Results of RIPOD (risk of postpartum depression) study: postpartum follow-ups, risk factors and prediction for clinical cases, and multimodal neuroimaging data

Abstract

As part of the RiPoD study, a large cohort (n = 700) of new mothers were recruited 1-6 days postpartum at the university hospital in Aachen and were observed for a period of 12 weeks. While 9% of them were found to develop postpartum depression (PPD), 13% developed postpartum adjustment disorder (AD). The PPD and AD cases were accurately identified by means of a combination of clinical and remote assessment tools (Hahn et al. 2021). In the exploration cohort, a balanced accuracy of 87% was achieved in week 3 postpartum using a combination of baseline and follow-up depression EPDS scores and mood scores (online mood assessment) for the differentiation between PPD and ND. The results were confirmed in the independent replication cohort. Within the first 6 weeks postpartum, the clinical manifestation of AD and PPD resembled each other based on personal and family history of depression, stressful life events, depressive symptoms, and attachment to the child. A comparison between cumulative hair cortisol and cortisone levels in the third trimester of pregnancy and the first 12 weeks postpartum revealed that only ND and AD (and not PPD) had pregnancy-related physiological adaptation in cortisol/cortisone levels, which reverted to the pre-pregnancy baseline following delivery (Stickel et al. 2021). Approximately 2 days after delivery, we also found that women who developed either AD or PPD within 12 weeks did not differ from ND immediately after delivery on the basis of structural and functional neuroimaging data (Schnakenberg et al. 2021). In the very early postpartum period, the mothers showed a significant reduction in gray matter volume in brain areas related to socio-cognitive and emotional processes compared to their nulliparous counterparts, indicating an effect of pregnancy on brain structure (Chechko et al. 2021).