title: Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression.
abstract: BACKGROUND
  Elevated hypothalamic CRH has been implicated in melancholic major depression in nonpregnant individuals, but the role of placental CRH in maternal prenatal and postpartum depression is largely unexplored.
  
  
  OBJECTIVE
  The objective of the study was to examine the association of maternal midpregnancy plasma CRH levels with prenatal and postpartum depression.
  
  
  METHODS
  The study included 800 participants in Project Viva, a pregnancy and childhood cohort.
  
  
  METHODS
  CRH levels were analyzed from blood samples obtained at mean 27.9 wk gestation (+/- 1.3 sd; range 24.6-37.4 wk) and were normalized on the logarithmic scale. Depression was assessed with the Edinburgh Postpartum Depression Scale (range 0-30 points) in midpregnancy and at 6 months postpartum. We used logistic regression to estimate the odds of scoring 13 or more points on the Edinburgh Postpartum Depression Scale as indicative of major or minor depression.
  
  
  RESULTS
  Seventy (8.8%) and 46 (7.5%) women had prenatal and postpartum depression symptoms, respectively. Mean log CRH was 4.93 (+/- 0.62 sd). After adjusting for confounders, an sd increase in log CRH was associated with nearly 50% higher odds of prenatal depression symptoms (odds ratio 1.48, 95% confidence interval 1.14-1.93). Higher CRH levels during pregnancy were unassociated with greater risk of postpartum depressive symptoms. In fact, there was a suggestion that prenatal CRH levels might be inversely associated with risk of postpartum depressive symptoms (odds ratio 0.82, 95% confidence interval 0.58-1.15).
  
  
  CONCLUSIONS
  Elevated placental CRH levels in midpregnancy are positively associated with risk of prenatal depression symptoms but not postpartum depression symptoms.
authors.affiliation: Connors Center for Women's Health amnd Gender Biology, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02215, USA. jr33@partners.org
authors.forename: J W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.forename: A P
authors.initials: AP
authors.lastname: Mohllajee
authors.forename: K
authors.initials: K
authors.lastname: Kleinman
authors.forename: M R
authors.initials: MR
authors.lastname: Hacker
authors.forename: J
authors.initials: J
authors.lastname: Majzoub
authors.forename: R J
authors.initials: RJ
authors.lastname: Wright
authors.forename: M W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D000328:Adult; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D003863:Depression / Q000097:blood / Q000209:etiology*; D019052:Depression, Postpartum / Q000097:blood / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D008425:Maternal Behavior; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000209:etiology*
chemical_list: D003346:Corticotropin-Releasing Hormone