Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

https://doi.org/10.5281/zenodo.10601765

Depression in pregnancy and puerperium in patients in a public hospital

institution

Depresión en el embarazo y puerperio en pacientes de una institución

hospitalaria pública

Shirley Fernanda Rosero-Ordóñez

shirley.rosero@espoch.edu.ec

Escuela Superior Politécnica de Chimborazo, Riobamba, Chimborazo,

Ecuador

https://orcid.org/0000-0003-4915-891X

ABSTRACT

Depression is one of the most notable challenges of our time. Objective: to analyse depression in

pregnancy and puerperium in patients in a public hospital in Ecuador. Method: clinical research of a

descriptive and investigative nature in the field, using the Edinburgh scale as an evaluative

instrument. The study population included 119 women. Results: When exploring feelings of sadness

and unhappiness, 40.6% of primigravida pregnant women indicated "No, not at all". Conclusion:

Underlining the importance of personalised care that is sensitive to the different needs and challenges

that may arise at each stage of pregnancy.

Descriptors: depression; pre-eclampsia; pregnancy abdominal. (Source: DeCS).

RESUMEN

La depresión se alza como uno de los desafíos más notables de nuestra época. Objetivo: analizar

la depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública en

Ecuador. Método: investigación clínica de índole descriptiva e investigativa en el terreno, haciendo

uso de la escala de Edimburgo como instrumento evaluativo, La población de estudio abarcó a 119

mujeres. Resultados: Al explorar el sentimiento de tristeza y desdicha, el 40.6% de las mujeres

embarazadas primigestas indicaron "No, nada". Conclusión: subrayando la importancia de una

atención personalizada y sensible a las diferentes necesidades y desafíos que puedan surgir en cada

etapa del embarazo.

Descriptores: depresión; preeclampsia; embarazo abdominal. (Fuente: DeCS).

Received: 17/11/2021. Revised: 08/12/2021. Approved: 27/12/2021. Published: 01/05/2022.

Clinical communication

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

INTRODUCTION

Depression stands as one of the most remarkable challenges of our time, weaving

its shadowy web in the psyche of millions of individuals, characterised by loss of

interest and difficulty in finding joy in daily activities. In the intricate dance between

body and mind, the human being, endowed with intelligence, seeks harmony in his

existence. However, contemporary reality, saturated with environmental,

psychological, emotional and interpersonal factors, exposes human vulnerability to

challenging changes and adaptations, significantly affecting mental health. In this

scenario, exploring the causes and consequences of depression in critical stages

such as the prenatal and postpartum period becomes imperative.

Mental health, a precious treasure that all individuals must safeguard, takes on

particular relevance during pregnancy and childbirth. These crucial moments,

marked by sleep disturbances, fatigue, loss of sexual desire and anxieties about the

new being to come, call for special attention. However, the delicate balance of mental

health is threatened during these phases of life, leading to alterations in mood that

could become a risk for both mother and foetus.

As the global burden of depression and other mental disorders intensifies, the need

for constant concern and medico-scientific advances becomes inescapable. This

article sets out to explore the complexities of depression during the prenatal and

postpartum period, in the hope of contributing to the development of more effective

strategies to address these life-threatening maternal-fetal conditions.

The complex tapestry of pregnancy and the postpartum period is obscured by the

frequent presence of depression, a complication that casts its shadow over the

delicate fabric of motherhood. In this complex scenario, several risk factors converge

to weave peripartum mood disorders, with a previous history of depression being the

most relevant thread. However, the connection between depression and

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

antidepressants introduces a duality of risks, where both maternal and infant health

are influenced.

The shadow of maternal depression casts its impact on prenatal and postnatal

development, leading to complications including preterm birth, low birth weight, fetal

growth restriction, and cognitive and emotional challenges in the offspring. In turn,

antidepressant exposure broadens the spectrum of risks, being associated with

preterm birth, reductions in birth weight, persistent pulmonary hypertension and the

intriguing postnatal adjustment syndrome (PNAS), as well as establishing a possible

connection to autism spectrum disorder. Paroxetine, specifically, looms as a

shadowy figure in this scenario, linked to cardiac malformations that add an

additional layer of concern.

3 4

The dichotomy between the need for treatment and potential risks manifests itself in

breastfeeding, as most antidepressants are excreted at low levels in breast milk and

are generally compatible. In this dilemma, the decision to use antidepressants during

pregnancy and postpartum becomes a delicate balance between the risks

associated with medication and the dangers of untreated depression in the mother.

A thoughtful and thoughtful act that illustrates the complexity of addressing mental

health in the precious context of motherhood.

The aim is to analyse depression in pregnancy and puerperium in patients in a public

hospital institution in Ecuador.

