Risk factors Associated with Elevated Antenatal and Postpartum Edinburgh Postnatal Depression Scale Scores: A Retrospective Cohort Study

This study aimed to identify the psychological, obstetric, and neonatal risk factors associated with elevated Edinburgh Postnatal Depression Scale (EPDS) scores during the antenatal and postpartum periods. This retrospective cohort study was conducted between January 2023 and December 2024 at the Kaohsiung Chang Gung Memorial Hospital. Participants completed the Chinese version of the EPDS during the second and third trimesters, and on postpartum day two. A cutoff score of ≥10 was considered high risk. Clinical and obstetric data were extracted from the structured electronic medical records. The Mann–Whitney U test was used for continuous variables, while chi-square or Fisher's exact tests were applied to categorical variables. The predictive consistency between antenatal and postpartum EPDS scores was assessed using McNemar's test and Cohen's kappa coefficient. Higher EPDS scores during the second trimester were significantly associated with a history of depression (10.3% vs. 1.9%, p = 0.002) and self-reported poor family relationships (7.4% vs. 0.6%, p = 0.001) among 550 participants. These associations remained significant in the third trimester along with vacuum-assisted delivery (9.3% vs. 2.6%, p = 0.024). During the postpartum period, elevated EPDS scores were significantly associated with prenatal ultrasound anomalies (6.8% vs. 1.2%, p = 0.029), vacuum-assisted delivery (9.1% vs. 2.8%, p = 0.048), low Apgar scores at 1 min (<4) and 5 min (<5) (4.5% vs. 0.2%, p = 0.018), and intrapartum or postpartum complications (15.9% vs. 6.9%, p = 0.032). EPDS scores in the third trimester showed stronger agreement with postpartum scores (90.9%, kappa = 0.440) compared with those in the second trimester (88.7%, kappa = 0.387). Third-trimester EPDS scores showed stronger predictive values for postpartum depression than second-trimester scores. Early identification of high-risk populations through antenatal screening can facilitate timely referral by physicians, thereby improving the quality of care for pregnant women.