Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands.
Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands.
J Affect Disord. 2018 Jan 1;225:399-403. doi: 10.1016/j.jad.2017.08.058. Epub 2017 Aug 23.
During the postpartum period, women are at risk for the new onset of both auto-immune thyroid disorders and depression. The presence of thyroid peroxidase antibodies (TPO-ab) during early gestation is predictive for postpartum auto-immune thyroid dysfunction. The aim of this study was to investigate the association between TPO-ab status during early gestation and first-onset postpartum depression.
Prospective cohort study (n = 1075) with follow-up during pregnancy up to one year postpartum. Thyroid function and TPO-ab status were measured during early gestation. Depressive symptomatology was assessed during each trimester and at four time points postpartum with the Edinburgh Depression Scale (EDS). Women with antenatal depression were not eligible for inclusion. Self-reported postpartum depression was defined with an EDS cut-off of ≥ 13.
The cumulative incidence of self-reported first-onset depression in the first postpartum year was 6.3%. A positive TPO-ab status was associated with an increased risk for self-reported first-onset depression at four months postpartum (adjusted OR 3.8; 95% CI 1.3-11.6), but not at other postpartum time points. Prevalence rates of self-reported postpartum depression declined after four months postpartum in the TPO-ab positive group, but remained constant in the TPO-ab negative group.
Depression was defined with a self-rating questionnaire (EDS).
Women with an increased TPO-ab titer during early gestation are at increased risk for self-reported first-onset depression. The longitudinal pattern of self-reported postpartum depression in the TPO-ab positive group was similar to the typical course of postpartum TPO-ab titers changes. This suggests overlap in the etiology of first-onset postpartum depression and auto-immune thyroid dysfunction. Thyroid function should be evaluated in women with first-onset postpartum depression.
在产后期间，女性有新发病的自身免疫性甲状腺疾病和抑郁症的风险。在早期妊娠期间存在甲状腺过氧化物酶抗体（TPO-ab）可预测产后自身免疫性甲状腺功能障碍。本研究的目的是研究早期妊娠期间 TPO-ab 状态与首次产后抑郁症之间的关联。
前瞻性队列研究（n = 1075），在妊娠期间进行随访，直至产后一年。在早期妊娠期间测量甲状腺功能和 TPO-ab 状态。在每个孕早期和产后四个时间点使用爱丁堡抑郁量表（EDS）评估抑郁症状。患有产前抑郁症的妇女不符合入选条件。自我报告的产后抑郁症定义为 EDS 截距≥13。
在产后第一年，自我报告的首次发病抑郁症的累积发病率为 6.3％。TPO-ab 阳性状态与产后四个月时自我报告的首次发病抑郁症的风险增加相关（调整后的 OR 3.8；95％CI 1.3-11.6），但与其他产后时间点无关。TPO-ab 阳性组产后四个月后自我报告的产后抑郁症的患病率下降，但 TPO-ab 阴性组保持不变。
抑郁症是通过自我评定问卷（EDS）定义的。
在早期妊娠期间 TPO-ab 滴度增加的女性发生自我报告的首次发病抑郁症的风险增加。TPO-ab 阳性组自我报告的产后抑郁症的纵向模式与产后 TPO-ab 滴度变化的典型过程相似。这表明首次发病产后抑郁症和自身免疫性甲状腺功能障碍的病因重叠。应评估首次发病产后抑郁症的女性的甲状腺功能。
