Risk of postpartum depression among women with endometriosis: the Norwegian mother, father and child cohort study (MoBa)

Marius Johansen; Tone Kristin Omsland; Katariina Laine; Siri Eldevik Håberg; Maria Christine Magnus

doi:10.1007/s10654-025-01338-2

Risk of postpartum depression among women with endometriosis: the Norwegian mother, father and child cohort study (MoBa)

Eur J Epidemiol. 2026 Jan 12. doi: 10.1007/s10654-025-01338-2. Online ahead of print.

Authors

Marius Johansen¹, Tone Kristin Omsland², Katariina Laine^{3

4}, Siri Eldevik Håberg^{5

6}, Maria Christine Magnus⁵

Affiliations

¹ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, 1130, 0318, Oslo, Norway. mariuj@medisin.uio.no.
² Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, 1130, 0318, Oslo, Norway.
³ Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.
⁴ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
⁶ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

PMID: 41524885
DOI: 10.1007/s10654-025-01338-2

Abstract

Women with endometriosis have a higher burden of anxiety and depression. Whether they are at increased risk of postpartum depression (PPD) remains unclear. We aimed to compare the risk of PPD between women with and without endometriosis and to explore mediation by previous history of major depression and infertility. In a population-based cohort study, we compared 1,159 singleton pregnancies to women with self-reported endometriosis and 74,590 pregnancies to women without endometriosis. We calculated a djusted risk ratios (aRR) with 95% confidence intervals (CI) using multivariable log-binomial regression, adjusting for age, body mass index, education and income. Mediation analyses assessed the indirect effect of any history of major depression or infertility. Women with endometriosis had a higher risk of PPD (aRR: 1.34, 95% CI: 1.15-1.55). Mediation analyses indicated that a large part of this association was explained by a higher lifetime prevalence of major depression among women with endometriosis (natural direct effect of endometriosis: aRR: 1.17, 95% CI: 1.00-1.36; natural indirect effect of any history of major depression: aRR: 1.14, 95% CI: 1.08-1.20), with 49.3% proportion mediated. Infertility demonstrated a negative natural indirect effect on the association between endometriosis and PPD (aRR: 0.87, 95% CI: 0.81-0.94). Women with endometriosis had an elevated risk of PPD which was largely explained by a higher lifetime prevalence of major depression. Our findings suggest that they constitute a high-risk group and could benefit from closer follow-up to facilitate early identification and intervention.

Keywords: Assisted reproductive technology; Endometriosis; Infertility; Medical Birth Registry of Norway; Postpartum depression; The Norwegian Mother, Father and Child Cohort Study.