Maternal Depression and Risk for Postpartum Complications: Role of Prenatal Corticotropin-releasing Hormone and Interleukin-1 Receptor Antagonist

Abstract

The pregnancies of 58 healthy adolescents (ages 13 to 19 years) were followed to examine links between symptoms of depression, corticotropin-releasing hormone (CRH), interleukin-1 beta, (IL-1 beta), and IL-1 receptor antagonist (IL-1ra) as possible predictors of maternal and infant outcomes. Maternal psychological adjustment and medical complications during gestation, labor, delivery, and the postpartum period were monitored. Plasma samples collected during gestation were assayed for CRH, IL-1 beta, and IL-1ra. During gestation, symptoms of maternal depression were found to be associated with lower levels of CRH; lower levels of CRH were associated with lower levels of IL-1ra. In addition, lower levels of IL-1ra predicted higher rates of maternal complications after childbirth. IL-1 beta, detected in only 4 mothers, was not associated with any predictor or outcome measures. During gestation, CRH may induce circulating cytokine inhibitors without significantly affecting cytokine production or synthesis. Maternal symptoms of depression during gestation may attenuate the association between CRH and IL-1ra.

Perinatal depression—The fourth inflammatory morbidity of pregnancy?

“…All five found a significant association between mood and at least one inflammatory marker. Schmeelk et al (1999) studied 58 pregnant adolescents. Blood samples for IL-1β and IL-1ra were drawn between 9 and 21 weeks of gestation.…”

“…While we know that the greatest risk factor for postpartum depression is antenatal depression, there is nevertheless some evidence that these may be two separate disorders, as a portion of women develop postpartum depression independent of any depressive symptoms during pregnancy (Wisner et al 2013); they certainly represent different endocrine and inflammatory states. Both the Scrandis et al (2008) and Schmeelk et al (1999) studies used blood draws at multiple time points in an attempt to account for changes across time. In the Scrandis et al study, however, the IL-1β sample was usable in only 4 subjects, blood was drawn many weeks before mood was assessed, inflammatory markers were measured during pregnancy and mood after, and the authors did not attempt a direct correlation between mood and inflammatory markers.…”

Naturally acquired regulatory mechanism of perioperative cytokine response in neonates

“…Geiger et al reported that in neonates who received invasive intensive care, circulating IL-1ra levels were significantly higher than those in the reference group of healthy newborns [18]. Schmeelk et al demonstrated clinical evidence that lower levels of IL-1ra predicted higher rates of maternal complications after childbirth [20].…”

Postpartum depression: what we know

“…For example, women who are depressed during pregnancy are at increased risk for anxiety disorders, substance use disorders, tobacco and alcohol use, and poor selfcare (Zuckerman, Amaro, Bauchner, & Cabral, 1989). In addition, these women may experience preeclampsia and other health complications (Kurki, Hiilesmaa, Raitasalo, Mattila, & Ylikorkla, 2000;Schmeelk, Granger, Susman, & Chrousos, 1999). Each of these maternal conditions/behaviors puts the developing fetus at risk for suboptimal outcomes including low birth weight, preterm delivery, and reduced neuromotor activity (Hoffman & Hatch, 2000;Hedegaard, Henriksen, Sabroe, & Secher, 1993;Rini, Dunkel-Schetter, Wadhwa, & Sandman, 1999;Lundy et al, 1999).…”