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Cross-tissue Mendelian randomization prioritizes RAB27B as a brain-derived candidate protein for postpartum depression.

OBJECTIVE: Postpartum depression (PPD) is one of the most common and debilitating complications of childbirth, yet the candidate proteins linking genetic risk to disease remain poorly defined. Building on recent genome-wide association studies (GWAS), we sought to integrate cross-tissue proteogenomic data to identify candidate proteins for PPD and explore therapeutic opportunities. METHODS: We conducted two-sample Mendelian randomization (MR) using genome-wide significant cis-protein QTLs from brain (n = 608 proteins), cerebrospinal fluid (CSF; n = 214), and plasma (n = 612). PPD summary statistics were obtained from FinnGen R8 (13,657 cases, 236,178 controls) and replicated in an independent GWAS. Phenome-wide association (PheWAS) was used to assess pleiotropy. Potential therapeutic targets were evaluated through DSigDB drug repurposing, molecular docking, and molecular dynamics simulations. RESULTS: Among all proteins tested, RAB27B was the only brain-derived protein surpassing Bonferroni correction (OR = 1.60; 95% CI: 1.30-1.96; P = 6.6 × 10⁻⁶), whereas no significant proteins were identified in CSF or plasma. This association was replicated in an independent GWAS (OR = 1.27; 95% CI: 1.02-1.58; P = 0.037). PheWAS identified no pleiotropic associations at genome-wide significance. In silico drug repurposing identified pregnenolone as a candidate ligand with computationally predicted stable binding to RAB27B, providing a starting point for future experimental validation. CONCLUSION: This study provides the first cross-tissue proteogenomic evidence that RAB27B is a brain-derived, reproducible candidate protein genetically associated with PPD. By extending GWAS signals to functional protein-level mechanisms and therapeutic inference, our findings nominate RAB27B and pregnenolone as promising directions for postpartum psychiatric research.

Humans

The relationship between previous elective abortions and postpartum depressive reactions.

To test the hypothesis that primiparas who have had a previous elective abortion will have a higher incidence of depressive reactions postpartum than will primiparas who have not, 48 women pregnant for the first time and 25 who had had one abortion were interviewed six to eight weeks postpartum. No significant difference in the incidence of depression between the two groups could be found. In addition, when associations between their mean depression scores and other variables such as planned pregnancy, preferred infant sex, identified obstetrical problems, help at home, experiencing the baby blues, and an identified recent sad life event were calculated, no significant differences were noted. Spontaneous comments from the previously aborted women suggested that anxiety during pregnancy concerning the infant's health was a greater source of discomfort than was postpartum depression.

Abortion, Legal

Prospective study of postpartum depression: 4 1/2-year follow-up of women and children.

The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.

Adaptation, Psychological

The comparison of postpartum with non-postpartum depression: a rose by any other name.

A strong tradition exists in the psychiatric literature to consider postpartum depression a distinct diagnosis. However, the empirical evidence indicates that, in terms of etiology and relapse rates, postpartum depression is indistinguishable from non-postpartum depression. Symptomatically, postpartum depression seems to involve a milder disturbance, suggesting that it is best seen as an adjustment disorder. This paper summarizes the empirical evidence relevant to the distinct diagnosis question, and considers the benefits to be derived from challenging the traditional view of postpartum depression.

Adjustment Disorders

The lived experience of postpartum depression: a phenomenological study.

The purpose of this phenomenological study was to describe the essential structure of the lived experience of postpartum depression. Seven mothers who had suffered from postpartum depression were interviewed regarding their subjective experiences. Data were analyzed using Colaizzi's (1978) method of phenomenology. Forty-five significant statements were extracted and clustered into 11 themes. These results were integrated into the essential structure of postpartum depression. Postpartum depression was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing.

Adult

Human skin microbiota and postpartum depression: A bidirectional Mendelian randomization study.

