | pmid = 29807325 | pmc = 6348074 | doi = 10.1016/j.psyneuen.2018.05.020 }}</ref>
Although several studies have measured lower levels of [[allopregnanolone]] associated with postpartum depression,<ref>{{Cite journal |last=Nappi |first=R |date=2001 |title=Serum allopregnanolone in women with postpartum "blues" |url=https://journals.lww.com/greenjournal/abstract/2001/01000/serum_allopregnanolone_in_women_with_postpartum.16.aspx |journal=Obstetrics & Gynecology |volume=97 |issue=1 |pages=77–80 |doi=10.1016/S0029-7844(00)01112-1|pmid=11152912 |url-access=subscription }}</ref> and identified lower allopregnanolone levels as a risk factor for postpartum depression, many others fail to demonstrate such a relationship. Those studies that do suggest a relationship demonstrate reductions in allopregnanolone levels in women with a risk of developing postpartum depression, a reduction in women experiencing postpartum blues, and a negative correlation with depression symptoms in postpartum women.<ref>{{Cite journal |last1=Walton |first1=Najah |last2=Maguire |first2=Jamie |date=2019 |title=Allopregnanolone-based treatments for postpartum depression: Why/how do they work? |journal=Neurobiology of Stress |language=en |volume=11 |article-number=100198 |doi=10.1016/j.ynstr.2019.100198|pmid=31709278 |pmc=6838978 }}</ref>
== Diagnosis ==
=== Classification === The proper diagnostic classification of postpartum blues has not been clearly established. Postpartum blues has long been considered to be the mildest condition on the spectrum of postpartum psychiatric disorders, which includes postpartum depression and postpartum psychosis. However, there exists some discussion in the literature of the possibility that postpartum blues may be an independent condition.<ref name=":04" />
=== Criteria === There are no standardized criteria for the diagnosis of postpartum blues.<ref name=":04" /> Unlike postpartum depression, postpartum blues is not a diagnosis included in the [[Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition|Diagnostic and Statistical Manual of Mental Disorders]].
Investigators have employed a variety of diagnostic tools in prospective and retrospective studies of postpartum blues, including repurposing screening tools, such as the [[Edinburgh Postnatal Depression Scale]] (EPDS) and Beck Depression Index (BDI), as well as developing blues-specific scales. Examples of blues-specific scales include the Maternity Blues Questionnaire<ref>{{cite journal | vauthors = Kennerley H, Gath D | title = Maternity blues. I. Detection and measurement by questionnaire | journal = The British Journal of Psychiatry | volume = 155 | pages = 356–62 | date = September 1989 | pmid = 2611547 | doi = 10.1192/bjp.155.3.356 | s2cid = 44208783 }}</ref> and the Stein Scale.<ref>{{cite journal | vauthors = Stein GS | title = The pattern of mental change and body weight change in the first post-partum week | journal = Journal of Psychosomatic Research | volume = 24 | issue = 3–4 | pages = 165–71 | date = 1980 | pmid = 7441584 | doi = 10.1016/0022-3999(80)90038-0 }}</ref>
=== Differential diagnosis === Although symptoms of postpartum blues present in a majority of mothers and the condition is self-limited, it is important to keep related psychiatric conditions in mind as they all have overlap in presentation and similar period of onset.
;Postpartum anxiety: Symptoms of anxiety and irritability are often predominant in the presentation of postpartum blues. However, compared to postpartum anxiety, symptoms of postpartum blues are less severe, resolve on their own, and last fewer than two weeks. ;Postpartum depression: Postpartum depression and postpartum blues may be indistinguishable when symptoms first begin. However, symptoms of postpartum blues are less severe, resolve on their own, and last fewer than two weeks. Mothers who experience severe postpartum blues appear to be at increased risk of developing depression.<ref name=":2" /> ;Postpartum psychosis: Although both conditions can cause periods of [[High mood|high]] and [[Low mood|low moods]], the [[Mood swing|mood swings]] in [[postpartum psychosis]] are significantly more severe and may include [[mania]], [[hallucination]]s, and [[delusion]]s. Postpartum psychosis is a rare condition, affecting 1-2 per 1000 women.<ref name=":6" /><ref>{{Cite web|title=Postpartum Psychosis |publisher=Postpartum Support International (PSI)|url=https://www.postpartum.net/learn-more/postpartum-psychosis/|access-date=2020-10-29 |archive-date=2015-04-06|archive-url=https://web.archive.org/web/20150406113539/https://www.postpartum.net/learn-more/postpartum-psychosis/|url-status=live}}</ref> Postpartum psychosis is classified as a psychiatric emergency and requires hospital admission.
