Is iron deficiency a risk factor for postpartum depression? A case–control study in the Gaza Strip, Palestine

OBJECTIVE: This study aims to investigate the association between iron body status and postpartum depression (PPD) among mothers during the postpartum period. DESIGN: This is a case–control study. SETTING: Governmental primary health care centres in the Gaza Strip, Palestine. PARTICIPANTS: This study involved 300 mothers a month after delivery, with one 150 mothers that were recruited in the cases group who were diagnosed with PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥ 10. The control group included 150 mothers did not have PPD (EPDS < 10). Body iron status is represented by the index of sTfR/log ferritin. RESULTS: Among PPD mothers, 43·3 % had low ferritin level v. 15·3 % for controls (P < 0·001) and cases v. controls difference in mean Hb level was −0·61 (95 % CI −0·86, −0·35). The results of the multiple logistic regression reported that there is a statistically significant association between PPD and the body iron status existed, as mothers who suffered from iron deficiency (ID) were three times more likely to have PPD (OR(adj) 3·25; P = 0·015). Furthermore, the results of the final regression model showed that the other factors that can lead to PPD are absence of psychological guidance services (OR(adj) 8·54; P = 0·001), suffering from undesired feeling in the last pregnancy (OR(adj) 1·77; P = 0·034), in addition to having one of the mental health disorders in the last pregnancy (P = 0·001). CONCLUSION: Body iron status might be a risk factor for postpartum depression and other possibilities of reverse causality may worsen the condition.