Unit:
Τομέας Υγείας - Μητέρας - ΠαιδιούLibrary of the School of Health Sciences
Author:
Χατζηχαραλάμπους Χαράλαμπος
Dissertation committee:
Αν. Καθ. Ε. Λαμπρινουδάκη
Original Title:
Βιοχημική διερεύνηση επιπέδων των θυρεοειδικών ανοσολογικών δεικτών και ορμονών και των στεροειδών του φύλου στην εμφάνιση διαταραχών συμπεριφοράς κατά τη λοχεία
Summary:
BACKGROUND:
Postpartum mood disturbances are common among Greek women, with postpartum
depression (PPD) being as high as 19% and postpartum blues as high as 44.5%.
Hormonal levels and immunological parameters have been involved in the
pathophysiology of anxiety states and major depression. Pregnancy is associated
with a characteristic immune activation to sustain the fetus and substantial
hormonal changes. This study aimed to investigate whether thyroid function
(thyroid hormone levels and antibody titers), sex steroid hormone levels in the
serum and cytokine levels in the serum and CSF, affect the incidence of
postpartum mood disturbances.
MATERIALS AND METHODS:
Fifty-seven women were evaluated for postpartum mood disturbances using the
Postpartum Blues Questionnaire and the Edinburgh Postnatal Depression Scale.
All of them completed the Postpartum Blues Questionnaire (on admission and on
days 1-4 postpartum) and the Edinburgh Postnatal Depression Scale (at first and
sixth week postpartum).
At delivery, a blood sample and a CSF sample while puncturing for epidural /
spinal anesthesia were taken. Subsequent blood samples were taken on postpartum
days 1-4. Serum estradiol, progesterone and testosterone concentrations along
with serum Free T4, Free T3 and TSH concentrations as well as thyroglobulin and
thyroid peroxidase antibodies were measured on admission for delivery and daily
until the fourth postpartum day. TNF-a and IL-6 were quantified with an ELISA
assay.
RESULTS:
A multiple regression analysis of psychometric scores depending on cytokine
levels revealed that cytokine levels were positively associated with depressive
mood during the first four days postpartum (p=0.035 for CSF IL-6, p=0.025 for
CSF TnF-a, p=0.023 for serum TnF-a) and also at sixth week postpartum (p=0.012
for CSF IL-6, p=0.072 for CSF TnF-a). Pregnancy duration had an adverse
association to psychometric scores.
Testosterone was the only hormone that was marginally associated with
psychometric scoring in simple regression analysis. (Postpartum Blues during
days 1- 4: b = 4.291, 95% C.I. -0.796 to 9.377 and p-value = 0.096). Women with
lower testosterone drops had higher scores in Postpartum Blues Questionnaire.
This association, however, lost statistical significance in the multivariable
analysis after adjusting for pregnancy duration. In multiple regression
analysis, only pregnancy duration had the most constant adverse effect on
psychometric scores: The shorter the duration of pregnancy, the higher the
scores for Postpartum Blues. (r = -0.39, p < 0.01).
Prepartum serum FT3 and FT4 correlated negatively with blues scores in the
first week postpartum (blues on day 4: with FT3, rho=-0.44, p < or = 0.01; with
FT4 rho=- 0.36, p < or = 0.01). Women with lower FT3 and FT4 levels belonged to
the high scoring group (high scoring group: FT3=1.22 pg/ml, FT4=0.66 ng/dl; low
scoring group: FT3=1.64 pg/ml, FT4=0.73 ng/dl). Serum FT3 showed a negative
independent correlation with postpartum blues scores in the first postpartum
days. No association was found between thyroid antibody levels and mood scores.
CONCLUSIONS:
Our findings do not indicate an association between the occurrence of
postpartum mood disorders and sex steroid hormone levels. In contrast,
antenatal thyroid function within normal limits and lower levels of serum FT3
and FT4 are associated with an increased incidence of mood disturbances in the
first postpartum week.
Additionally, immune mechanisms may play a role in the etiology of postpartum
depressive mood shifts by creating a postpatum "rebound" reaction of the
maternal immune system. Preterm labour may be associated with a higher risk of
postpartum mood disturbances. A possible causative relationship should be
further investigated.
Keywords:
Postpartum depression, Thyroid gland, Cytokines, Sex steroids, Postpartum blues
Number of references:
220
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