Additionally, a variety of medical co-morbidities [[Differential diagnoses of depression|can mimic or worsen psychiatric symptoms]].
== Prevention ==
=== Screening === There are no specific screening recommendations for postpartum blues. Nonetheless, a variety of professional organizations recommend routine screening for depression and/or assessment of [[emotional well-being]] during pregnancy and postpartum. Universal screening provides an opportunity to identify women with sub-clinical psychiatric conditions during this period and those at higher risk of developing more severe symptoms.<ref>{{Cite web|title=Postpartum Depression Screening |work=MedlinePlus Medical Test|url=https://medlineplus.gov/lab-tests/postpartum-depression-screening/|access-date=2020-10-29 |archive-date=2019-12-07|archive-url=https://web.archive.org/web/20191207132208/https://medlineplus.gov/lab-tests/postpartum-depression-screening/|url-status=live}}</ref> Specific recommendations are listed below:
* [[American College of Obstetricians and Gynecologists|American College of Obstetrics and Gynecology]] (ACOG): In 2018, ACOG recommended universal screening for depression and anxiety using a validated tool at least once during pregnancy or postpartum, in addition to a full assessment of mood and well-being at the postpartum visit. This is in addition to existing recommendations for annual depression screening in all women.<ref>{{cite web|url=https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression?IsMobileSet=false|title=Screening for Perinatal Depression|publisher=American College of Obstetricians and Gynecologists (ACOG)|access-date=2019-10-17|archive-date=2018-12-03|archive-url=https://web.archive.org/web/20181203200444/https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression?IsMobileSet=false|url-status=live}}</ref> * [[American Academy of Pediatrics]] (AAP): In 2017, the AAP recommended universal screening of mothers for postpartum depression at the 1-, 2-, 4-, and 6-month well child visits.<ref>{{cite web|url=http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Recommendations.aspx|title=Screening Recommendations|publisher=American Academy of Pediatrics|language=en-US|access-date=2019-10-17|archive-date=2019-10-17|archive-url=https://web.archive.org/web/20191017150406/http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Recommendations.aspx|url-status=live}}</ref><ref>{{cite book | veditors = Hagan JF, Shaw JS, Duncan PM | title = Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents [pocket guide] | edition = 4th | location = Elk Grove Village, IL | publisher = American Academy of Pediatrics | date = 2017 | url = https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdf | access-date = 2019-10-17 | archive-date = 2022-05-09 | archive-url = https://web.archive.org/web/20220509182335/https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdf | url-status = live }}</ref> * [[United States Preventive Services Task Force|United States Preventative Services Task Force]] (USPSTF): In 2016, the USPSTF recommended depression screening in the general adult population, including [[Pregnancy|pregnant]] and postpartum women.<ref>{{cite journal | vauthors = Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP | display-authors = 6 | title = Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 315 | issue = 4 | pages = 380–7 | date = January 2016 | pmid = 26813211 | doi = 10.1001/jama.2015.18392 | doi-access = free }}</ref> Their recommendations did not include guidelines for frequency of screening.
