The Effect of Sports on the Phenomenon of Baby Blues Syndrome (Postpartum Blues) in Postpartum Mothers - Atlantis Press
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Advances in Health Sciences Research, volume 45
5th International Conference on Sport Science and Health (ICSSH 2021)
The Effect of Sports on the Phenomenon of
Baby Blues Syndrome (Postpartum Blues) in
Postpartum Mothers
Ema Novita Deniati 2nd Annisaa 3rd Selvia Agnesfadia
Faculty of Sport Science, Faculty of Medicine Faculty of Medicine
Universitas Negeri Malang Sebelas Maret University Sebelas Maret University
Malang, Surakarta Surakarta
ema.deniati.fik@um.ac.id
Abstract—1) Purpose: baby blues syndrome often phase postpartum depression often occurs. This phase
occurs in postpartum mothers. The prevalence of baby lasts from the third to tenth day after delivery. The
blues syndrome worldwide according to WHO is around last phase is the letting go phase which takes place
3% to 8%. In Asia, cases of baby blues syndrome are after 10 days of delivery where at this phase the
still very high. In Indonesia, it will increase to 70-80% in mother will accept new responsibilities and roles as a
2020. The incidence of baby blues syndrome can be mother for the baby she is born with. If in this phase
prevented and overcome by intervention in the form of
exercise; 2) Methods: this study uses literature studies the mother cannot go through the psychological
from articles indexed by google scholars and pubmed adaptation process properly, then a mother has a high
with the keywords sports, baby blues, postpartum, probability of experiencing Baby Blues Syndrome.
depression in order to obtain 10 quantitative research
articles; 3) Results: several research articles stated that WHO (2018) noted the prevalence of postpartum
exercise was able to overcome postpartum depression or blues in general in the world population is 3-8% with
baby blues syndrome with an intervention time of about 50% of cases occurring in productive ages, namely
4-8 months as measured using the EPDS questionnaire; 20-50 years. WHO also states that this postpartum
4) Conclusion: exercise with light to moderate intensity blues disorder affects about 20% of women and 12%
can prevent symptoms of depression and is safe for
of men at some time in life [3]. The incidence of baby
mothers and babies.
blues or postpartum blues in Asia is quite high and
varies between 26-85%, while in Indonesia the
Keywords— Exercise, Baby Blues, Postpartum,
Psychological, Mother incidence of baby blues or postpartum blues is
between 50-70% of postpartum women [1]. In
Indonesia, the incidence rate will increase in 2020 to
I. INTRODUCTION around 70-80% of postpartum mothers experiencing
The postpartum period in the mother starts from baby blues syndrome and around 10-13% of them
the birth of the placenta until the uterus returns to its continue to have postnatal depression [4]–[7].
pre-pregnancy condition. The puerperal period lasts Baby blues syndrome is a mild emotional stability
for about 6 weeks, i.e. the delivery of the placenta to disorder in the mother as a result of the adjustment
42 days after delivery [1]. After giving birth, the process for the birth of the baby which takes place
mother will undergo several adaptation phases such as within a few hours to about two weeks with the peak
the taking in phase, taking hold phase, and letting go of instability occurring on days 3-5 [8]. Emotional
phase [2]. The taking-in phase is a dependency phase instability in postpartum mothers who experience
that takes place on the first and second day after baby blues syndrome triggers mothers to be irritable,
delivery. Mothers will focus on themselves, tend to be feel excessively worried, feel unable to perform their
passive in their surroundings and increase appetite. duties as a good mother, and at a severe level of
Furthermore, the taking hold phase is where the disturbance can make the mother indifferent and even
mother feels worried because she is unable to take abuse their biological child. [9]. The phenomenon of
care of the baby and is easily irritated so that in this Baby Blues Syndrome can be caused by tiredness of
Copyright © 2022 The Authors. Published by Atlantis Press International B.V.
This is an open access article distributed under the CC BY-NC 4.0 license -http://creativecommons.org/licenses/by-nc/4.0/. 66Advances in Health Sciences Research, volume 45
taking care of the baby, fatigue during the delivery [11]. In addition, the positive effect of regular physical
process, hormonal changes that go up and down activity in relieving depressive disorders was
quickly, excessive anxiety and worries about not explained using several mechanisms [12]. Exercise
being able to take care of the baby alone [10]. increases the concentration of neurotransmitters such
as 5HT, dopamine, and noradrenaline. In addition,
Baby Blues Syndrome as a mild emotional physical activity increases the secretion of BDNF (a
disorder can be prevented and minimized the risk with neurotic factor produced in the brain), the
physical activity. Interventions in the form of exercise concentration of which is low in people with
function to restore health conditions, accelerate depression [13]. A meta-analysis conducted by
healing, restore, improve muscle tension after McCurdy et al. showed that light or moderate physical
pregnancy, especially in the muscles of the back, activity effectively reduced depressive disorder
pelvic floor, and abdomen and prevent complications symptoms in women in the postpartum period [14].
