Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study

Abstract

Objective: Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1) to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2) to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3) to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum. Methods: Thirty-three healthy pregnant women were recruited from the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-a), and C-reactive protein (CRP) at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression. Results: Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p 4 0.001), IL-6 (p = 0.025), and IL-10 (p = 0.006) were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS) score. Conclusions: Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.

Association of Hypertension and <i>β</i>-Blocker Use with Depression during Pregnancy

“…For example, depression increases sympathetic nervous system tone [19]. Additionally, numerous studies link inflammation to depression in non-pregnant adults [20] [21], yet pregnancy-specific studies are notably less consistent in the association between inflammatory markers and depression [22] [23]. Our findings further support the association between hypertension and depression in pregnancy, and they strengthen the need for further mechanistic studies.…”

Roles of Inflammation and Depression in the Development of Gestational Diabetes

“…Cassidy-Bushrow and colleagues 58 similarly did not find any association between CRP concentrations and depressive symptoms in a sample of 187 pregnant women who were between 13–28 weeks gestation. Of two smaller studies, one with an N of 27 59 found an increase in CRP with depressive symptoms at both 35–38 weeks gestation and at 1–5 days postpartum, though not at 5–6 weeks postpartum; while another with an N of 31 60 found no association of CRP with depressive symptoms, either at 26+ weeks gestation or at 12 weeks postpartum. Given the disparate timeframes within which these studies were conducted, it is difficult to draw any solid conclusions; however taken together they suggest that CRP elevation is not a consistent feature of perinatal depression.…”

“…Two studies reported a negative association (N=105, 16–26 weeks gestation 70 ;and N=152, significant at all six postpartum timepoints measured 69 ). Three studies reported no association (N=31, 26+ wk gestation and postpartum 60 ; N=18, 13–28 weeks gestation 58 ; N=145, 18 and 32 weeks gestation 66 ).…”

“…Several available studies did produce an association of IL-6 concentration with depressive symptoms or with negative affect, including Maes et al (N=113, postpartum) 61 , Christian et al (N=60, mean 15 weeks gestation) 62 , Cassidy-Bushrow et al (N=187, 13–28 weeks gestation) 58 , Boufidou et al (N=33, postpartum, observed in CSF but not serum) 63 , and Fransson et al (at delivery, observed only for preterm group, N=27) 64 . However the majority of studies, including most of the larger ones, found no association (Groer et al, 4–6 weeks postpartum, N=200 65 ; Blackmore et al, 18 and 32 weeks gestation 66 , N=145; Okun et al, postpartum, N=33 67 ; Skalkidou et al, at delivery, N=347 68 ; Corwin et al, 3 rd trimester and multiple postpartum timepoints, N = 152 69 ; Simpson et al, 26+ weeks gestation and 12 weeks postpartum, N=31 60 ; Shelton et al, 16–26 weeks gestation, N=105 70 ). Simpson et al (N=31) 60 found that lower IL-6 in pregnancy was predictive of postpartum but not concurrent depressive symptoms.…”

“…However the majority of studies, including most of the larger ones, found no association (Groer et al, 4–6 weeks postpartum, N=200 65 ; Blackmore et al, 18 and 32 weeks gestation 66 , N=145; Okun et al, postpartum, N=33 67 ; Skalkidou et al, at delivery, N=347 68 ; Corwin et al, 3 rd trimester and multiple postpartum timepoints, N = 152 69 ; Simpson et al, 26+ weeks gestation and 12 weeks postpartum, N=31 60 ; Shelton et al, 16–26 weeks gestation, N=105 70 ). Simpson et al (N=31) 60 found that lower IL-6 in pregnancy was predictive of postpartum but not concurrent depressive symptoms. Taken together, these studies do not suggest any consistent association of IL-6 concentration with depressive symptoms, either during pregnancy or the postpartum period.…”