METHOD

A descriptive and field-based clinical research study was carried out using the

Edinburgh scale as an evaluative instrument.

The study population included all

pregnant and postpartum women who received care at the Ecuadorian Institute of

Social Security in Riobamba during the period June to December 2021, totalling 119

participants in the sample.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

During the course of the study, the total number of puerperal and pregnant women

was considered, establishing a differential limit between multiparous and primigravid

patients attended exclusively in the Gynaecology and Obstetrics Service of the IESS.

This was done according to specific criteria:

Inclusion criteria: comprised women in any trimester of pregnancy and in the

immediate and mid-postpartum period, both multiparous and primigravid, who

received care at the Gynaecology and Obstetrics Service of the IESS Riobamba.

Exclusion criteria: Patients with a known history of psychiatric disorders, pregnancies

with foetuses presenting malformations or associated comorbidities, as well as those

that ended in preterm delivery were excluded.

For data collection, clinical case reviews were used and subjected to descriptive

statistical analysis.

RESULTS

During the first trimester, participation was limited to two study subjects, representing

1.02% of primigravid pregnant women with no history of miscarriage. In the second

trimester, the sample expanded to 34 primigravidae, with no history of abortion,

constituting 17.34% of the total population. By the third trimester, the figure rose to

85 primigrams with no history of abortion, representing 43.36%.

In the exploration of emotional dimensions during pregnancy, self-criticism in

adverse situations was investigated. In this context, 37.5% of pregnant primigravida

women admitted to blaming themselves unnecessarily, answering "yes, sometimes".

On the other hand, 37.14% of multiparous women gave a similar answer.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

As for difficulty falling asleep due to unhappiness, 40.6% of primigravid pregnant

women admitted to having experienced this "yes, sometimes". In contrast, 48.5% of

multiparous women, who make up the majority, responded "No, not at all".

When exploring the feeling of sadness and unhappiness, 40.6% of primigravid

pregnant women indicated "No, not at all". In the case of multiparous women, 60%,

who constitute the majority, responded along the same lines.

DISCUSSION

The results obtained reveal figures of significant relevance, focusing on the

responses analysed. It was possible to establish that primigravid patients exhibited

a greater propensity towards depressive feelings, evidencing cases of sadness and

frustration in their actions, corroborating previous findings in the scientific literature

8 9

. In relation to the puerperiums, the majority of the population provided responses

which, statistically translated, indicated a prevalence towards depression

10 11 12

It is imperative to note that factors such as relationship stability, socio-economic

status, schooling, among others, also exert considerable influence on the pregnant

woman's mood. Although the study addressed the disparity between primigravid and

multiparous women, focusing on the results presented, it is crucial to recognise the

complexity of these additional factors.

In a scalar comparison between the total set of pregnant and postpartum women, no

gaps in responses were identified that would allow a direct connection between the

presence of depression and these two types of clinical cases. The results showed

substantial similarities in responses that did not generate signs of medical alarm.

However, the literature shows variability in the prevalence of depression during the

postpartum period, according to various clinical studies.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

Although the present research was limited to a specific sample and the results

cannot be completely extrapolated, given that further exploration in this field is

required to understand in detail the level of affectation according to problems or

factors that could affect a wider population perimeter, the results obtained allow us

to affirm conclusively that the phenomenon of depression is tangible and occurs in

our social context. This finding underlines the importance of addressing depression

as a clinical problem that demands attention.

CONCLUSION

This study has shed light on the emotional dynamics of pregnant women during

different stages of pregnancy. During the first trimester, the limited participation of

two subjects, representing 1.02% of primigravid pregnant women with no history of

miscarriage, points to the need for further research in this crucial early period.

The progressive increase in the sample in the second and third trimester, reaching

17.34% and 43.36% respectively, suggests a greater willingness and participation of

pregnant women as they progress through their gestation. These findings may

indicate the importance of considering temporal and emotional factors when

designing specific interventions and support services for each stage of pregnancy.

In terms of the emotional dimensions explored, self-criticism in adverse situations

revealed that 37.5% of primigravid pregnant women admitted to needlessly blaming

themselves, while 37.14% of multiparous women expressed a similar response. This

finding highlights the need to address self-criticism as a key component of mental

health during pregnancy.

Difficulty falling asleep due to unhappiness was expressed by 40.6% of primigravid

pregnant women, while the majority of multiparous women, 48.5%, did not

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

experience this problem. These results highlight the importance of assessing and

addressing sleep difficulties as an integral part of prenatal care.

In relation to feelings of sadness and unhappiness, 40.6% of primigravid pregnant

women indicated that they did not experience these feelings. In contrast, 60% of

multiparous women also reported not feeling sadness, suggesting that most women,

regardless of their obstetric history, experience an absence of these feelings during

pregnancy.

