Research Article: Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms

Date Published: February 14, 2018

Publisher: Public Library of Science

Author(s): Raji Ramachandran Pillai, Anand Babu Wilson, Nancy R. Premkumar, Shivanand Kattimani, Haritha Sagili, Soundravally Rajendiran, Manuel Portero-Otin.


Postpartum depression (PPD) is a psychiatric complication of childbirth affecting 10–20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015). Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale). The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05). Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI) and EPDS scores in case group (r = -0.146, p = 0.047), whereas a positive correlation between the same in controls (r = 0.187, p = 0.004). Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms.

Partial Text

In women, pregnancy and postpartum period are regarded as the crucial periods of time for the occurrence of psychiatric disorders. Postpartum depression (PPD) is a psychological complication following child birth. PPD differs from ‘postpartum blues’ which is a brief period of mood disturbance that begins three to five days after childbirth and may last up to two weeks [1] and ‘postpartum psychosis’ which is a rare psychiatric episode that develops within the first two weeks after delivery and requires hospitalization [2]. PPD can persist for a short period and remit abruptly and about 50% of women with postpartum depressive symptoms continue to have major depression throughout beyond the first year post-delivery [3].Varying rate of occurrence of postpartum depressive symptoms have been reported in and across countries, which ranges from 10–42%, with higher rates in developing countries [4]. Despite its serious outcomes, PPD often remains unrecognized. If untreated and left undiagnosed, it leads to detrimental outcomes: affects the mother- child bonding, increases risk of infanticide and maternal suicide and adversely affects the child’s cognitive and behavioural development [5].

This is a cross sectional study carried out in the Department of Biochemistry, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER) hospital, Puducherry, South India during the period from September 2014 to October2015. The study was approved by the Institute Ethics Committee (Human Studies), JIPMER (Ref no. JIP/IEC/2014/5/319).

Postpartum depression is a clinical condition defined as a depressive episode beginning within four to six weeks post-delivery, nevertheless the symptoms may last for up to a year [30]. A depressed mood in addition to sleep and appetite disturbances, loss in coherence to normal activities, loss of energy, and feelings of guilt and suicide thoughts may be present which is particularly challenging in differential diagnosis [31]. Since PPD is both under diagnosed and ineffectively treated, efforts for detection of this condition are of public health importance [32].

In conclusion, our study demonstrates that low levels of serum HDL-c is associated with higher depressive symptoms in women at six week post- delivery, implicating its association in the pathophysiology of PPD. Castelli’s Risk Indices are observed to be increased in PPD women with higher EPDS score because of the decrease in HDL-c and not due to increase in TC. Additional studies based on large sample size with methodology variation, postpartum period comparison may reveal the role of serum cholesterol in severe postpartum depressive symptomology may generate biological targets for future novel therapeutic strategies.

EPDS that has been used in our study to screen for postpartum depression at six week post-delivery has moderate sensitivity and specificity. Although this scale is validated, there is possibility of misclassification of depression as this instrument only screen for the presence or absence of depressive symptoms and we accept this as the limitation of our study.




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