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1、 HumanNutritionandMetabolismResearchCommunicationLowHemoglobinLevelIsaRiskFactorforPostpartumDepressionPPDisnotuncommon,witharecentstudyestimatinga12%prevalenceofmajorand19%ofminorPPD(11),ratescon-sistentwithpreviouslypublishedreports(12,13).1A number of psychosocial risk factors, including prenatal
2、depression, child-care stress, infant temperament, low self-esteem and poor social support have been identied as con-tributing to the development of PPD (11). However, exceptforevidencethatthyroiddysfunctionmayplayaroleinselectcases see (2) for review, few studies have identied physio-logicvariables
3、thatcontributetoPPD.Recently,weidentiedonephysiologicvariable,fatigue,asasignicantpredictorofPPD(14).Asecondphysiologicvariable,anemia,contributestofatigueandisassociatedwithadditionalsymptomssuchasirritability, apathy and an inability to concentrate (1517).Interestingly, iron deciency, a common cau
4、se of anemia,alters thyroid hormone metabolism (1821). All of thesesymptoms(fatigue,anemia,abnormalthyroidstatus)areprob-ably interrelated in certain individuals; if they occur duringthepostpartumperiod,theycouldaffectmaternalhealthout-come. Whether anemia plays a role in the development ofPPD,howev
5、er,hasreceivedlimitedattention.Thus,thefol-lowing study was designed to test the hypothesis that theoccurrence of anemia in the early postpartum period is asso-ciated with an increased likelihood of a woman developingdepressionfollowingthebirthofachild.(Manuscriptreceived21August2003.Initialreviewco
6、mpleted15September2003.Revisionaccepted26September2003.)ElizabethJ.Corwin,2 LauraE.Murray-Kolb*andJohnL.Beard*IntercollegePhysiologyProgramandtheSchoolofNursingand*DepartmentofNutritionalSciences,ThePennsylvaniaStateUniversity,UniversityPark,PA16802ABSTRACTThe role of maternal anemia in the develop-
7、mentofpostpartumdepression(PPD)isunclear.PPDisaseriousdisorderthatmaynegativelyaffectthephysicalandemotionalhealthofanewmotherandherinfant.Althoughpsychosocial factors that increase the risk of developingPPD are known, few studies have identied physiologicfactors that predispose a woman to PPD. New
8、motherswerevisitedathomeond7,14and28afteranuncompli-cated labor and delivery. Hemoglobin (Hb) concentrationwasmeasuredvianger-prickbloodateachvisit,andthewomencompletedtheCenterforEpidemiologicalStudies-DepressiveSymptomatologyScale(CES-D)ond28.TherewasanegativecorrelationbetweenHbconcentrationond7p
9、ostpartumanddepressivesymptomsond28(r4.26;P0.009).CES-Dscores(means SEM)ond7ofwomenwithnormalHblevels120g/L(12g/dL)weresignicantlylower (6.90 1.04) than those of women with Hb levels120g/L(12g/dL)16.363.34;t(35)3.632,P0.001.Thus,womensufferingearlypostpartumanemiamaybeatincreasedriskofdevelopingPPD.
10、 J.Nutr.133:41394142,2003.SUBJECTS AND METHODSThisstudywaspartofalargerinvestigationutilizingalongitudinaldesign to investigate the role of proinammatory cytokines in thedevelopment of postpartum fatigue (22). Correlational analysis wasusedtoevaluatethisrelationshipaswellastherelationshipofanemiatod
11、epressivesymptoms.Sample. Women(n37)wererecruitedfromtwohospitalsincentral Pennsylvania within 24 h of giving birth. Inclusion criteriaincludedthefollowing:vaginalbirthwithoutcomplicationsincludingpostpartumhemorrhage,full-termsingletoninfant,bothmotherandinfantleavingthehospitaltogetherwithin72h,ne
12、ithermotherorinfantdemonstratinganyacuteorchronicillnessupondischargeoratanytime,andneithermotherorinfanttakinganymedicationsotherthanmaternalusageofpostnatalvitamins.Childbirth is usually a time of great joy for all involved.Sometimes,however,thedevelopmentofpostpartumdepres-sion(PPD)3takesawaythej
13、oyandthreatensthehealthandhappinessofanewmotherandherinfant.Awomansufferingfrom PPD may experience interference in maternal role at-tainmentandinterruptionofmaternal-infantbonding(13).Long-termeffectsonherinfantmayresult,includingbehav-ioral, developmental and cognitive delay, and may last yearsbeyo
14、ndinfancy(39).Otherfamilymembers,includingpart-nersandolderchildren,mayalsosuffer(3,10).Unfortunately,Instrumentation.The Center for Epidemiological Studies-De-pressive Symptomatology Scale (CES-D) was used to screen forsymptoms of depression. This 20-item self-report scale has beenshowntobeavalidan
15、dreliablemeasureofsymptomsofdepression(23). The CES-D has been used frequently in studies of depressivesymptomatologyinpostpartumwomen(2429).Ofapossible060pointsthatcanbescoredontheCES-D,acut-offpointof16isusedtoindicatesymptomsofseveredepressionand11toindicatesymp-tomsofmilddepression(23).Procedure. Hospitalstaffmembersdistributedinvitation-to-par-ticipateletterstojust-deliveredmothers,requestingvolunteersforastudy concerning postpartum fatigue. Mothers who were willing toparticipate returned the completed invitation form to a staff nurse,whonotied
