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

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.

Pregnancy Intention and Its Relationship to Birth and Maternal Outcomes

OBJECTIVE

To examine whether there are associations between pregnancy intention (intended, unwanted, mistimed, or ambivalent) and negative birth and maternal outcomes: low birth weight (less than 2,500 g), preterm delivery (fewer than 37 weeks), small for gestational age, premature labor, hypertension, and other maternal outcomes.

METHODS

We analyzed data from the population-based Pregnancy Risk Assessment Monitoring System, including 87,087 women who gave birth between 1996 and 1999 in 18 states. Information on pregnancy outcomes was derived from birth certificate data and a self-administered questionnaire completed postpartum. We employed SUDAAN (RTI International, Research Triangle Park, NC) for univariable and logistical regression analyses.

RESULTS

In analyses controlling for demographic and behavioral factors, women with unwanted pregnancies had an increased likelihood of preterm delivery (adjusted odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33) and premature rupture of membranes (adjusted OR 1.37, 95% CI 1.01-1.85) compared with women with intended pregnancies. Women who were ambivalent toward their pregnancies had increased odds of delivering a low birth weight infant (adjusted OR 1.15, 95% CI 1.02-1.29); in contrast, women with mistimed pregnancies had a lower likelihood (adjusted OR 0.92, 95% CI 0.86-0.97).

CONCLUSION

Pregnancy intention, specifically unwanted and ambivalent, may be an indicator of increased risk for some poor birth and maternal outcomes and should be considered in interventions aimed at improving the health of the mother and child.

LEVEL OF EVIDENCE

III.