Higher neutrophil count, higher lymphocyte-to-monocyte ratio, and lower platelet-to-lymphocyte ratio are independently associated with postpartum depression symptoms in twin pregnancies

IntroductionPostpartum depression (PPD) is a common complication with adverse maternal and child outcomes. Immune−inflammatory dysregulation has been implicated in its pathogenesis, but evidence from twin pregnancies is limited.

This study aimed to investigate associations between routine prenatal inflammatory biomarkers and PPD symptoms in women with twin deliveries.MethodsThis retrospective cohort study included 846 women with twin pregnancies delivered between May 2022 and May 2024 at a tertiary hospital. PPD symptoms were screened within 4 weeks postpartum using the Edinburgh Postnatal Depression Scale.

Blood samples at admission provided complete blood counts, from which neutrophil, lymphocyte, monocyte, platelet counts, and derived ratios (NLR, LMR, PLR, SII, SIRI, PIV) were calculated. Multivariable logistic regression was used to assess associations.ResultsAmong 846 participants, 145 (17.14%) had PPD symptoms.

Women with PPD symptoms had significantly higher neutrophil, lymphocyte, and monocyte counts (all P<0.05). After full adjustment, higher neutrophil count (OR = 1.46, 95% CI: 1.01–2.12, P = 0.047), higher LMR (OR = 1.36, 95% CI: 1.01–1.83, P = 0.041), and lower PLR (OR = 0.98, 95% CI: 0.96–0.99, P = 0.029) were independently associated with PPD symptoms.