Spotlight on Postpartum Depression

160201 nyt depression prematurityTwo New York Times articles last week shed light on an important but often-overlooked issue around pregnancy: depression and premature births.

Depression in both mothers and fathers during pregnancy increases the risk of “moderately premature birth,” at 32-36 weeks’ gestation, according to a Well article based on a Swedish study published in British Journal of Obstetrics and Gynecology (BJOG). This increase in risk was surprisingly high at 34%. For mothers who have recurring depression, the increase was even more pronounced: mothers with recurrent depression was 42% more likely to have a premature birth.

In another article, the Times reported that the United States Preventive Services Task Force, an influential government body, issued a recommendation that women be screened for depression during pregnancy and after birth. This was the first time the task force recommended mental health screening for (soon-to-be) mothers. The recommendation comes following “new evidence that maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children,” according to the article.

Because Dr. Gleicher, CHR’s medical director and chief scientist, has written before about the connection between depression, premature births and their potential connection to autoimmunity1,2, we asked Dr. Gleicher for some explanation.

I have been making the point that postpartum depression presents with two typical features of autoimmunity in association with pregnancy:

  1. The pattern of postpartum depression is similar to autoimmune diseases. Like autoimmune diseases, postpartum depression typically flairs and/or presents for the first time in the weeks and months after a pregnancy ends.
  2. Significantly increased risk of premature delivery is associated with all autoimmune diseases. This is also the case with postpartum depression, as the Swedish study emphasized again.

It is encouraging to see that the importance of postpartum depression is finally properly appreciated, but until we understand the underlying pathophysiology that causes these associations, there is little we can do to prevent them from occurring.

It’s really time to start investigating the likelihood that postpartum depression is an autoimmune disease. Since my two articles appeared, there has been increasing research suggesting that depression, schizophrenia and bipolar disease may have an autoimmune component. Moreover, recent discovery of a central nervous “immune system” via lymphatics that had not been known to be present before, further suggests the importance of the immune system in the human brain.

For more information about the role of immune system and autoimmunity in women’s fertility, watch this video.

1 Gleicher N. Postpartum depression, an autoimmune disease? Autoimmune Rev 2007;6:572-6.
2 Gleicher N, Weghofer A. Why depression is associated with increased risk toward premature labor. Hum Reprod 2009;24:760-1.