Traditional postpartum practices and their association with postpartum depression among mothers with preterm infants

Background Postpartum depression (PPD) is common among mothers with preterm infants, particularly those exposed to neonatal intensive care unit (NICU)–related stress. Traditional postpartum practices (TPP) are widely adopted in Asian settings, but their impact on maternal mental health remains unclear. This study examined the prevalence of PPD and its association with TPP. Methods A cross-sectional study was conducted between February 2020 and January 2022 among 351 postpartum mothers with preterm infants from five government hospitals in Selangor, Malaysia. Data were collected using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), Parental Stressor Scale: NICU (PSS), and Confinement Practices Questionnaire. Univariable and multivariable logistic regression analyses were performed. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, with statistical significance set at p < 0.05. Results The prevalence of mothers at risk of PPD was 21.1%. Lower adherence to TPP (AOR = 4.36, 95% CI 2.26–8.39), reduced physical activity (AOR = 2.69, 95% CI 1.23–5.88), prolonged NICU stay (AOR = 3.56, 95% CI 1.80–7.02), and higher maternal stress (AOR = 17.37, 95% CI 3.14–96.21) were significantly associated with increased odds of PPD. Consumption of fewer confinement-specific meals was not significant in the fully adjusted model. Conclusion PPD is prevalent among mothers with preterm infants and is associated with both TPP and NICU-related stressors. While adherence to selected TPP was associated with lower odds of PPD, reduced physical activity and prolonged NICU were associated with higher odds of PPD. Integrating culturally appropriate practices with evidence-based interventions is essential to improve maternal mental health outcomes.