Associations of Thyroid Hormones Profile During Normal Pregnancy and Postpartum With Anxiety, Depression, and Obsessive/Compulsive Disorder Scores in Euthyroid Women.

Panagiota Konstantakou,Evangelos Grigoriou Sakkas,George Mastorakos,Georgios Valsamakis,Grigorios Evangelou Sakkas,Ioannis Zervas,Eleni Vousoura,Nikos Chalarakis,George Papadimitriou,Alexandros Gryparis

doi:10.3389/fnins.2021.663348

Abstract

ObjectiveThyroid dysfunction (overt and subclinical) has been consistently linked to pregnancy adversity and abnormal fetal growth and development. Mood disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD) are frequently diagnosed during pregnancy and at postpartum, and emerging evidence suggests association with impaired offspring neurodevelopment and growth. This study aimed to examine potential associations between thyroid function and mood symptoms during pregnancy and postpartum.DesignThis is a prospective study measuring thyroid hormones and assessing mood symptoms by employing specific questionnaires in the same cohort of 93 healthy pregnant women at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week.MethodsSerum thyroid hormones, TSH, anti-TPO, and anti-Tg antibodies were measured at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week. Specific validated questionnaires were employed at the same time-points to assess separately symptoms of anxiety [Generalized Anxiety Disorder Inventory (GADI), Penn State Worry Questionnaire (PSWQ), STAI-State Anxiety inventory (STAI-S), STAI-Trait Anxiety Inventory (STAI-T)], depression [Edinburgh Postnatal Depression Scale (EPDS), Stein’s Blues Scale (BLUES), Beck Depression Inventory (BDI)], and obsessive compulsive disorder (OCD) [Yale-Brown Obsessive Compulsive scale (Y-BOCS)].ResultsAt the 2nd trimester, GADI score correlated negatively with FT3 (p < 0.010, r = −0.545) and positively with TSH (p < 0.050, r = 0.837) concentrations; GADI, PSWQ, EPDS and Y-BOCS scores correlated negatively with FT4 concentrations (p < 0.010, r = −0.768; p < 0.010, r = −0.384; p < 0.050, r = −0.364; p < 0.010, r = −0.544, respectively). At the 3rd trimester, BLUES score correlated positively with rT3 concentrations (p = 0.00, r = 0.89); GADI, EPDS, and Y-BOCS scores correlated negatively with FT4 concentrations (p = 0.001, r = − 0.468; p = 0.036, r = −0.39; p = 0.001, r = −0.625, respectively); GADI, STAI-S, and Y-BOCS scores correlated positively with TSH concentrations (p = 0.015, r = 0.435; p = 0.024, r = 0.409 p = 0.041, r = 0.389, respectively). At postpartum, PSWQ, STAI-T, EPDS, and BDI scores correlated positively with rT3 concentrations (p = 0.024, r = 0.478; p = 0.014, r = 0.527; p = 0.046, r = 0.44; p = 0.021, r = 0.556, respectively, Y-BOCS score correlated positively with TSH (p = 0.045, r = 0.43), and BLUES score correlated positively with anti-TPO antibody concentrations (p = 0.070, r = 0.586).ConclusionThe reported findings demonstrate positive associations between low-normal thyroid function at the 2nd and 3rd trimesters of pregnancy and postpartum with anxiety, depression, and OCD scores.

Highlights

Mood disorders are common during pregnancy and postpartum and manifest as mild to severe depression, anxiety and obsessivecompulsive disorder (OCD), in previously healthy women (O’Hara and Swain Annette, 1996; Kemp et al, 2003; Gaynes et al, 2005)
Specific validated questionnaires were employed at the same time-points to assess separately symptoms of anxiety [Generalized Anxiety Disorder Inventory (GADI), Penn State Worry Questionnaire (PSWQ), State and Trait Anxiety Inventory (STAI)-State Anxiety inventory (STAI-S), STAI-Trait Anxiety Inventory (STAI-T)], depression [Edinburgh Postnatal Depression Scale (EPDS), Stein’s Blues Scale (BLUES), Beck Depression Inventory (BDI)], and obsessive compulsive disorder (OCD) [Yale-Brown Obsessive Compulsive scale (Y-BOCS)]
None of the participants developed a psychiatric illness during pregnancy some women have scored in certain questionnaires above the respective cut-off points

Summary

Introduction

Mood disorders are common during pregnancy and postpartum and manifest as mild to severe depression, anxiety and obsessivecompulsive disorder (OCD), in previously healthy women (O’Hara and Swain Annette, 1996; Kemp et al, 2003; Gaynes et al, 2005). Free T3 (FT3) and free T4 (FT4) concentrations typically decrease after the 1st trimester, usually remaining within low-normal range (Glinoer, 1997; Soldin et al, 2004). In a cohort of euthyroid pregnant women, we have shown that TT4 and reverse T3 (rT3) mean concentrations at the 1st postpartum week were significantly lower than those at the 2nd and the 3rd trimesters (Sakkas et al, 2018). Thyrotropin hormone (TSH) concentrations decrease during the 1st trimester of pregnancy following the stimulatory effect of placental human chorionic gonadotropin on TSH receptor, while during the 2nd and 3rd trimesters, they rise again to reach pre-pregnancy concentrations and usually remain stable throughout pregnancy (Glinoer, 1997)

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