# The Antenatal Origins of Postpartum Distress: A Retrospective Longitudinal Analysis of Depression and Anxiety Trajectories

## TL;DR

This study shows that depression and anxiety symptoms peak during pregnancy and persist after childbirth, suggesting earlier screening and better treatment strategies are needed.

## Contribution

The study identifies a strong antenatal origin of postpartum distress and highlights the need for early screening and improved intervention strategies.

## Key findings

- Depressive symptoms were highest during pregnancy and strongly correlated with postpartum scores.
- Anxiety scores remained stable during pregnancy before declining postpartum.
- Women receiving mental health services had slower recovery and higher symptoms at 12 weeks postpartum.

## Abstract

Background/Objectives: While postpartum depression is widely screened, the predictive value of antenatal symptoms remains underutilized. This study aimed to retrospectively analyze the longitudinal trajectory of depressive and anxiety symptoms from mid-pregnancy to the late postpartum period to identify critical windows for intervention and assess the impact of mental health service utilization. Methods: A retrospective longitudinal cohort study was conducted on 125 pregnant women monitored at the Emergency County Clinical Hospital of Craiova, Romania. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), while anxiety was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) scale. Data were collected at four intervals: 20–24 weeks (T1), 32–36 weeks (T2), 6 weeks postpartum (T3), and 12 weeks postpartum (T4). Results: The highest burden of depressive symptoms occurred in the antenatal period (mean EPDS: 15.6 ± 9.41) rather than postpartum. Antenatal depression scores were strongly correlated with postpartum scores (rho = 0.98, p < 0.001), indicating a stable continuum of distress, though this high correlation may also reflect measurement inertia. Anxiety scores demonstrated a “plateau” effect during pregnancy (mean GAD-7 ≈ 8.0) before declining postpartum. A stratified analysis revealed a “treatment paradox”: women receiving mental health services had higher baseline morbidity and a slower rate of recovery compared to those who did not, remaining symptomatic at 12 weeks (mean EPDS: 14.2 vs. 11.0, p = 0.049). Conclusions: Perinatal distress in this cohort was primarily an antenatal phenomenon that persisted in the postpartum period. The “antenatal peak” suggests the hypothesis that screening should commence in the second trimester. Current interventions appear to stabilize but not fully resolve symptoms in high-risk women, suggesting a need for more intensive management strategies.