From Pregnancy to Postpartum: A Longitudinal Analysis of Maternal Depressive Symptoms and Hemoglobin Concentration in Uttar Pradesh, India

Background: Perinatal depression and maternal anemia impact maternal health, pregnancy outcomes, and infant growth in low- and middle-income countries. This study examines the prevalence and risk factors of these conditions during pregnancy and postpartum in rural Uttar Pradesh, India. Methods: A prospective cohort study was conducted among 475 pregnant women recruited during early pregnancy (≤20 weeks gestation) and followed through late pregnancy (≥27 weeks) and postpartum (< 42 days of childbirth). The outcome variables were, i) depressive symptoms, assessed using the Edinburgh Postnatal Depression Scale (EPDS), and ii) hemoglobin concentrations, measured using HemoCue Hb 301 analyzer from capillary blood. Multivariable linear regression examined associations of the outcome variables with sociodemographic, obstetric, nutritional, interpersonal, and perinatal factors. Path analysis evaluated direct and indirect paths influencing postpartum hemoglobin. Results: Prevalence of probable depression (EPDS score≥13) peaked in early pregnancy (24%) and declined in late pregnancy (17%) and postpartum (4%). Mean hemoglobin declined from early (10.5 g/dL) to late pregnancy (9.7 g/dL), and partially recovering in postpartum (10.4 g/dL). Household food insecurity was associated with higher depressive symptoms during pregnancy and postpartum (early pregnancy:β=2.61, p=0.011; late pregnancy:β=2.84, p< 0.001; postpartum:β=1.40, p=0.023). Psychological intimate partner violence was associated with greater depressive symptoms in early pregnancy (β=3.19, p=0.001). Receiving more antenatal visits was associated with decrease in depressive symptoms in late pregnancy (β=-0.46, p=0.001) and hemoglobin at postpartum (β=-0.11, p=0.070). Consumption of more food groups was associated with increase in depressive symptoms (β=0.63, p=0.004) and hemoglobin in late pregnancy (β=0.10, p=0.026). Iron folic acid (IFA) consumption was associated with increase in hemoglobin in late pregnancy (β=0.01, p< 0.001) and postpartum (β=0.004, p=0.031). Experiencing postpartum health complications was associated with increase in depressive symptoms (β=0.41, p=0.013) and decrease in hemoglobin concentrations (β=-0.18, p=0.036). Antenatal hemoglobin concentrations mediated the associations of IFA supplementation and dietary diversity with postpartum concentrations. Conclusion: Perinatal depression was associated with socioeconomic vulnerabilities, food insecurity, and intimate partner violence, while hemoglobin concentrations were associated with maternal nutrition and perinatal care. Integrating mental health services and comprehensive nutrition interventions into antenatal and postpartum care can improve psychological and physical well-being of mothers during and after pregnancy.