Postpartum depression (PPD) is a common mental health disorder after childbirth. Although microbiome research in PPD has mainly focused on the gut, the role of skin microbiota remains unclear. We used Mendelian randomization (MR) to assess potential causal associations between skin microbiota and PPD. A bidirectional 2-sample MR analysis used genome-wide association study (GWAS) summary statistics. Genetic instruments for skin microbial features were obtained from a published skin microbiota GWAS, and PPD data were derived from 67,205 mothers (7604 cases, 59,601 controls). Instruments were selected at P&#x2005;<1&#x2005;&#xd7;&#x2005;10-5, linkage disequilibrium-clumped, harmonized, and filtered for weak instruments (F statistic&#x2005;<10). Because this microbiome threshold is exploratory, Benjamini-Hochberg false discovery rate correction was applied within taxonomic levels. The inverse-variance weighted method was primary, complemented by weighted median and mode-based methods. Heterogeneity, pleiotropy, and outliers were assessed using Cochran Q, MR-Egger intercept, and MR-PRESSO. Three skin microbial taxa showed nominal associations with PPD. Higher genetically predicted Acinetobacter on the dorsal forearm (dry skin; 9 single nucleotide polymorphisms [SNPs]; mean F&#x2005;=&#x2005;22.12) and Proteobacteria in the antecubital fossa (moist skin; 6 SNPs; mean F&#x2005;=&#x2005;23.44) were associated with increased PPD risk, whereas Betaproteobacteria in the antecubital fossa (11 SNPs; mean F&#x2005;=&#x2005;21.54) was associated with decreased risk. Associations were directionally consistent, with no substantial heterogeneity or horizontal pleiotropy. After multiple-testing assessment, the findings were exploratory rather than definitive. Reverse MR did not support an effect of PPD on the identified skin microbiota. This MR study provides exploratory genetic evidence linking specific skin microbial features to PPD risk. The findings extend microbiota-related hypotheses beyond the gut microbiome but require validation in larger microbiome GWAS datasets, longitudinal cohorts, and mechanistic studies before clinical or causal conclusions are drawn.

Humans

Prediction of postpartum depression.

This article briefly reviews definitions, etiology, and cultural aspects of postpartum depression. Studies attempting to predict postpartum depression are examined, and a summary of risk factors is given. The importance of educating all pregnant women about postpartum depression is stressed, and sample patient education information is presented.

Cultural Characteristics

Maternity blues and postpartum depression.

OBJECTIVE: To investigate the relationship between maternity blues and postpartum depression in mothers discharged early from the hospital and those discharged after the customary length of hospital stay. DESIGN: A descriptive correlation design. SETTING: 550-bed community and teaching hospital in the midwestern United States. PARTICIPANTS: 49 privately paying, primiparous, American-born women, 18 years of age or older, with uncomplicated pregnancies and vaginal deliveries of healthy neonates weighing 2,600-4,000 g. MEASURES: Stein Maternity Blues Scale and Beck Depression Inventory were used to collect data. RESULTS: No significant differences found between the two groups of mothers; significant relationships found between maternity blues at 1 week after delivery and postpartum depression at 6 and 12 weeks after delivery. CONCLUSIONS: Early discharge appears to pose no threat to psychologic well-being. Primiparas experiencing more severe maternity blues are at increased risk for postpartum depression.

Adult

Exploring the dose-response relationship between prenatal exercise and postpartum depression: A systematic review and meta-analysis of randomized controlled trials.

IMPORTANCE: Postpartum depression (PPD) is a hidden and widespread global public health crisis affecting millions of mothers and infants annually. Prenatal exercise is a potentially accessible nonpharmacological strategy for PPD prevention, but its optimal dose remains uncertain. OBJECTIVE: To explore the dose-response relationship between prenatal exercise and the incidence of PPD through meta-analysis of randomized controlled trials (RCTs). DATA SOURCES: Systematic searches were conducted in PubMed, Embase, Web of Science, and Cochrane Library using MeSH terms and keywords related to "pregnant women," "prenatal exercise," and "postpartum depression," up to June 23, 2025. STUDY SELECTION: RCTs included examined prenatal exercise interventions in pregnant women without a history of depression, with PPD incidence reported using validated depression scales (such as EPDS, CES-D). Non-RCT studies, duplicate publications, and studies with insufficient data were excluded. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data according to the PRISMA guidelines. A random-effects model was used to pool odds ratios (OR) and their 95% confidence intervals (CI). Linear and nonlinear dose-response models were employed to analyze and evaluate the relationship between exercise dose (measured in METs-min/week) and the incidence of PPD. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome is the incidence of PPD, analyzing its relationship with prenatal exercise dose. RESULTS: Eight RCTs involving 2231 pregnant women were included. The pooled analysis showed that prenatal exercise was associated with a potential reduction in PPD incidence, although the overall effect did not reach statistical significance (OR=0.58, 95% CI [0.33, 1.02]). In dose-stratified analysis, exercise doses &#x2265;500 METs-min/week were associated with significantly lower PPD incidence (OR=0.44, 95% CI [0.24, 0.78]). Subgroup analyses suggested trends toward greater benefits among women aged &#x2265;30 years and those initiating exercise between 14 and 28 weeks of gestation; however, subgroup differences did not reach statistical significance. The linear dose-response trend did not reach statistical significance (p = 0.0533), and neither the overall spline association (p = 0.1704) nor the test for nonlinearity (p = 0.6361) was statistically significant. CONCLUSIONS AND RELEVANCE: Prenatal exercise may be associated with a lower risk of PPD, but the overall pooled effect did not reach statistical significance. Findings concerning &#x2265;500 METs-min/week and the apparent flattening of the dose-response curve should be considered exploratory and require confirmation in larger trials.

