Trajectories and dimensional phenotypes of depressive symptoms throughout pregnancy and postpartum in relation to prior premenstrual symptoms

Abstract

Background: Sensitivity to ovarian hormone fluctuations can lead to mental distress during the luteal phase of the menstrual cycle, such as in premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), and also during pregnancy and postpartum, as in perinatal depression (PND).

Aims: In two cohorts, we investigated the relationship between history of PMS/PMDD and PND symptoms. We also examined how premenstrual symptoms are associated with perinatal symptom trajectories and dimensional phenotypes of PND symptoms, which remains unidentified.

Method: From early pregnancy until 6 months postpartum, participants of two large longitudinal cohorts were followed using the Edinburgh Postnatal Depression Scale (EPDS). Premenstrual symptoms were self-reported retrospectively.

Results: Both pre-pregnancy PMS and PMDD were associated with higher EPDS scores across pregnancy and postpartum, even after adjustment for confounders. The odds of developing PND were higher among those reporting PMS and PMDD, ranging up to 1.68 (95% CI 1.25-2.29) (6-13 weeks postpartum) and 3.05 (95% CI 2.26-4.10) (late pregnancy) respectively for PMS and PMDD, throughout the perinatal period. Premenstrual symptomatology was associated more with certain PND trajectories based on the time of occurrence and persistence of symptoms. However, PND symptom severity did not differ depending on premenstrual symptomatology in any trajectory. Prior PMS/PMDD was associated with underlying dimensions of symptom constructs of PND, including severe and moderate symptoms of depressed mood, anxiety and anhedonia.

Conclusions: Women with a history of PMS/PMDD require coordinated care by psychiatrists, other mental health clinicians, midwives and gynaecologists during pregnancy as well as postpartum.

Keywords: Reproductive psychiatry; ovarian hormones; perinatal depression; premenstrual disorder; women.

Fig. 1

Study design and perinatal depression (PND) symptom severity in relation to premenstrual symptomatology over time. (a) The study design of the BASIC and Mom2B studies showing the time points for completion of the Edinburgh Postnatal Depression Scale (EPDS); (b1) and (c1) group differences on continuous EPDS scores at all time points during pregnancy and postpartum between those with no premenstrual syndrome (No PMS), with premenstrual syndrome (PMS) and with premenstrual dysphoric disorder (PMDD) (BASIC)/severe PMS (Mom2B) for the BASIC and Mom2B cohorts respectively; (b2) and (c2) mean EPDS scores over all time points during pregnancy and postpartum by group: no PMS, PMS and PMDD (BASIC)/severe PMS (Mom2B) for the BASIC and Mom2B cohorts respectively. Shaded areas indicate 95% confidence intervals. Statistical significance was set at P < 0.05. ****P ≤ 0.0001.

Fig. 2

Dimensional phenotypes of perinatal depression (PND) symptoms and their association with premenstrual symptomatology over time. (a1) and (b1) 3D visualisation of the dimensional phenotypes of PND symptoms and severity for the BASIC and Mom2B cohorts respectively; (a2) and (b2) the proportions of the dimensional phenotypes of PND symptoms over time grouped by no premenstrual syndrome (No PMS), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (BASIC)/severe PMS (Mom2B) for the BASIC and Mom2B cohorts respectively.

Fig. 3

Proportions of perinatal depression (PND) severity over time in relation to premenstrual symptomatology. The distribution of PND severity categories during pregnancy and postpartum in (a) the BASIC cohort and (b) the Mom2B cohort. The plots are grouped by no premenstrual syndrome (No PMS), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (BASIC)/severe PMS (Mom2B) for the BASIC and Mom2B cohorts respectively. PND severity was defined in terms of total score on the Edinburgh Postnatal Depression Scale: none (no PND), 0–9; mild to moderate, 10–15; moderate to severe, 16–21; and very severe, 22–30.

Fig. 4

Symptom severity by perinatal depression (PND) trajectory in relation to premenstrual symptomatology. Mean Edinburgh Postnatal Depression Scale (EPDS) score plots of PND trajectories based on onset and persistence of symptoms. The trajectories are: gestational PND (EPDS ≥ 12 sometime during pregnancy); postpartum PND (EPDS ≥ 12 sometime postpartum); and persistent PND (EPDS ≥ 12 during both pregnancy and postpartum); trajectories are grouped on no premenstrual syndrome (No PMS), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (BASIC)/severe PMS (Mom2B) for the BASIC (a1)–(a3) and Mom2B cohorts (b1)–(b3) respectively. The data points indicate mean values and the lines 95% confidence intervals. *P < 0.05.