Prenatal β-endorphin as an early predictor of postpartum depressive symptoms in euthymic women

Background: After delivery, many women experience symptoms of postpartum depression (PPD), and early identification of women at risk is therefore important. The opioid peptide beta-endorphin has been implicated in non-puerperal depression but its role in the development of PPD is unknown. Methods: Three hundred and seven women with a singleton, full-term (>37.0 weeks' GA) pregnancy were recruited early in pregnancy and followed up into the postpartum period. Blood samples were obtained at 15, 19, 25, 31 and 37 weeks' gestational age (GA) and at 9 weeks postpartum for assessment of beta-endorphin. Depressive symptoms were assessed with the Center for Epidemiological Studies-Depression scale at the last four pregnancy visits and with the Edinburgh Postnatal Depression Scale postpartum. Results: Among women who were euthymic at 25 weeks' GA, those who proceeded to develop PPD symptoms had higher levels of beta-endorphin throughout pregnancy compared to women without PPD symptoms (all t>2.11, p <.05). At each assessment, women above the cut-off score for beta-endorphin were at more than three-fold risk for PPD symptoms (odds ratios 3.19-4.68) compared to women below the cut-off score. Limitations: Self-report of depressive symptoms, no mental health history. Conclusions: beta-Endorphin may be a useful early predictor of PPD symptoms in women who do not report depressive symptoms in mid-pregnancy. If replicated, these findings have clinical implications for the identification and treatment of this at-risk group and further suggest that some of the pathways leading to this complex disorder may be specific to subgroups of women. (C) 2009 Elsevier B.V. All rights reserved.