=== Primary prevention === Given the mixed evidence regarding causes of postpartum blues, it is unclear whether prevention strategies would be effective in decreasing the risk of developing this condition. However, educating women during pregnancy about postpartum blues may help to prepare them for these symptoms that are often unexpected and concerning in the setting of excitement and anticipation of a new baby.<ref name=":04" /> Mothers who develop postpartum blues often have significant shame or guilt for feelings of anxiety or depression during a time that is expected to be joyful.<ref name=":3">{{cite web |url=https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression |title=Postpartum depression |date=2018-04-09 |work=Office on Women's Health |publisher=U.S. Department of Health and Human Services |language=en |access-date=2019-10-17 |archive-date=2019-11-15 |archive-url=https://web.archive.org/web/20191115234039/https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression |url-status=live }}</ref> It is important to reassure new parents that low mood symptoms after childbirth are common and transient. Obstetric providers may recommend that patients and their families prepare ahead of time to ensure the mother will have adequate support and rest after the delivery. Additionally, they should provide education and resources to family and friends about red flags of more severe perinatal psychiatric conditions that may develop, such as postpartum depression and [[postpartum psychosis]].<ref name=":4">{{cite web |url= https://www.nimh.nih.gov/health/publications/perinatal-depression |title= Postpartum Depression Facts |work= The National Institute of Mental Health (NIMH) |publisher= U.S. Department of Health and Human Services |access-date= 2019-10-17 |archive-date= 2017-06-21 |archive-url= https://web.archive.org/web/20170621200731/https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml |url-status= live }}</ref>
== Treatment == Postpartum blues is a self-limited condition. Signs and symptoms are expected to resolve within two weeks of onset without any treatment. Nevertheless, there are a number of recommendations to help relieve symptoms, including:<ref name=":22" /><ref name=":33" /><ref>{{Cite web|title=Mom's Mental Health Matters: Moms-to-be and Moms - NCMHEP|url=https://www.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms|access-date=2020-10-29|website=www.nichd.nih.gov/|language=en|archive-date=2016-10-04|archive-url=https://web.archive.org/web/20161004203519/https://www.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms|url-status=live}}</ref>
* Getting enough sleep * Taking time to relax and do activities that you enjoy * Asking for help from family and friends * Reaching out to other new parents * Avoiding alcohol and other drugs that may worsen mood symptoms * Reassurance that symptoms are very common and will resolve on their own
Additional supportive interventions have also been studied. Structured peer-support programs, even those delivered through telephone conversations, have been shown to reduce postpartum mood symptoms.<ref name=":05">{{Cite journal |last1=Kamalifard |first1=Mahin |last2=Yavarikia |first2=Parisa |last3=Babapour Kheiroddin |first3=Jalil |last4=Salehi Pourmehr |first4=Hanieh |last5=Iraji Iranagh |first5=Rogayyeh |date=2013 |title=The Effect of Peers Support on Postpartum Depression: A Single-Blind Randomized Clinical Trial |url=http://journals.tbzmed.ac.ir/JCS/Abstract/JCS_20130829084108 |journal=Journal of Caring Sciences |volume=2 |issue=3 |pages=237–244 |language=en |doi=10.5681/JCS.2013.029 |pmc=4134152 |pmid=25276732}}</ref> A randomized [[clinical trial]] found that mothers who received scheduled [[peer support]] during the late stages of pregnancy and continuing into the first two months of the postpartum period had significantly lower depression scores at two months postpartum compared to mothers receiving routine care.<ref name=":05" /> Another qualitative study demonstrated that consistent [[social support]] from partners, family, and peers is an important component in the postpartum period, but is oftentimes variable due to stigma, cultural differences, and limited follow-up conversations.<ref name=":13">{{Cite journal |last1=De Sousa Machado |first1=Tiffany |last2=Chur-Hansen |first2=Anna |last3=Due |first3=Clemence |date=January 2020 |title=First-time mothers' perceptions of social support: Recommendations for best practice |url=https://journals.sagepub.com/doi/10.1177/2055102919898611 |journal=Health Psychology Open |language=en |volume=7 |issue=1 |article-number=2055102919898611 |doi=10.1177/2055102919898611 |pmid=32095254 |issn=2055-1029|pmc=7008558 }}</ref>
If symptoms do not resolve within two weeks or if they interfere with functioning, individuals are encouraged to contact their healthcare provider. Early diagnosis and treatment of more severe postpartum psychiatric conditions, such as postpartum depression, postpartum anxiety, and postpartum psychosis, are critical for improved outcomes in both the parent and child.<ref name=":42" /><ref name=":52" />
== Prognosis == Most mothers who develop postpartum blues experience complete resolution of symptoms by two weeks. However, a number of prospective studies have identified more severe postpartum blues as an independent risk factor for developing subsequent postpartum depression.<ref name=":2">{{cite journal | vauthors = Henshaw C, Foreman D, Cox J | title = Postnatal blues: a risk factor for postnatal depression | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 25 | issue = 3–4 | pages = 267–72 | date = 2004 | pmid = 15715025 | doi = 10.1080/01674820400024414 | s2cid = 12141830 }}</ref><ref>{{cite journal | vauthors = Zanardo V, Volpe F, de Luca F, Giliberti L, Giustardi A, Parotto M, Straface G, Soldera G | display-authors = 6 | title = Maternity blues: a risk factor for anhedonia, anxiety, and depression components of Edinburgh Postnatal Depression Scale | journal = The Journal of Maternal-Fetal & Neonatal Medicine | pages = 3962–8 | date = March 2019 | volume = 33 | issue = 23 | pmid = 30909766 | doi = 10.1080/14767058.2019.1593363 | s2cid = 85514575 | url = https://eprints.soton.ac.uk/432592/1/Final_Text_MATERNITY_BLUES_Psychiatry_Research.docx | access-date = 2020-09-03 | archive-date = 2023-01-15 | archive-url = https://web.archive.org/web/20230115174306/https://eprints.soton.ac.uk/432592/1/Final_Text_MATERNITY_BLUES_Psychiatry_Research.docx | url-status = live }}</ref> More research is necessary to fully elucidate the association between postpartum blues and postpartum depression.
