Wouldn’t it be nice if we could identify women who were at risk for postpartum depression (PPD)? Maybe if we could do that, we could actually prevent the depression from occurring. Or at least, we could intervene in some way so that the depression would not significantly affect the mother and her family.
Some of you might remember an article published in 2009 which claimed to have found a biological marker for vulnerability to PPD that could be used to screen women during pregnancy. In this study, researchers found that women with higher levels of placental corticotrophin releasing hormone (pCRH) at 25 weeks of gestation were more likely to develop PPD. CRH is a neuropeptide essential to the regulation of the hypothalamic-pituitary-adrenal (HPA) axis. The authors hypothesized that over-reactivity of the HPA axis — the endocrine system that is activated in response to stress — may be a trigger for depressive symptoms. While this initial study seemed promising, another study showed no association between CRH levels and risk for PPD. A subsequent study demonstrated a correlation between CRH levels and antenatal – but not postpartum – depression.
And now there is another study (presented at the International Congress of Endocrinology/European Congress of Endocrinology) which also suggests a link between hyperactivity of the HPA axis and postpartum depression. In this study, a group of 200 pregnant women were recruited and followed prospectively. The EPDS was used to assess for depressive symptoms at weeks 2 and 8 postpartum. The researchers found that women who developed PPD were more likely to have specific genetic variants of the bcl1 and rs242939 single nucleotide polymorphisms (SNPs) of the glucocorticoid receptor and the corticotrophin-releasing hormone receptor-1 genes, respectively. These receptors control the activity of the HPA axis, and the authors hypothesize that women with these genetic variants may respond more robustly to environmental stressors and may thus be more vulnerable to depression after delivery.
While these high tech blood tests may at some point be useful tools for identifying women at risk for postpartum depression, they are still in their infancy. At this point in time, we must not forget that we do have tools which can be used to screen women during pregnancy and, although they may be low tech, they are not all that bad. If we used them consistently, we could probably identify most of the women at highest risk of PPD. Simply asking a woman if she has had a history of depression (especially PPD) or if she has been depressed during her pregnancy is one of the easiest ways of identifying a woman at risk for postpartum depression.
Maybe a blood test seems easier or more scientific, but we just need to ask a few questions.
Ruta Nonacs, MD PhD
Read more in Science Daily: Blood Test Could Show Women at Risk of Postnatal Depression
Yim IS, Glynn LM, Dunkel-Schecther C, et al. Risk of Postpartum Depressive Symptoms With Elevated Corticotropin-Releasing Hormone in Human Pregnancy. Arch Gen Psychiatry. 2009;66(2):162-9.
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