# Association Between Postpartum Depression Symptoms of Primiparas and Uterine Recovery, Sleep Quality and Postpartum Stress

## TL;DR

This study explores how postpartum depression in first-time mothers is linked to uterine recovery, sleep quality, and postpartum stress.

## Contribution

The study identifies specific risk and protective factors for postpartum depression in primiparous women.

## Key findings

- Poor sleep quality and high postpartum stress are significant risk factors for postpartum depression.
- Adequate lochia volume and good pelvic floor muscle recovery act as protective factors against postpartum depression.
- Lower education level and illness during pregnancy are also independent risk factors for postpartum depression.

## Abstract

To investigate the relationship between postpartum depression (PPD) symptoms in primiparous women and uterine recovery, sleep quality and postpartum stress.

This retrospective study enrolled 194 postpartum women who underwent 42-day postpartum examinations in our hospital from February 2024 to February 2025. General demographic information, uterine recovery (including uterine fundal height decline, lochia volume and pelvic floor muscle recovery), sleep quality (determined using the Pittsburgh Sleep Quality Index [PSQI]) and postnatal stress levels (measured using the Maternal Postpartum Stress Scale [MPSS]) were collected through the electronic medical record system. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with an EPDS score ≥10 were classified into the PPD group, and those with <10 were classified into the non-PPD group. Univariate and multivariate logistic regression analyses were performed to assess the factors influencing PPD.

A total of 194 primiparous women were included, 56 in the PPD group and 138 in the non-PPD group. The PPD group showed significantly higher percentage of high school education and below, discordant relationship with husband, lack of regular maternity check-ups, illness during pregnancy and poor health of newborn than the non-PPD group (p < 0.05). PSQI (p = 0.001) and MPSS (p < 0.001) scores were significantly higher in the PPD group than in the non-PPD group. In terms of uterine recovery, the PPD group had a significantly lower lochia volume at 24 and 48 h postpartum than the non-PPD group (p < 0.001) and poorer recovery of pelvic floor muscle strength (p < 0.05). Logistic regression analysis showed that high school education or less, illness during pregnancy, PSQI and MPSS scores were independent risk factors for PPD, whereas higher lochia volume at 24 and 48 h postpartum and pelvic floor muscle strength ≥grade III were protective factors.

This study identified several specific independent risk factors (lower education level, illness during pregnancy, poor sleep quality and high postpartum stress) and protective factors (adequate lochia volume and good pelvic floor muscle recovery) for PPD. Clinical practice should strengthen the identification and intervention of high-risk groups and pay attention to the integrated management of postpartum physiological recovery and mental health.