Articles identified by keyword (n: 2610)
PubMed : 110
Google Cendekia : 2500
Articles filtered by title Exclude by abstract (n: 120)
(n: 230) a. Does not answer research
PubMed : 80 questions
Google Cendekia : 150 b. Not a research article
Complete articles that are Exclude by full text (n: 19)
assessed for eligibility Type of sport, time, research design,
(n: 48) respondents, data collection,
research results
Articles include
quantitative research and
types of non-therapy
physical exercise (n: 10)
FIGURE 1. PRISMA FLOWCHART OF RESEARCH DATA EXTRACTION
and PubMed. The literature in this study is an article
II. METHOD on the results of primary quantitative research
conducted from 2011 to 2021 which contains research
A. Data Source on the effect of exercise on postpartum mothers who
This study uses a literature study method taken experience the baby blues syndrome. This study uses
from scientific databases indexed by Google Scholar several keywords to search for relevant literature such
67Advances in Health Sciences Research, volume 45
as exercise, baby blues syndrome, postpartum blues, levels associated with the psychological condition of
mothers giving birth, postpartum, and postpartum the mother after giving birth [16]. The sports concept
mothers. Next, a list of related articles will appear in the form of Low, Moderate to Virgous Physical
which will be further selected. Activity was chosen as an intervention in the study
(n=5). The concept is the provision of physical
B. Data Extraction exercise with different intensity levels based on
The search and data extraction strategy in this international physical activity guidelines which are
study used the PRISMA flow chart (figure 1) [15]. categorized into low intensity with Metabolic
The total search results of research articles based on Equivalent (MET)Advances in Health Sciences Research, volume 45
ideation [26]. EPDS can be used after one month In 2019, there were 3 studies from Indonesia,
postpartum to 8 months postpartum to detect the Norway and Brazil. The results of research in
presence of postpartum depression in the mother. Indonesia by Jehan Puspasari and Dian Fitria showed
that there was an effect between qigong exercise
intervention and prevention of postpartum depression
3.1.3. Characteristics of Pregnant Women symptoms in adolescent mothers with a p value of
Who Received Intervention 0.000. In a study in Norway stated that there was no
This research is a research that requires a long difference in EPDS between the group given the
time. This is because this study does not only focus on exercise 2.96 and the control group 3.48 (p=0.55). So
postnatal events but also on maternal prenatal there was no effect between exercise during
activities. There are 8 studies involving the prenatal pregnancy and postpartum depression. And the results
period and 2 other studies only examining the of a study in Brazil by Carolina de Vargas Nunes
postnatal period of the mother. Pregnant women who stated that there was no significant difference in the
are respondents are women who check their pregnancy mean score for postpartum depression between the
and postnatal conditions in the same place. They were intervention group and the control group. There was
then given an intervention at a gestation period also no significant difference in the rate of postpartum
between 14-36 weeks. In addition, women who are
depression between the intervention group and the
respondents in the study are women who do not have
contraindications such as hypertension, diabetes, and control group.
obesity because they can be confounding variables. However, a recent study in 2020 and 2021 stated that
Mother's compliance in doing sports exercises that women with light activity only had lower
have been determined also affects. psychological distress during pregnancy than those
who did not do physical activity, low physical activity
B. DISCUSSION during pregnancy had a 2.3 times chance of
In this study, the article used is a research article experiencing depression. postpartum and were 3.15
that discusses the effect of exercise on the incidence times more likely to experience postpartum blues in
of postpartum depression or baby blues syndrome. In obese, hypertensive, and diabetic mothers, and
Kristian's research in 2011 stated that there was no women in the intervention group were less likely to
significant difference in EPDS scores between women report anxiety or depression on the EQ5D and had a
who did regular exercise and women in the control lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p <
group with 3 times of data collection so that the EPDS 0.010).
scores were 10 (p=0.46), 13 (p=0.25), and 10
(p=0.03). Furthermore, in 2012, research by Amanda
J Daley stated that there is a relationship between
exercise and postnatal depression so that exercise is
effective for treating postnatal depression.
Research conducted by Zewditu Demissie, (2013)
stated that there was no significant relationship
between total MVPA during pregnancy and
symptoms of postpartum depression. However, there
was a decrease in postpartum depression symptoms
found in pregnant women who did MVPA exercises
at 17-22 weeks of gestation. While research by Parvin
Bahadoran, (2014) showed that 74.7% (n = 68)
subjects had light physical activity and 25.3% (n =
23) had moderate and heavy physical activity. The
results of this study stated that there was no
significant difference between the two groups of
physical activity. The mean score of maternal well-
being in the light physical activity group was lower
than in the moderate and strenuous activity group.
