Can a Blood Test Predict Postpartum Depression?
< Feb. 04, 2009 > -- Measuring hormone levels produced by the placenta during pregnancy may predict whether a woman is likely to develop postpartum depression, suggests a report published in the Archives of General Psychiatry.
Approximately 13 percent of women will experience postpartum depression, a condition that holds significant consequences for women, infants, and families, experts say. Once a woman has had postpartum depression, she is at risk for having future bouts of depression, which puts infants and children at risk for cognitive, behavioral, and social problems.
"If we know early on that a woman is at high risk to develop postpartum depression, then we can implement interventions before symptoms actually occur," says lead researcher Ilona S. Yim, PhD, an assistant professor of psychology at the University of California, Irvine.
"By means of a simple blood draw, we could correctly identify 75 percent of women who would later develop postpartum depression," Dr. Yim says.
Research Study and Results
Women who were pregnant with only one baby were recruited from two southern California medical centers. One hundred women participated in this study and visits were held in research laboratories.
Dr. Yim's group looked for a link between placental corticotropin-releasing hormone (pCRH) and postpartum depression. Researchers took blood samples from the pregnant women at various stages - 15, 19, 25, 31, and 37 weeks' gestational age (GA) - during their pregnancy and tested for levels of pCRH. This hormone is normally secreted in very small amounts by the hypothalamus, and regulates the body's response to stress.
During pregnancy, large amounts of pCRH are produced in the placenta and are associated with delivery.
The research subjects were also assessed for signs of depression during pregnancy and about eight weeks after delivery with the Edinburgh Postnatal Depression Scale.
Sixteen women developed postpartum depression and all of them had high levels of pCRH at 25 weeks into their pregnancies, the study found. The blood test, which was found to have a high degree of both specificity and sensitivity, could predict almost 75 percent of women who would develop postpartum depression, Dr. Yim's team found. Twenty-five percent of the women were misclassified using this testing method.
Dr. Yim noted that the blood test was even more predictive of postpartum depression when it was combined with assessing symptoms of depression during pregnancy. If the findings can be replicated, then testing the level of this hormone might become standard care, says Dr. Yim.
Methods to Predict Postpartum Depression
"Postpartum depression affects so many women that it would be great to have something that would help to identify being at risk early on, and perhaps develop strategies to prevent it," Dr. Yim says.
Women who know they are at risk for postpartum depression can take steps to decrease stress that might prevent the condition, Dr. Yim says. "They could take yoga classes and avoid severe stressors," she adds.
Postpartum depression generally occurs four to six weeks after delivery. Risk factors may consist of a history of depression, stressful life events, a lack of social support, low self-esteem, and depression, anxiety, or stress during pregnancy.
Postpartum depression expert Jeanelle Sheeder, a clinical sciences senior instructor of obstetrics and gynecology and pediatrics at the University of Colorado Medical Center in Denver, says she was not certain if the blood test could add more information than what can be collected from screening women for signs of depression before and during their pregnancies.
"It is encouraging to have a prenatal biologic measure that predicts postpartum depression," Sheeder says. "However, I am not sure about the practicality of using pCRH as a screening tool. It has been shown that prenatal depression is predictive of postpartum depression, and it is easier and cheaper to do that type of screening than pCRH in most clinical settings."
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Is it Baby Blues or Postpartum Depression?
It is not uncommon for women to experience the "baby blues" during the first days or weeks after delivery (most commonly seen occurring suddenly on the third or fourth day after delivery). Although each woman may experience symptoms differently, the "baby blues" are characterized by feelings of disappointment and crying with no known reason.
Symptoms of irritability, impatience, anxiety, and restlessness have also been reported. But it is common for these "baby blues" feelings to go away soon after onset and, in most cases, without treatment.
Much more serious and lasting than the "baby blues," some women experience what is clinically referred to as postpartum depression. The following are the most common symptoms of postpartum depression. However, each woman experiences these symptoms differently. Symptoms may include feelings of sadness, hopelessness, and confusion.
Some mothers have reported symptoms of fatigue or exhaustion, poor concentration, and a fear of harming the newborn or themselves. Mood swings characterized by exaggerated highs and/or lows, diminished libido (sex drive), and low self-esteem are also seen in women diagnosed with postpartum depression.
Feelings of guilt, uncontrolled crying and with no known cause, overconcern/overattentiveness for the newborn and/or a lack of interest for the newborn have been associated with postpartum depression. Appetite changes, sleep disturbances, resentment, memory loss, and feelings of isolation have also been identified as symptoms.
While the exact cause for postpartum depression is unknown, it is likely that a number of different factors, such as the following, are involved:
In addition to a complete medical history, physical examination and/or psychiatric evaluation, diagnostic procedures for postpartum depression may include a thyroid screening - to detect any hormonal or metabolic abnormalities or conditions that may serve as an underlying cause.
It is important to note that most women who experience the "baby blues," postpartum depression, postpartum anxiety, and/or postpartum obsessive-compulsive disorder have never experienced these types of symptoms before, especially with such intensity. In any case, it is important for women to seek proper treatment early - not only to ensure that the newborn remains safe and properly cared for, but also so that the mother can resolve these symptoms and experience all the joys of motherhood.
Specific treatment for postpartum depression will be determined by a physician. Treatment is based on age; overall health; medical history; severity and duration of the symptoms; whether or not a mother is breastfeeding; tolerance for specific medications, procedures, or therapies; and the mother's opinion or preference regarding types of therapies.
Treatment(s) may consists of medication (i.e., hormonal treatments and/or antidepressants); psychological treatment (may include the new mother and/or the family or spouse); peer support (i.e., support groups, educational classes); stress management and relaxation training; and assertiveness training.
Always consult your physician for more information.