NEW YORK (Reuters Health) – Polycystic ovary syndrome (PCOS) is associated with postpartum depression, and prenatal depressed mood and anxiety mediate the association, highlighting the need for prenatal psychological screening in this population, researchers say.
“Clinicians should be aware that PCOS is associated with a near two-fold increased risk of postpartum depression, and that intervening before or during early pregnancy is important for reducing the risk,” Dr. Karen Schliep of the University of Utah School of Medicine in Salt Lake City told Reuters Health by email.
“Up to 20% of women may not have a clinical diagnosis of PCOS but still be exhibiting two or more PCOS symptoms,” she noted. “Clinicians may benefit from screening preconception and pregnant women for PCOS based on symptoms in addition to reported physician diagnosis.”
Further, she said, “after accounting for preconception depression, at least 20% of postpartum depression could be resolved by treating depressive symptoms that occur during pregnancy. Our findings highlight the importance of assessing for PCOS symptoms in addition to clinical diagnosis in nationally representative population-based surveys, such as PRAMS.”
As reported in the American Journal of Obstetrics and Gynecology, Dr. Schliep and colleagues analyzed 3,906 postpartum women (mean age, about 29) two-to-six months postpartum who completed the Utah Pregnancy Risk Assessment Monitoring System Phase 8 questionnaire (2016-2018).
Weighted adjusted prevalence ratios (aPR) were used to assess the association between PCOS and postpartum depression, considering potential confounders and assessing mediating effects of depression and anxiety during pregnancy.
Among the participants, 8.2% reported clinical PCOS: 19.1% experienced irregular periods and acne; 6.2%, irregular periods and hirsutism; and 4.4%, all three symptoms.
Further, 17.7% experienced prenatal depression; 23.5%, prenatal anxiety; 9.5%, postpartum depressed moods; and 10.2%, postpartum anhedonia.
Clinical PCOS was associated with a 1.76 higher aPR for postpartum depressed mood or anhedonia after adjusting for age, pre-pregnancy BMI, race/ethnicity, education, and marital status.
Similar higher prevalences were seen for irregular periods and acne (aPR 1.65); irregular periods and hirsutism (aPR, 1.40); and all three symptoms (aPR, 1.75), as well as postpartum depressed mood or anhedonia.
A mediation analysis showed that prenatal depression and anxiety mediated 20% and of the effect of clinical PCOS on postpartum depressed and 32% of the effect on mood and anhedonia.
Dr. Schliep said, “What the best interventions are for treating maternal depression, especially among women with a prior PCOS diagnosis, was not addressed in our study and warrants further research.”
Dr. Carolyn Cokes, an obstetrician-gynecologist with the Metropolitan OB-GYN group, a Baltimore- based practice affiliated with Mercy Medical Center, commented in an email to Reuters Health, “This study speaks to the larger issue of prenatal psychological screening in general; it is important because regardless of whether a pregnant person has PCOS or not, if they have depression or anxiety, they are at increased risk of postpartum depression.”
“It’s important both during and after pregnancy for providers to be aware of these conditions so the patient has access to a full range of safe mental healthcare options, including medications, cognitive behavioral therapy, and socio-economic support,” she said. Prenatal management “doesn’t necessarily change, whether they have PCOS or not, but screening just becomes that much more important.”
SOURCE: https://bit.ly/2LWSgAK American Journal of Obstetrics and Gynecology, online January 4, 2021.