Perinatal depression—The fourth inflammatory morbidity of pregnancy?

Abstract

Perinatal depression is one of the leading causes of maternal morbidity and mortality. The biological etiology of this disorder remains in question, despite considerable research into the contributions of hormonal imbalance, the role of monoamines, and dysregulation of the HPA axis. Because inflammation is known to be associated with major depression in men and non-perinatal women as well as with other important morbidities of pregnancy (such as preeclampsia, preterm birth, and gestational diabetes), and because these morbidities may correlate with perinatal depression, inflammation may be a common physiological pathway that can also help explain perinatal depression. In this paper, we review the theoretical background of inflammation in perinatal depression and then review the literature concerning immune and inflammatory factors in the etiology and course of perinatal depression. We close with recommendations for future studies in this still relatively unexplored area. Identification and understanding of a common pathophysiology between other pregnancy morbidities and perinatal depression would link physical and mental well-being, likely leading to better treatment and prevention.

Fear of childbirth predicts postpartum depression: a population-based analysis of 511 422 singleton births in Finland

“…Furthermore, women with a history of depression and gestational diabetes experienced postpartum depression more frequently compared with women without depression, which was in line with several previous studies 10 11 18. This observation suggests that the proinflammatory state related to gestational diabetes may facilitate the development of postpartum depression 19. Correspondingly, pregnancies of women without a history of depression but with subsequent postpartum depression more frequently resulted in adverse perinatal outcomes, such as major congenital anomaly, preterm or caesarean birth, compared with women with no history of depression and no postpartum depression.…”

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

“…The perinatal period involves a unique hormonal and immunological milieu, and perinatal depressive symptoms often co-occur with inflammatory morbidities of pregnancy, including preeclampsia, gestational diabetes, and preterm birth. 5 To date, many studies have examined this phenomenon by assessing differences in the levels cytokines and other inflammatory biomarkers during the perinatal period.…”

Tryptophan pathway alterations in the postpartum period and in acute postpartum psychosis and depression

“…Moreover, we investigated the association of tryptophan metabolism with postpartum psychosis and postpartum depression compared to healthy postpartum women. We hypothesized that the physiological enhancement of the tryptophan breakdown pathway is aggravated in patients with postpartum psychosis and severe depression, considering their previously demonstrated inflammatory character (Bergink et al, 2013;Gleicher, 2007;Osborne and Monk, 2013). 6 C. Veen et al…”