Impact of Postpartum Hemorrhage in Postpartum Depressive and Anxiety Symptoms in Twin Delivery: A Retrospective Cohort Study

Objectives: This study aimed to investigate the association between postpartum hemorrhage (PPH) and the risk of postpartum depressive and anxiety symptoms. Methods: A retrospective cohort study of twin delivery was conducted at a tertiary women’s and children’s hospital from May 2022 to May 2024. Participants were screened using the Edinburgh Postnatal Depression Scale and the Self-Rating Anxiety Scale. Participants with a pre-existing psychiatric history were excluded. The association between PPH and psychological outcomes was analyzed using multivariate logistic regression. Results: Among the 885 participants, 57 (6.44%) experienced PPH. The prevalence of postpartum depressive symptoms was significantly higher in the PPH group (29.8%) compared to the non-PPH group (17.75%, p = 0.02). After full adjustment for confounders, PPH remained significantly associated with an increased odds of postpartum depressive symptoms (OR = 2.45; 95% CI: 1.24–4.85; p = 0.01). Subgroup analyses indicated this association was particularly strong in women with a normal BMI and those who delivered via cesarean section. In contrast, no statistically significant association was found between PPH and postpartum anxiety symptoms in any of the adjusted models. Conclusions: In twin pregnancies, postpartum hemorrhage is an independent risk factor for postpartum depressive symptoms, but not for anxiety symptoms. These findings highlight the critical need for targeted and enhanced postpartum mental health screening and follow-up care for mothers of twins who experience PPH to facilitate early detection and intervention for depression.