== Epidemiology == Postpartum blues is a very common condition, affecting around 50–80% of new mothers based on most sources.<ref name=":42">{{cite journal | vauthors = Bobo WV, Yawn BP | title = Concise review for physicians and other clinicians: postpartum depression | journal = Mayo Clinic Proceedings | volume = 89 | issue = 6 | pages = 835–44 | date = June 2014 | pmid = 24943697 | pmc = 4113321 | doi = 10.1016/j.mayocp.2014.01.027 }}</ref> However, estimates of prevalence vary greatly in the literature, from 26 to 85%, depending on the criteria used.<ref name=":52">{{cite journal | vauthors = Howard MM, Mehta ND, Powrie R | title = Peripartum depression: Early recognition improves outcomes | journal = Cleveland Clinic Journal of Medicine | volume = 84 | issue = 5 | pages = 388–396 | date = May 2017 | pmid = 28530897 | doi = 10.3949/ccjm.84a.14060 | doi-access = free }}</ref><ref name=":1">{{cite journal | vauthors = O'Hara MW, Wisner KL | title = Perinatal mental illness: definition, description and aetiology | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 28 | issue = 1 | pages = 3–12 | date = January 2014 | pmid = 24140480 | doi = 10.1016/j.bpobgyn.2013.09.002 | pmc = 7077785 }}</ref><ref name=":04">{{cite journal | vauthors = Seyfried LS, Marcus SM | title = Postpartum mood disorders | journal = International Review of Psychiatry | volume = 15 | issue = 3 | pages = 231–42 | date = August 2003 | pmid = 15276962 | doi = 10.1080/0954026031000136857 | s2cid = 25021211 }}</ref><ref name=":6">{{cite web |url=https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/ |title=Postpartum Psychiatric Disorders |work=MGH Center for Women's Mental Health |language=en-US |access-date=2019-10-16 |archive-date=2008-05-12 |archive-url=https://web.archive.org/web/20080512130834/https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/ |url-status=live }}</ref> Precise rates are difficult to obtain given lack of standardized diagnostic criteria, inconsistency of presentation to medical care, and methodological limitations of retrospective reporting of symptoms.
Evidence demonstrates that postpartum blues exists across a variety of countries and cultures, however there is considerable heterogeneity in reported prevalence rates. For instance, reports of prevalence of postpartum blues in the literature vary from 15% in Japan<ref>{{cite journal | vauthors = Watanabe M, Wada K, Sakata Y, Aratake Y, Kato N, Ohta H, Tanaka K | title = Maternity blues as predictor of postpartum depression: a prospective cohort study among Japanese women | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 29 | issue = 3 | pages = 206–12 | date = September 2008 | pmid = 18608817 | doi = 10.1080/01674820801990577 | s2cid = 8152986 }}</ref> to 60% in Iran.<ref>{{cite journal | vauthors = Akbarzadeh M, Mokhtaryan T, Amooee S, Moshfeghy Z, Zare N | title = Investigation of the effect of religious doctrines on religious knowledge and attitude and postpartum blues in primiparous women | journal = Iranian Journal of Nursing and Midwifery Research | volume = 20 | issue = 5 | pages = 570–6 | date = 2015 | pmid = 26457094 | pmc = 4598903 | doi = 10.4103/1735-9066.164586 | doi-access = free }}</ref> Underreporting of symptoms due to cultural norms and expectations may be one explanation for this heterogeneity.<ref>{{cite journal |vauthors=Zhang X, Wang C, Zuo X, Aertgeerts B, Buntinx F, Li T, Vermandere M |title=Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis |journal=Front Public Health |volume=11 |issue= |article-number=1102618 |date=2023 |pmid=36875385 |pmc=9975262 |doi=10.3389/fpubh.2023.1102618 |bibcode=2023FrPH...1102618Z |quote=Conclusions: The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia. |doi-access=free}}</ref>
== Males == {{see also|Paternal depression}} Literature is lacking on whether new fathers also experience postpartum blues. However, given similar causes of postpartum blues and postpartum depression in women, it may be relevant to examine rates of postpartum depression in men.