Humans

Unravelling the biological nexus of smoking and postpartum depression: a meta-analysis and functional genomics approach.

PURPOSE: Postpartum depression (PPD) is a prevalent psychological condition among birthing women. While several psycho-socio-economic and neurobiological factors influence its development, its relationship with smoking behavior and nicotine addiction remains largely inconclusive. METHODS: In this combinatorial study, we first evaluate the relationship between smoking and depressive behaviors in postpartum women using data extracted from pertinent primary epidemiological studies. Additionally, to discern the molecular and cellular mechanisms underlying this association, we identified common genetic elements and evaluated their functional attributes using in silico analyses. RESULTS: Meta-analytical assessment of systematically collected data from 38 studies indicated that smoking women are twice as likely to develop PPD, compared to their non-smoking counterparts. While geocultural attributes did not affect this relationship, timing of smoking was a significant moderator, with current and gestational smoking statuses being more strongly linked with PPD outcome, compared to the past smoking habit. Further, depression scores in smoking postpartum women were higher than those in non-smoking controls. Analysis of the common protein-encoding genes underlying the pathophysiology of nicotine addiction and PPD revealed several critical hub proteins (viz., AKT1, JUN, CTNNB1, PTEN, EGFR, ESR1, SRC, STAT3, FN1, IL1B, IL6, TNF, TP53, GAPDH, INS, MYC, and ALB) which were predicted to alter multiple pathophysiological pathways associated with transcriptional expression, intra- and intercellular signaling transduction, metabolism, and immune functions. CONCLUSION: Our results indicate that smoking is strongly associated with depressive behavior in postpartum women, although this association involve mediation of additional environmental and psychosocial elements. Moreover, network analysis of common genetic elements identified several potentially disrupted neurophysiological pathways in postpartum women with smoking and depressive behaviors which may aid in characterizing the underlying relationship between the two conditions.

Humans

Vitamin B6 status in women with postpartum depression.

We have assessed the vitamin B6 status of 40 nonpregnant women of reproductive age, 30 pregnant women, 20 postpartum, not depressed, women and 24 postpartum, depressed women by means of the erythrocyte glutamate-oxaloacetate transaminase activation test (alpha EGOT). The level of mental depression was evaluated in the nonpregnant controls, the postpartum controls and the postpartum, depressed patients by the Beck Depression Inventory and the Depression Adjective Check Lists. The results of the alpha EGOT did not indicate any significant differences between the postpartum, depressed patients and any of the control groups. The Beck and Depression Adjective Check Lists scores were significantly higher in the postpartum depressed patients than in the postpartum controls or nonpregnant controls. On the basis of this study, there is no evidence for vitamin B6 deficiency in women suffering from postpartum depression.

Adolescent

Prevalence and correlates of postpartum depression in first-time mothers.

The prevalence and correlates of postpartum depression were examined in a large (N = 1,033) sample of married, primiparous, middle-class mothers of full-term, healthy infants; 9.3% met modified Research Diagnostic Criteria for depression. However, 39% of the nondepressed women also reported at least 1 somatic symptom. Depressed women whose symptoms were current obtained elevated scores on the Center for Epidemiological Studies-Depression scale, as did some women who did not meet depression criteria. Depressed women different from nondepressed women on several socioeconomic status indicators and the occurrence of obstetric complications, even in this low-risk sample. These data have implications for the assessment of depression in postpartum women.

