Are women with PCOS at greater risk of postnatal depresion (PND); and to what extent is PND mediated by pregnancy complications?

Dr Melissa Whitrow, Research Fellow, The University of Adelaide

Dr Whitrow’s project was selected as a recipient of the Centre for Research Excellence in PCOS Project Grant awarded recently by the Training Committee.

Dr Melissa Whitrow

Overview

Depression in the postpartum period (PND) is a debilitating conditions that affects up to 16.0% of mothers in Australia (PMHC 2008). Women with PCOS may be at increased risk of PND, for a range of reasons. Evidence from the literature suggests women with PCOS present with multiple risk factors for PND, as they are more likely to have 1) a history of depression prior to the pregnancy; 2) a stressful time trying to fall pregnant (including the need for infertility treatments); and 3) may be at higher risk of serious perinatal complications than women without PCOS.

There is scant evidence examining the risk of PND among women with PCOS, despite this condition affecting up to 20% of the female population (March et. al. 2010; Conway et al. 2014). A literature search in MEDLINE using the terms PCOS and PND (with associated terminology) retrieved 25 articles. None of these articles examined PND in women with PCOS or included this topic in any part of a study.

Methods

Study design

Cross-sectional study of 416 women who had a live birth, derived from a cohort established retrospectively at around age 30, in Adelaide, South Australia.

Participants/materials, setting, methods

Data will be derived from a questionnaire in which women reported PCOS and pregnancy details. A comparison of the frequency of PND will be made between 47 women with PCOS, diagnosed using the Rotterdam criteria, and 369 women without this diagnosis. Potential mediating factors will be considered, including, a prior depression diagnosis, difficulties becoming pregnant (e.g. prior miscarriages, ectopic pregnancies), seeking assistance to becoming pregnant (e.g. IVF), and complications during pregnancy (e.g. high blood pressure, pre-eclampsia).

Analysis

A description of the PCOS and non-PCOS population will be made, and compared using parametric or non-parametric tests, as appropriate. Logistic regression will be used to assess the association (if any) between PCOS (exposure variable) and PND (dependent variable). Mediating variables will be added to the models to determine the extent to which this affects any association between PCOS and PND. The following confounding variables will be considered in the models: obesity, age and life stressors/social support (an index of socio-economic status will be used as a proxy).

The specific aims of this proposal are:

  1. Compare the frequency of PND between women with and without PCOS, to determine if women with PCOS should to be targeted for psychological support in the postnatal period.
  2. To explore the extent to which the following factors contribute to PND (if at all) among women with PCOS:
    • maternal history of depression
    • difficulties becoming pregnancy (e.g. history of infertility)
    • use of infertility treatment
    • a history of pregnancy complications.
  3. To use this information to improve awareness of the emotional difficulties women with PCOS may face when seeking to become pregnant.

Significance

If left untreated PND has a significant impact on the health and welling of the woman and her family. It can affect her ability to function at work and home, and particularly care for her child, impacting the child’s health and development. Furthermore, a psychiatric illness in the perinatal period has been identified as the leading cause of maternal suicide . A woman with PND is also at greater risk of substantial weight retention after birth, which may exacerbate the risk that PCOS women have for obesity. Therefore, if women with PCOS are identified as having an increased risk of PND, they could be targeted for additional postnatal support, particularly following infertility treatment.