Additional research has examined the presentation and impact of paternal postpartum mood symptoms.<ref name=":23">{{Cite journal |last1=Attia Hussein Mahmoud |first1=Hussein |last2=Lakkimsetti |first2=Mohit |last3=Barroso Alverde |first3=Maria Jimena |last4=Shukla |first4=Pranav S |last5=Nazeer |first5=Alviya T |last6=Shah |first6=Sukesh |last7=Chougule |first7=Yuktha |last8=Nimawat |first8=Amisha |last9=Pradhan |first9=Swetapadma |date=2024-08-08 |title=Impact of Paternal Postpartum Depression on Maternal and Infant Health: A Narrative Review of the Literature |journal=Cureus |volume=16 |issue=8 |article-number=e66478 |language=en |doi=10.7759/cureus.66478 |doi-access=free |issn=2168-8184 |pmc=11380704 |pmid=39246890}}</ref> Paternal postpartum depression can emerge anytime within the first year after childbirth, and typically presents as irritability, low mood, sleep disruption, appetite changes, and loss of interest in usual activities.<ref name=":23" />
Fathers experiencing symptoms of postpartum depression frequently report uncertainty about whether their symptoms are legitimate and whether they should receive support for them.<ref name=":32">{{Cite journal |last1=Darwin |first1=Z. |last2=Galdas |first2=P. |last3=Hinchliff |first3=S. |last4=Littlewood |first4=E. |last5=McMillan |first5=D. |last6=McGowan |first6=L. |last7=Gilbody |first7=S. |last8=on behalf of the Born and Bred in Yorkshire (BaBY) team |date=2017-01-26 |title=Fathers' views and experiences of their own mental health during pregnancy and the first postnatal year: a qualitative interview study of men participating in the UK Born and Bred in Yorkshire (BaBY) cohort |journal=BMC Pregnancy and Childbirth |language=en |volume=17 |issue=1 |page=45 |doi=10.1186/s12884-017-1229-4 |doi-access=free |issn=1471-2393 |pmc=5270346 |pmid=28125983}}</ref> A qualitative study highlighted that many fathers experience stress related to their new role changes, partner expectations, and limited mental health resources for themselves.<ref name=":32" />
A 2010 [[meta-analysis]] published in JAMA with over 28,000 participants across various countries showed that prenatal and postpartum depression affects about 10% of men.<ref name=":03">{{cite journal | vauthors = Paulson JF, Bazemore SD | title = Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis | journal = JAMA | volume = 303 | issue = 19 | pages = 1961–9 | date = May 2010 | pmid = 20483973 | doi = 10.1001/jama.2010.605 }}</ref> This analysis was updated by an independent research team in 2016, who found the prevalence to be 8.4% in over 40,000 participants.<ref name=":12">{{cite journal | vauthors = Cameron EE, Sedov ID, Tomfohr-Madsen LM | title = Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis | journal = Journal of Affective Disorders | volume = 206 | pages = 189–203 | date = December 2016 | pmid = 27475890 | doi = 10.1016/j.jad.2016.07.044 }}</ref> Both were significantly higher than previously reported rates of 3–4% from two large cohort studies in the United Kingdom,<ref>{{cite journal | vauthors = Ramchandani P, Stein A, Evans J, O'Connor TG | title = Paternal depression in the postnatal period and child development: a prospective population study | journal = Lancet | volume = 365 | issue = 9478 | pages = 2201–5 | date = 2005 | pmid = 15978928 | doi = 10.1016/S0140-6736(05)66778-5 | s2cid = 34516133 }}</ref><ref>{{cite journal | vauthors = Davé S, Petersen I, Sherr L, Nazareth I | title = Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database | journal = Archives of Pediatrics & Adolescent Medicine | volume = 164 | issue = 11 | pages = 1038–44 | date = November 2010 | pmid = 20819960 | doi = 10.1001/archpediatrics.2010.184 | doi-access = free }}</ref> which may reflect heterogeneity across countries. Both meta-analyses found higher rates in the United States (12.8–14.1%) compared to studies conducted internationally (7.1–8.2%).<ref name=":03" /><ref name=":12" /> Furthermore, there was a moderate positive correlation between paternal and maternal depression (''r'' = 0.308; 95% CI, 0.228–0.384).<ref name=":03" />
== References == {{reflist}} [[Category:Pathology of pregnancy, childbirth and the puerperium]] [[Category:Mental disorders associated with pregnancy, childbirth or the puerperium]]