Lin Yafan, Che Xiangming, Li Tianzuo
Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Beijing SHIJITAN Hospital, Capital Medical University, Beijing, China.
J Matern Fetal Neonatal Med. 2025 Dec;38(1):2463402. doi: 10.1080/14767058.2025.2463402. Epub 2025 Feb 13.
Postpartum depression (PPD) is a common psychological condition affecting 10-20% of postpartum women, characterized by emotional instability, anxiety, and, in severe cases, hallucinations or suicidal ideation. Growing evidence suggests a link between oxidative stress and depression, with nitrite-a key metabolite of nitric oxide (NO)-emerging as a potential biomarker. This study explores the association between salivary nitrite levels, perinatal anxiety, and PPD, aiming to identify predictive factors for early intervention.
A prospective clinical study was conducted involving 220 naturally delivered women. Saliva samples were collected at three time points: before labor analgesia, one hour post-analgesia, and on the discharge day. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 and 42 days postpartum. Logistic regression was applied to analyze the relationship between salivary nitrite levels and PPD risk (EPDS ≥ 9). Anxiety, information needs, and fear were evaluated as additional predictors.
Of 220 participants, 194 completed the study. The incidence of PPD was 10.82% at 28 days and 15.98% at 42 days postpartum. Higher pre-analgesia salivary nitrite levels were significantly associated with increased PPD risk at 28 days (OR = 1.017, < 0.05) and 42 days (OR = 1.008, < 0.05), with a stronger effect at 28 days. Preoperative anxiety was a strong predictor at 28 days (OR = 1.76, = 0.019), while preoperative information needs were significant at 42 days (OR = 1.22, = 0.043). Salivary nitrite levels significantly decreased after labor analgesia and remained low at discharge.
This study is the first to demonstrate a significant association between salivary nitrite levels and the occurrence of postpartum depression (PPD), with this association being particularly pronounced at 28 days postpartum. Perinatal anxiety and information needs were also identified as important predictors of PPD. This research provides a new perspective for the early screening and intervention of PPD and points the way for future studies to further explore its mechanisms and predictive factors.
产后抑郁症（PPD）是一种常见的心理疾病，影响10%-20%的产后女性，其特征为情绪不稳定、焦虑，严重时会出现幻觉或自杀念头。越来越多的证据表明氧化应激与抑郁症之间存在联系，亚硝酸盐——一氧化氮（NO）的关键代谢产物——已成为一种潜在的生物标志物。本研究探讨唾液亚硝酸盐水平、围产期焦虑与产后抑郁症之间的关联，旨在确定早期干预的预测因素。
对220名自然分娩的女性进行了一项前瞻性临床研究。在三个时间点采集唾液样本：分娩镇痛前、镇痛后一小时和出院日。在产后28天和42天使用爱丁堡产后抑郁量表（EPDS）评估产后抑郁症。应用逻辑回归分析唾液亚硝酸盐水平与产后抑郁症风险（EPDS≥9）之间的关系。将焦虑、信息需求和恐惧作为额外的预测因素进行评估。
220名参与者中，194名完成了研究。产后28天产后抑郁症的发生率为10.82%，产后42天为15.98%。镇痛前唾液亚硝酸盐水平较高与产后28天（OR=1.017，<0.05）和42天（OR=1.008，<0.05）产后抑郁症风险增加显著相关，在28天时影响更强。术前焦虑在产后28天是一个强有力的预测因素（OR=1.76，=0.019），而术前信息需求在产后42天具有显著性（OR=1.22，=0.043）。分娩镇痛后唾液亚硝酸盐水平显著下降，出院时仍保持在较低水平。
本研究首次证明唾液亚硝酸盐水平与产后抑郁症（PPD）的发生之间存在显著关联，这种关联在产后28天尤为明显。围产期焦虑和信息需求也被确定为产后抑郁症的重要预测因素。本研究为产后抑郁症的早期筛查和干预提供了新的视角，并为未来进一步探索其机制和预测因素的研究指明了方向。
