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Pregnancy and postpartum are periods of high susceptibility to major depression (MD) and other mood disorders. The peripartum period is also a time of considerable changes in the levels of hormones, including cortisol, thyroid-stimulating hormone (TSH), prolactin, gonadotropins, and gonadal steroids. To investigate the relationship between mood and hormonal changes during and after pregnancy, we reviewed published reports of hormonal measures during this time frame, searched via PubMed and Web of Science. Studies were included if women in the antepartum or postpartum periods were clinically diagnosed with MD, and if there were repeated measures of cortisol, TSH, or prolactin. For these three hormones, the numbers of human studies that met these criteria were 15, 7, and 3, respectively. Convergent findings suggest that morning cortisol is reduced in pregnant and postpartum women with MD. Evidence did not support changes in TSH as a marker of MD during the peripartum period, and evidence for changes in prolactin in peripartum MD was equivocal. Aside from reduced morning cortisol in peripartum women with MD, definitive evidence for an association between specific hormonal fluctuations and mood disorders in the peripartum period remains elusive.

The biology of peripartum depression remains unclear, with altered stress and the Hypothalamus-Pituitary-Adrenal axis response having been implicated in its pathophysiology. The current study was undertaken as a part of the BASIC project (Biology, Affect, Stress, Imaging, Cognition), a population-based longitudinal study of psychological wellbeing during pregnancy and the postpartum period in Uppsala County, Sweden, in order to assess the association between evening salivary cortisol levels and depressive symptoms in the peripartum period. Three hundred and sixty-five pregnant women from the BASIC cohort were recruited at pregnancy week 18 and instructed to complete a Swedish validated version of the Edinburgh Postnatal Depression Scale at the 36th week of pregnancy as well as the sixth week after delivery. At both times, they were also asked to provide evening salivary samples for cortisol analysis. A comprehensive review of the relevant literature is also provided. Women with postpartum EPDS score ≥ 10 had higher salivary evening cortisol at six weeks postpartum compared to healthy controls (median cortisol 1.19 vs 0.89 nmol/L). A logistic regression model showed a positive association between cortisol levels and depressive symptoms postpartum (OR = 4.1; 95% CI 1.7-9.7). This association remained significant even after controlling for history of depression, use of tobacco, partner support, breastfeeding, stressful life events, and sleep problems, as possible confounders (aOR = 4.5; 95% CI 1.5-14.1). Additionally, women with postpartum depressive symptoms had higher postpartum cortisol levels compared to both women with depressive symptoms antenatally and controls (p = 0.019 and p = 0.004, respectively). Women with depressive symptoms postpartum had higher postpartum cortisol levels, indicating an altered response of the HPA-axis in postpartum depression.

Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied. We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum. Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4-3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure. Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.

Purpose of the Review Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue. Recent Findings PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants’ cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold. Summary

Background Peripartum depression is a common but potentially debilitating pregnancy complication. Mobile applications can be used to collect data throughout the pregnancy and postpartum period to improve understanding of early risk indicators. Aim This study aimed to improve understanding of why women drop out of a peripartum depression mHealth study, and how we can improve the app design. Method Participants who dropped out of the Mom2B study ( n  = 134) answered closed and open questions on their motives for dropping out of the study, suggestions for improvement, and preferred timeframe of the study. A mix of quantitative and qualitative strategies was used to analyze the responses. Results The most common reasons for discontinuation were lack of time, problems with or loss of the pregnancy, the use of other pregnancy applications, surveys being too lengthy, the app draining too much battery, and participants incorrectly believing that their answers were irrelevant for the study. Participants suggested fewer survey moments, more reminders, and a need for more unique content compared to commercially available apps. Conclusions Researcher who want to use mHealth designs in peripartum studies need to ensure that their study designs are as time-efficient as possible, remind participants about the study, manage expectations about the study and what is expected of participants throughout the study, design their apps to be attractive in a competitive market, and follow-up with participants who are excluded from the study due to pregnancy complications.