69Table 1. Analysis of previous research articles
Date of Research Method of Data Respondents Number of
No Author Title Country Sports Type Research Results
Publication Design Collection Criteria Respondents
1 Kristian M. Does Exercise 2011 Norway Randomized Group training EPDS Pregnant woman 855 were There was no significant difference in
Songoygard, during Pregnancy controlled trial sessions with a Questionnaire after having prenatal randomized EPDS scores between women who did
Signe N Prevent Postnatal physiotherapist 3 months of giving care at to intervention regular exercise and women in the control
Stafne, Kari Depression? once a week and birth Trondheim and and control group. The scores obtained are 10
Anne I self-training at Stavanger groups (p=0.46), 13 (p=0.25), and 10 (p=0.03)
Evensen, Kjell home twice Hospitals (receiving
A Salvesen, weekly for 12 regular ANC)
Torstein Vik, weeks
Siv Morkved
2 Amanda J The Effectiveness 2012 English Randomized Sports training EPDS questionnaire Women with a 208 This study states that there is a relationship
Daley, Kate of Exercise as a controlled trial accompanied by after 6 months of clinical definition between exercise and postnatal
Jolly, Debbie Treatment for an instructor for 6 delivery and IPAQ of postpartum depression. Exercise is effective for treating
J Sharp, Postnatal months during practice clinical postnatal depression.
Katrina M Depression: Study depression based
Turner, Ruth Protocol on the ICD-10
V Blamey, at diagnosis of
all depression.
3 Zewditu Physical Activity 2013 North Prospective Moderate-to- EPDS questionnaire Women attending 652 There was no significant relationship
Demissie, Durung Pregnancy Carolina, cohort Vigorous Physical assessment prenatal and between total MVPA during pregnancy and
Anna Maria and Postpartum United State research Activity (MVPA) conducted for 3 postnatal postpartum depression symptoms.
Siega-Riz, Depressive months postpartum checkups at the However, there was a decrease in
Kelly R. Symptoms University of postpartum depression symptoms found in
Evenson, North Carolina pregnant women who did MVPA exercises
Amy H. clinic during 2001 at 17-22 weeks of gestation.
Herring, - 2005
Nancy Dole,
Advances in Health Sciences Research, volume 45
Bradley N.
Gaynes
4 Parvin Association 2014 Dezfoul, Iran Historical Light, moderate, A 3-stage iranian, can read 91 The results showed that 74.7% (n = 68)
Bahadoran, Between Physical cohort heavy physical questionnaire, the and write, subjects had light physical activity and
Fatemeh Activity 3-12 Months research exercise first is about breastfeeding, 3- 25.3% (n = 23) had moderate and heavy
Tirkesh, After Delivery and demographic 12 months physical activity. There was no significant
Hamid Reza Postpartum Well- characteristics, the postpartum, difference between the two groups
Oreizi being second is about the singleton birth regarding physical activity. The mean score
standard of physical of maternal well-being in the light physical
activity, the third is activity group was lower than in the
about the intensity moderate and strenuous activity group.
of physical activity
5 Jehan Efektivitas Qigong 2019 Indonesia Quasi Qigong Exercise Demographic Teenage mothers 27 The results showed that there was an effect
Puspasari, Exercise Selama experiment questionnaire and aged 16-19 years between qigong exercise intervention and
Dian Fitria Kehamilan dalam with purposive EPDS questionnaire who are pregnant prevention of postpartum depression
70Pencegahan Gejala sampling (Edinburgh in the third symptoms in adolescent mothers with a p
Depresi Postpartum technique Postnatal trimester value of 0.000.
pada Ibu Remaja Depression Scale)
6 Kirsti Krohn Effects of 2019 Norway Single-center, Group exercise in To assess Age 31.2±4.1 91 The results showed that there was no
Garnaes, A. Supervisied parallel group, 3 times per week psychological well- years, BMI difference in EPDS between the group
S. Helvik, Exercise Training and until delivery. being, we used the 34.5±4.2 kg/m2, given the 2.96 exercise and the control
Signe N durung Pregnancy randomized Each session is PGWBI with 46 group 3.48 (p=0.55). So that no effect was
Stafne, Siv on Psychological controlled trials divided into 35 (Psychological respondents in found between exercise during pregnancy
Morkved, Kjell well-being among minutes of light General Well-Being the exercise and postpartum depression.
Salvesen, Overweight and exercise Index) at weeks 12- group and 45
Oyvind Obese Women: (walking/running) 18 of gestation, late respondents in
Salvesen, Secondary and 25 minutes of pregnancy (weeks the control group
Trine Moholdt Analyses of the resistance 34-37) and 3
ETIP-Trial, a training. months postpartum.
Randomised Assessment of
Controlled Trial postpartum
depression using
the EPDS
questionnaire.
