IMMUNE PATHOPHYSIOLOGY OF POSTPARTUM DEPRESSION AND MATERNITY
Willem Ombelet, Eugene Bosmans, Simon Scharpe, Aihua Lin
The pathophysiology of maternity
blues, a very common disorder in the early puerperium with
anxiety and depressive symptoms, and postpartum depression, has
remained elusive. It has been shown that nonpostpartum depression
and anxiety disorders are characterized by signs of activation of
the inflammatory response system (IRS).
In order to examine the IRS in
relation to postpartum depression and maternity blues we have
assayed the serum concentrations of interleukin-6 (IL-6), IL-6
receptor (IL-6R), gp 130 (the IL-6 signaling protein), IL-1R
antagonist (IL-IRA), leukemia inhibitory factor receptor (LIFR)
and CC16 (Clara Cell Protein) in 22 nonpregnant females and in 91
pregnant females, three to five days before delivery and one and
three days after delivery. Females completed the state version of
the State-Trait-Anxiety-Inventory (STAI) and the Zung Depression
Rating Scale (ZDS).
Serum CC16 was significantly
lower in pregnant females. Serum IL-6, IL-1RA and LIFR were
significantly higher in pregnant women at the end of term than in
nonpregnant women. Serum IL-6, IL-6R and IL-1RA were
significantly higher and LIFR significantly lower in the early
puerperium than before delivery.
Parturients who developed a
postpartum major depression had significantly lower serum CC16
concentrations at the end of term and in the early puerperium
than women who did not. There were no significant relationships
between any of the other IRS variables and postpartum depression.
Puerperae with increased STAI
scores in the early puerperium had significantly higher serum
IL-6 and IL-1RA and lower LIFR than those without. Puerperae with
increased ZDS scores in the early puerperium had significantly
higher serum IL-6 and IL-6R concentrations than those without.
The results suggests that 1) normal pregnancy is accompanied by
indications of immunosuppression (increased LIFR) immune
activation (increased serum IL-6), and a decreased
anti-inflammatory capacity in the serum (decreased serum CC16);
2) the early puerperium is characterized by indications of IRS
activation as compared with the prepartum (increased serum IL-6
and the IL-6R and lowered LIFR); 3) lower serum CC16 appears to
be related to the development of postpartum depression; and 4)
postpartum anxious and depressive blues are characterized by IRS
activation and by a lowered anti-inflammatory activity in the
serum. It is concluded that IRS activation may play a role in the
etiopathology of postpartum disorders.