Association of gestational thyroid function and thyroid peroxidase antibody positivity with postpartum depression: a prospective cohort study and systematic literature review with meta-analysis

Abstract

Postpartum depression (PPD) has a major impact on maternal and offspring wellbeing, with multiple possible risk factors: studies on the association of thyroid peroxidase antibody (TPOAb) positivity and thyroid function with PPD provide heterogeneous results. Objective: To study the association of thyroid function and TPOAb positivity with PPD. Design: We assessed the association of TPOAb and thyroid function with PPD in a population-based prospective cohort study and performed a systematic literature review and meta-analysis. Methods: We measured TSH, FT4, and TPOAb between 9-17 weeks gestation. Postpartum depression was assessed with Edinburgh Postpartum Depression Scale at 2 months postpartum and Brief Symptom Inventory at 2, 6, and 36 months postpartum. Additionally, we performed a systematic literature review and meta-analysis assessing this association. Results: In the present study, there was no association of thyroid function with PPD (TSH OR:0.83, 95%CI 0.58-1.19, p=0.32; fT4 OR:0.99, 95%CI 0.95-1.05, p=0.86), or TPOAb positivity with PPD (OR:0.79, 95%CI 0.47-1.33, p=0.37). An impaired thyroidal response to hCG, a surrogate marker for TPOAb positivity, was associated with a lower risk of PPD (P for interaction TSH=0.04, FT4=0.06). Our systematic review and meta-analysis included three articles which were combined with the present study. There was no statistically significant association of TPOAb positivity with PPD (OR:1.93, 95%CI 0.91-4.10, p= 0.08) but results were heterogeneous (I2=79%). Conclusions: There was no significant association of TPOAb positivity, TSH or FT4 with PPD. Our systematic review and meta-analysis revealed high heterogeneity of the current literature. Although TPOAb-positive women should be monitored for postpartum thyroiditis, our findings do not support routinely screening for PPD.