Glynn Laura M, Sandman Curt A
From the Crean College of Health and Behavioral Sciences (L.M.G.), Chapman University, Orange, California; and Department of Psychiatry and Human Behavior (L.M.G., C.A.S.), University of California, Irvine, Orange, California.
Psychosom Med. 2014 Jun;76(5):355-62. doi: 10.1097/PSY.0000000000000066.
Postpartum depression (PPD) represents a significant threat to maternal-child health. Although PPD is common, with an estimated prevalence of 10% to 15%, critical questions concerning its etiology remain unanswered. Existing studies seem to provide conflicting evidence regarding the relation between placental corticotrophin-releasing hormone (pCRH) and the development of PPD. The purpose of the present investigation was to determine whether maternal prepartum hypothalamic-pituitary-adrenal and placental dysregulation, in particular elevated midgestational pCRH, represent markers of risk for the development of PPD symptoms.
One hundred seventy adult women with singleton, term pregnancies were recruited during the first trimester and participated in study visits at 15, 19, 25, 31, and 36+ weeks' gestation and at 3 and 6 months postpartum. At each prenatal visit, blood samples were obtained and assayed to determine maternal cortisol, adrenocorticotropic hormone, and pCRH concentrations. Depressive symptoms were assessed at all visits.
Depressive symptoms at 3 months postpartum were associated with elevated midgestational pCRH (partial r = 0.26; p < .01) and also accelerated trajectories of pCRH (B values ranged from 6.9 to 8.3, p < .05). Placental CRH was not predictive of PPD symptoms at 6 months postpartum. Furthermore, prepartum cortisol and corticotrophin profiles were not associated with PPD symptoms.
The current prospective study provides results that reconcile both the positive and negative findings in the existing literature and identifies elevated pCRH as a marker of risk for the development of PPD symptoms.
产后抑郁症（PPD）对母婴健康构成重大威胁。尽管PPD很常见，估计患病率为10%至15%，但其病因的关键问题仍未得到解答。现有研究似乎就胎盘促肾上腺皮质激素释放激素（pCRH）与PPD发展之间的关系提供了相互矛盾的证据。本研究的目的是确定孕产妇产前下丘脑-垂体-肾上腺和胎盘功能失调，特别是孕中期pCRH升高，是否代表PPD症状发展的风险标志物。
招募了170名单胎足月妊娠的成年女性，她们在孕早期参与研究，并在妊娠15、19、25、31和36 +周以及产后3个月和6个月进行研究访视。每次产前访视时，采集血样并检测以确定孕产妇皮质醇、促肾上腺皮质激素和pCRH浓度。在所有访视中评估抑郁症状。
产后3个月的抑郁症状与孕中期pCRH升高有关（偏相关系数r = 0.26；p < 0.01），并且pCRH的变化轨迹也加快（B值范围为6.9至8.3，p < 0.05）。胎盘CRH不能预测产后6个月的PPD症状。此外，产前皮质醇和促肾上腺皮质激素水平与PPD症状无关。
当前的前瞻性研究结果调和了现有文献中的阳性和阴性发现，并确定pCRH升高是PPD症状发展的风险标志物。
