Ilona S. Yim, PhD, Laura M. Glynn, PhD, Christine Dunkel Schetter, PhD, Calvin J. Hobel, MD, Aleksandra Chicz-DeMet, PhD, and Curt A. Sandman, PhD
Departments of Psychology and Social Behavior (Dr Yim), and Psychiatry and Human Behavior (Drs Glynn, Chicz-DeMet, and Sandman), University of California, Irvine; Department of Psychology, University of California, Los Angeles (Dr Dunkel Schetter); and Miriam Jacobs Chair, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Hobel).
Corresponding Author: Ilona S. Yim, Department of Psychology and Social Behavior, 3340 Social Ecology II, Irvine, CA 92697−7085, USA; Email: ifederen@uci.edu ; phone: 949−824−0130; fax: 949−824−3002.
The publisher's final edited version of this article is available at Arch Gen Psychiatry.
Abstract
Context
Postpartum depression (PPD) is common and has serious implications for the mother and her newborn. A possible link between placental corticotropin-releasing hormone (pCRH) and PPD incidence has been discussed, but there is a lack of empirical evidence.
Objective
To determine whether accelerated pCRH increases throughout pregnancy are associated with PPD symptoms.
Design
Pregnant women were recruited into this longitudinal cohort study. Blood samples were obtained at 15, 19, 25, 31 and 37 weeks gestational age (GA) for assessment of pCRH, cortisol and ACTH. Depressive symptoms were assessed with a standardized questionnaire at the last four pregnancy visits and postpartum.
Setting
Subjects were recruited from two Southern California Medical Centers, and visits were conducted in university research laboratories.
Participants
100 adult women with a singleton pregnancy.
Main Outcome Measure
PPD symptoms were assessed 8.7 weeks (SD = 2.94 wks) after delivery with the Edinburgh Postnatal Depression Scale.
Results
Sixteen women developed PPD symptoms. At 25 weeks GA, pCRH was a strong predictor of PPD symptoms (R2 = .21, β = .46, p < .001), an effect that remained significant after controlling for prenatal depressive symptoms. No significant associations were found for cortisol and ACTH. Receiver Operating Characteristic curve analyses revealed that pCRH at 25 weeks GA is a useful diagnostic test (area under the curve = .78, p = .001). Sensitivity (.75) and specificity (.74) at the ideal cut-off point (56.86 pg/ml pCRH) were high. Growth curve analyses indicated that pCRH trajectories in women with PPD symptoms are significantly accelerated between 23 and 26 weeks GA.
Conclusion
There is a critical period in mid-pregnancy during which pCRH is a sensitive and specific early diagnostic test for PPD symptoms. If replicated, these results have implications for identification and treatment of pregnant women at risk of PPD.
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