Associations Between Early-Pregnancy Vitamin D Status and Postpartum Depressive and Anxiety Symptoms

Abstract

Objective: Maternal postpartum depressive and anxiety symptoms are risk factors for subsequent maternal and child mental health problems. Little is known about the potential role of antepartum vitamin D and C-reactive protein (CRP) in the etiology of maternal postpartum affective symptoms. We investigated associations between antepartum vitamin D status and postpartum depressive and anxiety symptoms and whether antepartum CRP mediated these associations.

Methods: In 2483 participants of the Amsterdam Born Children and their Development prospective cohort, maternal serum vitamin D and CRP were measured at a median of 13 weeks' gestation. Vitamin D status was defined as deficient (≤29.9 nM), insufficient (30-49.9 nM), sufficient (50-79.9 nM), or normal (≥80 nM). Maternal depressive symptoms (Center for Epidemiologic Studies-Depression) and anxiety (State-Trait Anxiety Inventory) were assessed 3 months postpartum.

Results: After adjustments for confounders, vitamin D deficiency was only associated with increased postpartum anxiety symptoms ( B = 0.17, 95% confidence interval [CI] = 0.03-0.30, p = .017) compared to normal vitamin D levels (≥80 nM). In women not taking vitamin D supplementation ( n = 2303), vitamin D deficiency was associated with increased postpartum depressive and anxiety symptoms ( B = 0.14, 95% CI = 0.03-0.28, p = .045; and B = 0.17, 95% CI = 0.03-0.32, p = .015). Antepartum CRP did not mediate these links.

Conclusions: We found some evidence that antepartum vitamin D deficiency was associated with increased postpartum affective symptoms, especially in women not taking vitamin D supplementation. Clinical trials should determine whether vitamin D supplementation can reduce the risk for postpartum affective disorders.

FIGURE 1

A, Single mediator model of the link between antepartum vitamin D status and postpartum depressive symptoms via antepartum CRP levels after adjustment for covariates/confounders. Note. The mediation model testing the association between maternal antepartum vitamin D level and postpartum depressive symptoms via maternal antepartum CRP levels was adjusted for maternal age, maternal educational level, ethnicity, employment, marital status, BMI, and parity. Antepartum CRP was not a significant mediator (β = 0.0002, 95% CI = −0.0009 to 0.0020). All other effects tested by this model were also nonsignificant. B, Single mediator model of the link between antepartum vitamin D status and postpartum anxiety via antepartum CRP levels after adjustment for covariates/confounders. Note. The mediation model testing the association between maternal antepartum vitamin D level and postpartum anxiety symptoms via maternal antepartum CRP levels was adjusted for maternal age, maternal educational level, ethnicity, employment, marital status, BMI, and parity. Antepartum CRP was not a significant mediator (β = 0.0001, 95% CI = −0.0007 to 0.0015). All other effects tested by this model were also nonsignificant. n.s. = nonsignificant. BMI = body mass index; CRP = C-reactive protein.