Researchers at Weill Cornell Medicine and the University of Virginia have discovered blood biomarkers that could predict a woman’s risk of postpartum depression. Their findings offer hope for earlier interventions and highlight the crucial role neuroactive steroids play in mental health post-childbirth.
In a new study, researchers at Weill Cornell Medicine and the University of Virginia have identified potential blood biomarkers that may predict a woman’s risk of developing postpartum depression (PPD). Published in the journal Neuropsychopharmacology, this development could revolutionize how doctors identify and treat PPD, potentially safeguarding mental health for millions of new mothers.
“Postpartum is the only time in people’s lifespans when we know there is a biological trigger which guarantees that a certain percentage of people will become ill,” co-lead author Lauren Osborne, an associate professor of obstetrics and gynecology and of psychiatry at Weill Cornell Medicine, said in a news release. “If we can untangle this biology and find predictors for it, not only will we be helping women, but it may give us a step up in trying to find predictors for other psychiatric illnesses also.”
Postpartum depression severely impacts 10-15% of new mothers, manifesting symptoms such as difficulty bonding with the baby, feelings of hopelessness, fatigue, loss of appetite and disrupted sleep.
Current treatments, including brexanolone and zuranolone, are administered after diagnosis, often when symptoms have already significantly affected the individual’s life.
The study revealed that characteristic levels of neuroactive steroids — molecules derived from the hormone progesterone — in a woman’s blood during the third trimester could serve as a predictive marker for PPD. These neuroactive steroids, like pregnanolone and isoallopregnanolone, play crucial roles in the brain’s stress response and emotional regulation.
“Studying postpartum depression gives us a way to identify biological changes that occur before someone becomes depressed because the timing of postpartum depression is predictable,” added co-lead author Jennifer Payne, a professor and vice chair of research in psychiatry and neurobehavioral sciences at the University of Virginia.
Neuroactive Steroid Levels: The Indicators
During the study, 136 women in their second and third trimesters were examined, none of whom showed symptoms of depression during pregnancy.
Following them up to nine months postpartum, the researchers found that 33 participants developed PPD. They noticed that those who developed PPD exhibited a lower pregnanolone/progesterone ratio and a higher isoallopregnanolone/pregnanolone ratio during the third trimester compared to unaffected participants.
Higher progesterone levels in late pregnancy were also indicative of increased PPD risk, hinting at a disruption in the hormone’s metabolic pathway.
“Many papers have compared averages of neuroactive steroid levels with averages of mood across time, which just tells us there is some biological correlation but doesn’t help us clinically,” added Osborne.
These metabolic imbalances, influenced by the enzymes 3α-HSD and 3β-HSD that convert progesterone into its metabolites, could offer a predictive criterion for PPD. Women with these hormonal discrepancies were four times more likely to develop PPD.
Looking Ahead: Preventive Treatments and Further Research
Osborne noted the potential for these findings to convert into a clinical blood test that predicts the likelihood of PPD. The promising results open avenues for preventive treatments for pregnant women displaying high-risk neuroactive steroid profiles.
“We don’t know if these drugs would work as a preventive measure for people who are at risk of developing postpartum depression, but based on our findings, they have the potential to prevent the development of postpartum depression,” Osborne added, referring to brexanolone and zuranolone.
Future research will focus on replicating the findings in a larger, more diverse group of patients. Furthermore, Osborne, Payne and their teams aim to explore the progesterone metabolic pathway in greater detail by directly measuring enzyme levels that could alter progesterone metabolism.