Thyroid peroxidase antibodies during early gestation and the subsequent risk of first-onset postpartum depression: A prospective cohort study

Abstract

Women with an increased TPO-ab titer during early gestation are at increased risk for self-reported first-onset depression. The longitudinal pattern of self-reported postpartum depression in the TPO-ab positive group was similar to the typical course of postpartum TPO-ab titers changes. This suggests overlap in the etiology of first-onset postpartum depression and auto-immune thyroid dysfunction. Thyroid function should be evaluated in women with first-onset postpartum depression.

Postpartum Depression and Subsequent Autoimmune Diseases in Taiwan

“…For example, in a Danish nationwide population-based cohort study, women with first-onset postpartum psychiatric disorders had a higher risk of autoimmune thyroid diseases than women without psychiatric disorders (incidence rate ratio = 2.16, 95% CI: 1.45–3.20) [35]. Although the underlying etiologies connecting PPD and Graves’ diseases have not been completely elucidated, evaluations of thyroid function in women with first-onset PPD are suggested [38]. The value of individualized management of PPD and comorbid thyroid disease in postpartum women is also reinforced by the results of this study [39].…”

Postpartum psychiatric disorders

“…This effect is hypothesized to be due to the biological differences between first and subsequent pregnancies, and has raised the possibility of an aetiological link with other medical conditions that have a similar increase in prevalence in first pregnancies such as pre-eclampsia 120 . Intriguingly, preeclampsia and postpartum psychosis are both associated with immune dysregulation, for example the increased rates of postpartum autoimmune thyroiditis 108,109 and alterations in immune biomarkers (such as, CNS autoantibodies) in women with postpartum psychosis 121 . In addition, abnormalities in monocyte and T cell function and tryptophan breakdown has been demonstrated in patients with postpartum psychosis or mania, compared with postpartum women without any psychiatric symptoms.…”

Postpartum Psychiatric Disorders

“…In addition, first-onset postpartum autoimmune thyroid disorders often cooccur with postpartum mood disorders 108 . The occurrence of both disorders coincides with the postpartum rebound phenomena of the maternal immune system, suggesting an overlap in aetiology 109 . Supporting this hypothesis, women with increased thyroid peroxidase antibodies during pregnancy have an increased risk for postpartum psychiatric episodes 109,110 .…”

“…The occurrence of both disorders coincides with the postpartum rebound phenomena of the maternal immune system, suggesting an overlap in aetiology 109 . Supporting this hypothesis, women with increased thyroid peroxidase antibodies during pregnancy have an increased risk for postpartum psychiatric episodes 109,110 . Accordingly, the assessment of thyroid function (such as measurement of thyroid-stimulating hormone levels, tri-iodothyronine (T3) and tetraiodothyronine (T4)) is an essential part of diagnostic evaluations in women with postpartum psychiatric episodes.…”