Background To better understand previously observed racial/ethnic disparities in perinatal depression treatment rates we examined care engagement factors across and within race/ethnicity. Methods Obstetric patients and women’s health clinician experts from a large healthcare system participated in this qualitative study. We conducted focus groups with 30 pregnant or postpartum women of Asian, Black, Latina, and White race/ethnicity with positive depression screens. Nine clinician experts in perinatal depression (obstetric, mental health, and primary care providers) were interviewed. A semi-structured format elicited treatment barriers, cultural factors, and helpful strategies. Discussion transcripts were coded using a general inductive approach with themes mapped to the Capability-Opportunity-Motivation-Behavior (COM-B) theoretical framework. Results Treatment barriers included social stigma, difficulties recognizing one’s own depression, low understanding of treatment options, and lack of time for treatment. Distinct factors emerged for non-White women including culturally specific messages discouraging treatment, low social support, trauma history, and difficulty taking time off from work for treatment. Clinician factors included knowledge and skill handling perinatal depression, cultural competencies, and language barriers. Participants recommended better integration of mental health treatment with obstetric care, greater treatment convenience (e.g., telemedicine), and programmatic attention to cultural factors and social determinants of health. Conclusions Women from diverse backgrounds with perinatal depression encounter individual-level, social, and clinician-related barriers to treatment engagement, necessitating care strategies that reduce stigma, offer convenience, and attend to cultural and economic factors. Our findings suggest the importance of intervention and policy approaches effecting change at multiple levels to increase perinatal depression treatment engagement.

Peripartum depression (PPD) is a prevalent and serious mental health disorder that is often underdiagnosed and undertreated due to limited effective and safe treatment options. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive treatment for PPD, yet awareness among patients is low. This study aims to identify barriers and facilitators to accessing mental health treatment, particularly rTMS, for PPD. We conducted 36 interviews with individuals who experienced depressive symptoms during the peripartum period and health providers, followed by a descriptive interpretive thematic analysis. Key risk factors identified include personal (i.e., age), clinical (i.e., traumatic birth), situational (i.e., COVID-19, homelessness), and social (i.e., discrimination, domestic abuse). Five themes emerged regarding barriers and facilitators: 1) the need for mom-centered care, 2) systemic challenges, 3) the importance of mental health education, 4) stigma and custody concerns, and 5) challenges in accessing care. Eighty-three percent of participants were unaware of rTMS, but following a brief description, 75% were willing to receive or refer to rTMS if it was available to them. Addressing systemic and access-related concerns is crucial to ensuring patients with PPD have access to safe, effective, and accessible treatments.

Background Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. Methods Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. Results Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P  < 0.001, 2.92, P  = 0.003, 1.58, P  = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P  < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P  < 0.05) were associated with depression throughout pregnancy. Conclusions The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.

Background Traditional statistical methods have dominated research on peripartum depression (PPD), but innovative approaches may provide deeper insights. This study aims to predict the impact factors of PPD using elastic net regression (ENR) combined with machine learning (ML) model. Methods This longitudinal study was conducted from June 2020 to May 2023, involving healthy pregnant women in the first trimester, followed up until the completion of the assessment in the second trimester. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Features with p < .05 from logistic regression were selected and refined using ENR. These features were then used to build six ML models to identify the best-performing one. SHapley Additive exPlanations (SHAP) analysis was employed to enhance model interpretability by visualizing its decision-making process. Results A total of 608 participants were followed, resulting in 384 valid questionnaires. After excluding incomplete or incorrect baseline data, 325 participants were ultimately included in the study. Among these, 130 were classified as having mild depression, and 32 were classified with major depression. Nineteen features were initially identified as being associated with PPD, with 14 retained after ENR refinement. The random forest (RF) model outperformed the other ML models. SHAP analysis identified the top five predictors of PPD: magnesium (Mg), remnant cholesterol (RC), calcium (Ca), mean corpuscular hemoglobin concentration (MCHc), and potassium (K). Mg, Ca, MCHc, and K were negatively correlated with PPD, while RC showed a positive correlation. Conclusions The RF model effectively identified associations between exposure factors and PPD. Mg, Ca, MCHc, and K were found to be protective factors, while RC emerged as a potential risk factor, highlighting its potential as a novel biomarker for PPD.

This study aimed to determine how paternal and maternal parenting before adolescence affects adult attachment to a partner during the perinatal period, using three different models of attachment. We used the Parental Bonding Instrument (PBI) and the Relationship Questionnaire (RQ) to examine perceived parenting practices and adult attachment styles, respectively. The participants included 4586 Japanese women who were pregnant or who had given birth, up until one month after childbirth. We performed structural equation modeling analysis between PBI and RQ scores with three different category models, including the four-category model (secure, fearful, preoccupied, and dismissive attachment) as Model 1, the two-category model (model of the self and others) as Model 2, and the single-category model (total attachment style) as Model 3. Models 1 and 2 showed a good fit. Both path models showed a significant association between adult attachment style and perceived paternal and maternal parenting before adolescence, where high care and low overprotection from both paternal and maternal parents predicted adult attachment. Our findings indicate that attachment styles are best described using the four-category and two-category models, and suggest that both paternal and maternal overprotection and care influence adult attachment with a partner during the perinatal period.