Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression

Abstract

Context: Elevated hypothalamic CRH has been implicated in melancholic major depression in nonpregnant individuals, but the role of placental CRH in maternal prenatal and postpartum depression is largely unexplored.

Objective: The objective of the study was to examine the association of maternal midpregnancy plasma CRH levels with prenatal and postpartum depression.

Participants: The study included 800 participants in Project Viva, a pregnancy and childhood cohort.

Methods: CRH levels were analyzed from blood samples obtained at mean 27.9 wk gestation (+/- 1.3 sd; range 24.6-37.4 wk) and were normalized on the logarithmic scale. Depression was assessed with the Edinburgh Postpartum Depression Scale (range 0-30 points) in midpregnancy and at 6 months postpartum. We used logistic regression to estimate the odds of scoring 13 or more points on the Edinburgh Postpartum Depression Scale as indicative of major or minor depression.

Results: Seventy (8.8%) and 46 (7.5%) women had prenatal and postpartum depression symptoms, respectively. Mean log CRH was 4.93 (+/- 0.62 sd). After adjusting for confounders, an sd increase in log CRH was associated with nearly 50% higher odds of prenatal depression symptoms (odds ratio 1.48, 95% confidence interval 1.14-1.93). Higher CRH levels during pregnancy were unassociated with greater risk of postpartum depressive symptoms. In fact, there was a suggestion that prenatal CRH levels might be inversely associated with risk of postpartum depressive symptoms (odds ratio 0.82, 95% confidence interval 0.58-1.15).

Conclusions: Elevated placental CRH levels in midpregnancy are positively associated with risk of prenatal depression symptoms but not postpartum depression symptoms.

Figure 1

Adjusted odds ratios and 95% confidence intervals for risk of prenatal and postpartum depression symptoms per sd increase in midpregnancy log CRH, Project Viva, adjusted for gestational length in weeks at blood draw, maternal age, maternal race/ethnicity, household income, parity, marital status, and (for postpartum depression symptoms) preterm delivery.