Polycystic Ovary Syndrome and Postpartum Depression Symptoms: A Population-Based Cohort Study.

ABSTRACT Background Women with polycystic ovary syndrome (PCOS) are more likely to experience several pregnancy complications including hypertensive disorders, gestational diabetes mellitus, and preterm births than women without PCOS. However, at present there is limited research whether PCOS is associated with both anxiety and depression during pregnancy, and whether this augments a woman’s risk of postpartum depression, particularly among high-risk populations who have limited access to care. Objectives Our primary objective was to assess the association between pre-pregnancy PCOS and postpartum depression, considering important baseline confounding factors. Our secondary objective was to evaluate the mediating role of prenatal depression and anxiety on the association between PCOS and postpartum depression. Study design A population-based sample of 3,906 postpartum (2–6 months) women who completed the Utah Pregnancy Risk Assessment Monitoring System (UT–PRAMS) Phase 8 questionnaire (2016–2018). Weighted adjusted prevalence ratios (aPR) were used to assess the association between PCOS and postpartum depression, considering potential confounding factors and assessing mediating effects of depression and anxiety experienced during pregnancy. Results Following exclusion criteria, 8.2% of women reported clinical PCOS and 19.1%, 6.2%, and 4.4% reported irregular periods and acne, irregular periods and hirsutism, and all three symptoms, respectively. 17.7% and 23.5% reported experiencing prenatal depression and anxiety, 9.5% and 10.2% reported experiencing postpartum depressed mood and anhedonia. Clinical PCOS was associated with a 1.76 (95% confidence interval (CI), 1.03–3.00) higher adjusted prevalence ratio (aPR) for postpartum depressed mood or anhedonia after taking into consideration age, pre-pregnancy BMI, race/ethnicity, education, and marital status. Similar higher prevalence was seen for irregular periods and acne (aPR 1.65; 95% CI, 1.13–2.41), irregular periods and hirsutism (aPR, 1.40; 95% CI, 0.82–2.40), and all three symptoms (aPR, 1.75; 95% CI, 0.96–3.19) and postpartum depressed mood or anhedonia. Prenatal depression and anxiety mediated 20% and 32% of the effect of clinical PCOS on postpartum depressed mood and anhedonia, respectively. Conclusion Clinical PCOS is associated with postpartum depressed mood and symptoms among this population-based sample inclusive of high-risk mothers. Prenatal depression and anxiety mediate this association, emphasizing the importance of prenatal psychological screening among women with PCOS. An additional important clinical and public health implication of this study lies in the finding that nearly 20% of women in this population-based sample who reported at least two PCOS symptoms (including at-risk women who may not have access to care) had not received a clinical diagnosis for PCOS.