These findings provide a nuanced view of pregnant women's emotional experiences,

highlighting the importance of personalised and sensitive care for the different needs

and challenges that may arise at each stage of pregnancy. They also highlight the

need for further research to fully understand the emotional complexities of pregnant

women and to develop more effective support strategies.

FUNDING

Non-monetary

CONFLICT OF INTEREST

There is no conflict of interest with persons or institutions involved in the research.

ACKNOWLEDGEMENTS

To the women who participated in the research.

REFERENCES

1. Evins GG, Theofrastous JP, Galvin SL. Postpartum depression: a comparison

of screening and routine clinical evaluation. Am J Obstet Gynecol.

2000;182(5):1080-1082. doi:10.1067/mob.2000.105409

2. Learman LA. Screening for Depression in Pregnancy and the Postpartum

Period. Clin Obstet Gynecol. 2018;61(3):525-532.

doi:10.1097/GRF.0000000000000359

3. Maurer DM, Raymond TJ, Davis BN. Depression: Screening and

Diagnosis. Am Fam Physician. 2018;98(8):508-515.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

4. Eustis EH, Ernst S, Sutton K, Battle CL. Innovations in the Treatment of

Perinatal Depression: the Role of Yoga and Physical Activity Interventions

During Pregnancy and Postpartum. Curr Psychiatry Rep. 2019;21(12):133.

Published 2019 Dec 4. doi:10.1007/s11920-019-1121-1

5. Ben-Kimhy R, Youngster M, Medina-Artom TR, et al. Fertility patients under

COVID-19: attitudes, perceptions and psychological reactions. Hum Reprod.

2020;35(12):2774-2783. doi:10.1093/humrep/deaa248

6. Cox J, Holden J, Sagovsky R. Escala de Depresión de Post-Parto de

Edinburgh [Edinburgh Post Partum Depression Scale]. Brit Journ o psyquitr

[Internet]. 1987; 150:1-2.

7. Raglan GB, Dunietz GL, O'Brien LM, Rosenblum KL, Muzik M, Swanson LM.

Snoring and depression symptoms in pregnant women. Sleep Health.

2021;7(2):155-160. doi:10.1016/j.sleh.2020.12.007

8. Becker M, Weinberger T, Chandy A, Schmukler S. Depression During

Pregnancy and Postpartum. Curr Psychiatry Rep. 2016;18(3):32.

doi:10.1007/s11920-016-0664-7

9. Howdeshell KL, Ornoy A. Depression and Its Treatment During Pregnancy:

Overview and Highlights. Birth Defects Res. 2017;109(12):877-878.

doi:10.1002/bdr2.1080

10. Ruiz G, Organista G, López R, Cortaza L, Vinalay I. Prevalencia de Depresión

en Embarazadas de una Institución de Salud de Primer Nivel [Prevalence of

Depression in Pregnant Women in a First Level Health Institution]. Sal y Adm

[Internet]. 2017; 4(12):24-30.

11. Herrera K. Depresión, ansiedad y disfunción familiar en el embarazo

[Depression, anxiety and family dysfunction in pregnancy]. Rev Méd Sinerg

[Internet]. 2018; 2(1):3-8.

12. Vega M. Torres V. Patiño C. Ventura I. Vida cotidiana y preeclampsia:

Experiencias de mujeres del Estado de México [Everyday life and

preeclampsia: Experiences of women from the State of Mexico.]. Rev UNAM

[Internet]. 2016; 13(1).

13. Geren A, Birge Ö, Bakır MS, Sakıncı M, Sanhal CY. Does time change the

anxiety and depression scores for pregnant women on Covid-19 pandemic? J

Obstet Gynaecol Res. 2021;47(10):3516-3523. doi:10.1111/jog.14935

14. Sweet L, Arjyal S, Kuller JA, Dotters-Katz S. A Review of Sleep Architecture

and Sleep Changes During Pregnancy. Obstet Gynecol Surv.

2020;75(4):253-262. doi:10.1097/OGX.0000000000000770

15. Cox J, Holden J, Sagovsky R. Escala de Depresión de Post-Parto de

Edinburgh [Edinburgh Post Partum Depression Scale]. Brit Journ o psyquitr

[Internet]. 1987; 150:1-2.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 1(2), 1-9, 2022

Depresión en el embarazo y puerperio en pacientes de una institución hospitalaria pública

Depression in pregnancy and puerperium in patients in a public hospital institution

Shirley Fernanda Rosero-Ordóñez

and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

International (CC BY-NC-SA 4.0) licence.

https://creativecommons.org/licenses/by-nc-sa/4.0/