Psychological support and postpartum depression in twin gestations: a prospective analysis using the Edinburgh Scale

Abstract Objective: To assess the risk of postpartum depression (PPD) in women with twin pregnancies using the Edinburgh Postnatal Depression Scale (EPDS), and to explore associations between maternal and neonatal complications and depressive symptoms during the postpartum period. Methods: This prospective, mixed-methods study was conducted at the Multiple Pregnancy Outpatient Clinic. Fourteen women with twin pregnancies received psychodynamic psychological prenatal care throughout the pregnancy-puerperal cycle. Postpartum depressive symptoms were screened using the EPDS, with scores ≥13 indicating probable PPD. Associations between EPDS scores and obstetric or perinatal variables were analyzed using Pearson correlation and contingency tables. Results: A high prevalence of depressive symptoms was observed among participants, with 28.6% screening positive for probable PPD and an additional 21.4% at mild risk. Higher EPDS scores were associated with intrapartum hemorrhage, low APGAR scores (1st and 5th <7), cesarean delivery, and neonatal intensive care unit (NICU) admission. Breastfeeding was associated with lower depressive symptom scores. Despite the presence of depressive symptoms in part of the sample, improvements in emotional domains such as anxiety and sadness were noted, suggesting a potential benefit of continuous psychodynamic support. Conclusion: Women with twin pregnancies are at increased risk of postpartum depression, particularly when compounded by obstetric and neonatal complications. Routine mental health screening and structured psychological support—such as psychodynamic prenatal care—should be considered integral components of care for women with multiple gestations. Further studies with larger samples and comparison groups are needed to refine preventive strategies.