Review articleThyroid peroxidase autoantibodies and perinatal depression risk: A systematic review
Introduction
Depression during the perinatal period is associated with an increased risk of adverse outcomes for both women and their children. Depression during pregnancy (i.e., antenatal depression) has been linked to elevated rates of obstetrical complications (Grote et al., 2010), as well as depression in the postpartum period (O’hara and Swain, 1996). Postnatal depression is associated with impaired mother-infant bonding (Moehler et al., 2006, O’Higgins et al., 2013) and increased levels of emotional and cognitive problems in offspring during both childhood (Beck, 1998) and adolescence (Hay et al., 2008, Korhonen et al., 2014, Murray et al., 2010, Verbeek et al., 2012).
Research suggests that the etiology of perinatal depression involves a combination of social (Beck, 2001, Lancaster et al., 2010), psychological (Bunevicius et al., 2009a, Leigh and Milgrom, 2008, O’hara and Swain, 1996, Zeng et al., 2015), and biological factors (Leung and Kaplan, 2009, Meltzer-Brody, 2011, Serati et al., 2016, Skalkidou et al., 2012). Indeed, dysregulation of various endocrine systems have been implicated in the pathophysiology of both antenatal and postnatal depression (Meltzer-Brody, 2011, Serati et al., 2016, Skalkidou et al., 2012). Multiple studies examining associations between thyroid hormones (e.g., thyroxine, thyrotropin, and triiodothyronine) and depression during the perinatal period have been suggestive of a link (Abou-Saleh et al., 1998, Ijuin et al., 1998, Lambrinoudaki et al., 2010, Pedersen et al., 2007, Pedersen et al., 2016, Saleh et al., 2012, Sylvén et al., 2013), though a consensus does not exist as to whether clinical syndromes of thyroid dysfunction (e.g., hyper- and/or hypothyroidism) are linked to depression in the perinatal period (Basraon and Costantine, 2011, Lazarus, 1997, Lucas et al., 2001, Pop et al., 1991, Walfish et al., 1992).
During pregnancy, the maternal immune system undergoes many changes to accommodate for the development of the fetus (Zenclussen, 2013) and attempts to return to its pre-pregnancy state in the postpartum period. These changes include alterations in the production of autoantibodies that target thyroid antigens such as thyroid peroxidase (TPO-AB)1 (Glinoer et al., 1994, Stagnaro-Green et al., 1992). TPO-AB, previously referred to as microsomal antibody (Portmann et al., 1985, Ruf et al., 1987), is the most common type of thyroid autoantibody found in euthyroid individuals (Hollowell et al., 2002) and is associated with various forms of thyroid dysfunction (Hollowell et al., 2002, Vanderpump et al., 1995). Though not yet fully substantiated, multiple studies have suggested that an association may exist between thyroid autoantibodies and depression in general population samples (Carta et al., 2004, Degner et al., 2015, Pop et al., 1998, van de Ven et al., 2012). However, it is not yet clear if similar associations exist for women in the perinatal period (e.g., McCoy et al., 2008, Harris et al., 1989).
Since an understanding of the links between TPO-AB and depression in the perinatal period not only has important pathophysiological implications, but may also have significant clinical utility, we set out to systematically review studies examining associations between abnormal TPO-AB titers in the perinatal period and depression during pregnancy and the puerperium.
Section snippets
Search strategies for systematic review
We searched MEDLINE, EMBASE, PsycINFO, and CINAHL from their respective inceptions through February 13th, 2016 for studies that examined associations between thyroid indices during pregnancy or the first year of postpartum and antenatal or postnatal depression. The search strategy employed for MEDLINE utilized the following terms: (exp depressive disorder/ or exp depression, postpartum/ or exp depressive disorder, major/ or exp depression/ or exp puerperal disorders/) and (exp obstetrics/ or
Results
Our initial searches yielded 1026, 1284, 38, and 54 studies in MEDLINE, EMBASE, PsycINFO, and CINAHL, respectively (Fig.1). Forty-six full text articles were examined as they were thought to contain data that could address our objective (associations between TPO-AB during pregnancy or the puerperium and antenatal or postnatal depression). Thirty-three failed to contain relevant data and thirteen articles were selected for review. However, two of the thirteen were later excluded because both
Discussion
In this systematic review of studies examining associations between abnormal titers of TPO-AB during the perinatal period and antenatal and postnatal depression, we found that three of five studies reported significant associations between TPO-AB+ and concurrent depression at 12–25 weeks of gestation (Groer and Vaughan, 2013, Kuijpens et al., 2001, Pop et al., 2006). Four of five studies also found significant associations between TPO-AB+ at 12–25 weeks of gestation and depression in the
Conclusions
In summary, the studies comprising this systematic review suggest that associations may exist between TPO-AB+ status during early to mid-gestation and perinatal depression. However, more research is required to clarify the predictive value and pathophysiological implications of these associations. Future studies that adjust for confounding variables, and that examine TPO-AB levels at different time points during pregnancy and the postpartum period, and that define it as a continuous variable
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2018, Journal of Affective DisordersCitation Excerpt :However, none of these studies focused on first-onset depression and three out of four studies did not take into account antenatal depression (Groer and Vaughan, 2013; Harris et al., 1992; Lazarus et al., 1996), while one study only briefly mentioned this in a sub analysis (Kuijpens et al., 2001). Together, as acknowledged by Dama and colleagues in their recent review, in previous studies antenatal depression may have confounded the association between a TPO-ab positive status during pregnancy and postpartum depression (Dama et al., 2016). Accordingly, the current study was designed to investigate the association between a positive TPO-ab status during early gestation and first-onset postpartum depression.