title: MID-PREGNANCY CORTICOTROPIN-RELEASING HORMONE LEVELS IN ASSOCIATION WITH POSTPARTUM DEPRESSIVE SYMPTOMS.
abstract: BACKGROUND
  Peripartum depression is a common cause of pregnancy- and postpartum-related morbidity. The production of corticotropin-releasing hormone (CRH) from the placenta alters the profile of hypothalamus-pituitary-adrenal axis hormones and may be associated with postpartum depression. The purpose of this study was to assess, in nondepressed pregnant women, the possible association between CRH levels in pregnancy and depressive symptoms postpartum.
  
  
  METHODS
  A questionnaire containing demographic data and the Edinburgh Postnatal Depression Scale (EPDS) was filled in gestational weeks 17 and 32, and 6 week postpartum. Blood samples were collected in week 17 for assessment of CRH. A logistic regression model was constructed, using postpartum EPDS score as the dependent variable and log-transformed CRH levels as the independent variable. Confounding factors were included in the model. Subanalyses after exclusion of study subjects with preterm birth, newborns small for gestational age (SGA), and women on corticosteroids were performed.
  
  
  RESULTS
  Five hundred thirty-five women without depressive symptoms during pregnancy were included. Logistic regression showed an association between high CRH levels in gestational week 17 and postpartum depressive symptoms, before and after controlling for several confounders (unadjusted OR = 1.11, 95% CI 1.01-1.22; adjusted OR = 1.13, 95% CI 1.02-1.26; per 0.1 unit increase in log CRH). Exclusion of women with preterm birth and newborns SGA as well as women who used inhalation corticosteroids during pregnancy did not alter the results.
  
  
  CONCLUSIONS
  This study suggests an association between high CRH levels in gestational week 17 and the development of postpartum depressive symptoms, among women without depressive symptoms during pregnancy.
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Iliadis
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Sylvén
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hellgren
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.|Department of Behavioural Neuroscience, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands.
authors.forename: Jocelien D
authors.initials: JD
authors.lastname: Olivier
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Dick
authors.initials: D
authors.lastname: Schijven
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.|Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: Erika
authors.initials: E
authors.lastname: Comasco
authors.affiliation: Department of Pediatrics, Athens University Medical School, Athens, Greece.
authors.forename: George P
authors.initials: GP
authors.lastname: Chrousos
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Sundström Poromaa
authors.affiliation: Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Alkistis
authors.initials: A
authors.lastname: Skalkidou
keywords: EPDS; HPA axis; corticotropin-releasing hormone; peripartum depression; postpartum depression; pregnancy