Immune Alterations in Postpartum Depression and Maternity Blues




Michael Maes*,

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.