7 Carolina de Efficacy of Regular 2019 Brazil Randomized Physical exercise EPDS Mothers enrolled 639 which There is no significant difference in the
Vargas Nunes Exercise During clinical trial includes aerobic Questionnaire 3 in the longitudinal were divided mean scores for postpartum depression
Coll, Marlos Pregnancy on the with birth and resistance months postpartum analysis study, into 71 blocks between the intervention group (4.8) and
Rodrigues, Prevention of cohort study training for 16 living and born in where 1 block the control group (5.4 ) (95% CI, 1.3–0.1).
Alan Stein, Postpartum design weeks with 3 the city of consisted of 9 There was also no significant difference in
Bruna Depression workouts (60 Pelotas, respondents rates of postpartum depression between
Goncalves minutes/session) gestational age (3 the intervention group (6.3%) and the
Cordeiro da per week 16-20 weeks, no intervention control group (9.3%) (ratio, 0.65; 95% CI,
Silva, Diego congenital groups and 6 0.33 to 1.28). Instrumental variable analysis
Garcia disease, age > 18 control indicated that non-adherence may have
Bassani, etc years groups) weakened the effect obtained in the main
analysis in which adherence to the protocol,
defined as engaging in at least 70% of
Advances in Health Sciences Research, volume 45
exercise sessions, was low (40.4%).
8 Ryoko Association of 2020 Japan National birth Different intensity Prenatal Pregnant woman, 92.743 Women with only light activity had lower
Susukida, Prenatal cohort study of daily physical psychological Japanese psychological distress during pregnancy
Kentaro Psychological activity (low, distress was nationality, and than those who did not do physical activity.
Usuda, Kei Distress and medium, high) assessed using the participating in However, women with a combination of
Hamazaki, Postpartum Kessler JECS from 2011 light, moderate, and vigorous activity had a
Akiko Depression with Psychological to 2016 higher likelihood of psychological distress
Tsuchida, Varying Physical Distress Scale during pregnancy and postpartum
Kenta Activity Intensity: questionnaire. depression. Therefore, it is necessary to
Matsumura, Japan Environment Activity during have a certain physical exercise program
Daisuke Nishi, and Children’s pregnancy was with optimal intensity for pregnant women
Hidekuni Study (JECS) assessed using the to prevent and treat psychological stress
Inadera International and postpartum depression.
Physical Activity
Questionnaire
71(IPAQ). Postpartum
depression was
assessed using the
EPDS 1 month after
delivery.
9 Yamuna Ana, Is Physical Activity 2021 India Cohort study Physical exercise Pre-test, validated Pregnant women 1405 The results showed that low physical
Melissa in Pregnancy with different Physical Activity with a gestational activity during pregnancy has a 2.3 times
Glenda Lewis, Associated with intensity levels Level (PAL) age of 14 – 36 chance of experiencing postpartum
Onno C.P. Prenatal and based on questionnaire and weeks who come depression and has a 3.15 times greater
van Schayck, Postnatal international EPDS questionnaire to a general likelihood of experiencing postpartum blues
Giridhara R. Depressive physical activity during the postnatal hospital in obese, hypertensive, and diabetic
Babu Symptoms?: guidelines period mothers.
Results from
MAASTHI Cohort
Study in South India
10 Araceli Effectiveness of 2021 Spain Randomized, The intervention One month Pregnant women 320 Women in the intervention group were less
Navas, Maria Moderate Intensity parallel, and group (moderate postpartum were with a gestational likely to report anxiety or depression on the
del Carmen Aerobic Water centralized aquatic aerobic recorded sleep age of 14-20 EQ5D (11.5% vs 22.7%; p < 0.05) and had
Carrascova, Exercise during controlled exercise) and the quality (MOS sleep), weeks, have a a lower mean EPDS score (6.1 ± 1.9 vs 6, 8
Catalina Pregnancy on study. Where control group (an quality of life (EQ- low risk of ± 2.4, p < 0.010). The two groups had no
Artigues, Quality of Life and there is an ANC examination 5D), and depression complications, significant differences in other outcomes,
Silvia Ortas, Postpartum intervention as usual) or anxiety (EPDS). and come from maternal adverse events, and indicators of
Elena Depression: A Multi group and a five primary care newborn status.
Portells, Aina Center, control group centers in the So it can be said that moderate-intensity
Soler, Aina M Randomized obstetric unit area aquatic exercise during pregnancy reduces
Yanez, Miquel Controlled Trial of Son Llatzer postpartum anxiety and depressive
Bennasar- Hospital symptoms in mothers and is safe for
Veny, Alfonso (Mallorca, Spain) mothers and babies.
Leiva
Advances in Health Sciences Research, volume 45
72Advances in Health Sciences Research, volume 45
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[11] S. I. V. S. I. Victoria and J. S. Y. J. S. Yanti,
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