Effect of premenstrual syndrome on the risk of postpartum depression within one year after childbirth among primiparous women: Evidence from TriNetX.

BACKGROUND

Premenstrual syndrome (PMS) and postpartum depression (PPD) are hormonally mediated mood disorders occurring at different but physiologically related reproductive stages. Although previous studies suggest an association between PMS and PPD, evidence from cohort study regarding the effect of PMS on new-onset PPD remains limited.

OBJECTIVE

To examine the association between prepregnancy PMS and risk of new-onset PPD within one year after childbirth among primiparous women.

METHODS

This retrospective cohort study used data from the TriNetX global collaborative network. A total of 4376 primiparous women with a documented diagnosis of PMS before pregnancy were identified and followed for PPD onset within one year postpartum. A comparison cohort without PMS was created using 1:1 propensity score matching for age, race, ethnicity, and comorbidities. Cox proportional hazards regression was conducted within the TriNetX platform to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

This study showed 236 (5.4%) women with PMS and 167(3.8%) women without PMS developed new onset PPD with an incidence rate of 9.2 and 6.3 per 1000 person-days respectively. Prepregnancy PMS was significantly associated with an increased risk of PPD within one year postpartum (HR: 1.454; 95% CI: 1.274, 1.836; p < 0.001).

CONCLUSION

This large, multicenter cohort study showed that PMS was associated with an increased risk of PPD within one year after childbirth. A history of PMS may serve as a potential clinical indicator for identifying women at elevated risk of PPD and may inform closer mental health monitoring during the perinatal period. However, further prospective and mechanistic studies are needed to confirm this association and to evaluate potential preventive strategies.