Adult

Postpartum depression in the breastfeeding mother.

This article reviews the literature discussing postpartum depression and lactation, noting that most studies are plagued by definitional problems relating to feeding group purity and lack of clarity regarding the definition of depression. The implications for nurses when they are asked to care for a breastfeeding mother with postpartum depression are identified and discussed, with special attention paid to the importance of maintaining and/or supporting the maternal role. Decision-making relating to interruption or continuation of breastfeeding as a result of psychotropic drug therapy is discussed.

Breast Feeding

Prospective investigation of postpartum depression: factors involved in onset and recovery.

We examined the role of a number of psychosocial variables in the onset of postpartum depression and in recovery from depression that occurs during pregnancy. Women (N = 730) were recruited during pregnancy and were followed through 1 month postpartum. They were assessed on demographic variables and on measures of depressive symptomatology and diagnostic status, perceived stress, marital satisfaction, perceptions of their own parents, dysfunctional cognitions, and coping style. Onset of depression in the postpartum was predicted by the levels during pregnancy of depressive symptomatology and perceived maternal and paternal care during childhood. In contrast, recovery in the postpartum from depression during pregnancy was not predicted by the variables examined in this study. These results are discussed with reference to previous investigations that have examined depression that occurs outside the context of childbirth.

Adaptation, Psychological

Postpartum depression: a nursing perspective on women's health and behaviors.

Postpartum depression is examined from different disciplinary perspectives including obstetrics, psychiatry, psychology and nursing. These perspectives are compared in relation to knowledge development, research designs and interventions for clinical practice. Nursing's contributions to understanding women's health and behaviors are highlighted in three areas: exploring women's experiences with symptoms of depression; delineating the character of women's affective changes during childbearing; and further study of another form of symptom distress conceptualized as dysphoria. Three alternative hypotheses are presented as new directions for future nursing research.

Adaptation, Psychological

Screening for the patient at risk for postpartum depression.

A simple, accurate, and practical device was designed for detecting the woman at risk for postpartum emotional disorder (PED). Women attending the Sainte-Justine prenatal clinic were requested to complete a 19-item "yes/no" type of questionnaire. Each patient was classified for presence or absence of PED according to preestablished criteria. The responses of the patients classified as having emotional disorders were compared to the "normal" group. Thirteen percent developed PED. Six items showed predictive value: 1) admission of often feeling unloved by husband; 2) admission of feeling that pregnancy is undesired; 3) past history of postpartum depression; 4) being single or separated; 5) admission of marital problems; 6) admission that pregnancy was unplanned. The presentation of these items as part of a routine patient prenatal history questionnaire would constitute a means of identifying the woman at risk to develop PED and preventive measures could be taken.

Depression

Gender roles, social support, and postpartum depressive symptomatology. The benefits of caring.

Although women are assumed to be particularly vulnerable to depressive symptomatology after childbirth, the extent to which this symptomatology predominates over that found in men at this life cycle stage has not been addressed. This study examined gender differences in postpartum depressive symptomatology and the link between postpartum symptomatology and gender roles and relationships in a sample obtained from childbirth preparation classes. The data show no gender difference in depressive symptomatology at 2 months after childbirth. Women manifested a decrease in depressive symptomatology and men showed a slight increase from the preparenthood point. We partially link women's equivalent rather than higher distress levels to the protective effects of their varied social supports. By contrast, men depended primarily on their spouses, but both genders experienced a decrease in spouse support after childbirth. Female lack of support was more strongly associated with symptomatology in homemakers compared with employed women or women on maternity leave. Within the context of gender role changes, the data highlight benefits of female bonding in contrast to the "costs of caring" depicted by other researchers.

Adult

Predicting postpartum depressive symptoms: a structural modelling analysis.

In this prospective, longitudinal study, 42 first-time mothers, recruited through prenatal classes, were assessed on variables predictive of postpartum depressive symptoms. Using a causal modelling structural analysis, it was found that prenatal depression, partners' support, and infant-related factors all contributed to the development of depression following childbirth.

Adult