Does premenstrual syndrome before pregnancy increase the risk of postpartum depression? Findings from the Australian Longitudinal Study on Women's Health

Abstract

BackgroundPrevious literature suggests a positive association between history of premenstrual syndrome (PMS) and development of postpartum depression (PPD); however, limited evidence has come from prospective population-based studies and whether history of depression affects this association is unknown. MethodsThis study included 5479 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health and estimated the association between pre-pregnancy PMS and PPD. Participants were followed from 22-27 years in 2000 to 37-42 years in 2015. PMS was collected from a 4category Likert-scale reporting on frequency of PMS in the last 12 months (never, rarely, sometimes, or often) at the survey preceding an index birth. PPD was ascertained from reports of doctor diagnoses for each birth. Relative risks (RRs) and 95% confidence intervals (CIs) were used to estimate the association of interest. The role of history of depression was assessed by testing its interaction with pre-pregnancy PMS. ResultsDuring 15 years' follow-up, 15.4% of participating women reported PPD; and 55.1% reported PMS (rarely: 17.2%, sometimes: 25.7%, and often: 12.2%). Compared to women who had no PMS

Relationship of premenstrual syndrome with postpartum depression and mother–infant bonding

“…showing that there is a positive and significant relationship between PMS and postpartum depression. 6,28,29 Çoban et al 30 determined that the presence of PMS is among the factors affecting the development of postpartum depression. Maliszewska et al 31 found that a history of PMS was associated with a greater chance of depressive symptoms in the postpartum second month.…”

“…Because estrogen and progesterone regulate biological systems, neural networks, and behaviors associated with mood, changes in the levels of the two hormones can trigger depressive symptoms. Since the sudden drop in hormonal levels occurs in the luteal phase as well as after birth, women sensitive to hormonal fluctuations may have both PMS and postpartum depression 6 . Studies have reported that there is a strong relationship between the menstrual cycle and mood disorders that occur in the postpartum period.…”

“…Since the sudden drop in hormonal levels occurs in the luteal phase as well as after birth, women sensitive to hormonal fluctuations may have both PMS and postpartum depression. 6 Studies have reported that there is a strong relationship between the menstrual cycle and mood disorders that occur in the postpartum period. Sylvén et al 7 in a study of 2318 women identified a positive correlation between PMS and premenstrual dysphoric disorder with postpartum depression.…”

Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome

“…Therefore, further research is needed to determine whether isoallopregnanolone, which antagonizes the effect of allopregnanolone on the GABA-A receptor, has the potential to become a treatment for PMDD 64 , 65 . The US Food and Drug Administration recently approved allopregnanolone itself (brexanolone) for the treatment of postpartum depression (PPD) 68 , 69 , a disorder extensively associated with PMS/PMDD 70 , 71 in the context of reproductive depression 72 . Exposure to high allopregnanolone levels during pregnancy has a protective and mood-stabilizing effect, while in susceptible women, the sudden decrease in allopregnanolone following placental detachment at birth alters the GABAergic signaling 73 – 76 .…”

“…In recent years, increasing research further investigated the comorbidities of severe PMS/PMDD, and a strong association with psychiatric disorders was confirmed 12 , 137 . Women with severe PMS/PMDD are at higher risk to develop PPD 70 and suicide experiences 138 – 140 and manifest increased incidences of generalized anxiety disorder 141 , bipolar disorder 142 , eating disorders 143 , addictive behaviors such as nicotine or alcohol use 144 , and poor sleep quality 145 . Exposure to traumatic events, childhood physical and emotional abuse, and post-traumatic stress disorder also correlate with PMS/PMDD 146 – 148 .…”