Maternal thyroid-stimulating hormone and thyroid peroxidase antibody levels: Associations with postpartum depression and impacts on adverse pregnancy outcomes

BACKGROUND Postpartum depression (PPD) is closely associated with adverse pregnancy outcomes (APOs); thus, early PPD detection and prevention may help safeguard maternal and neonatal health. AIM To clarify the roles played by maternal serum thyroid-stimulating hormone (TSH) and thyroid peroxidase antibody (TPOAb) in PPD risk and APOs. METHODS We enrolled 83 women with PPD and 80 healthy pregnant controls from Shenzhen Bao’an District Songgang People’s Hospital (March 2021 to March 2024). Serum TSH and TPOAb levels were compared between groups. In PPD cases, association between thyroid markers and depressive severity, measured using the Edinburgh Postnatal Depression Scale and Self-Rating Depression Scale, were examined using Spearman’s correlations. Based on pregnancy outcomes, APOs (premature membrane rupture, preterm birth, postpartum hemorrhage, macrosomia, hypertensive disorders complicating pregnancy, and gestational diabetes) were contrasted with favorable outcomes. Univariate and multivariable analyses identified APOs predictors. RESULTS Compared with controls, PPD cases had higher TSH and TPOAb levels, both positively correlated with Edinburgh Postnatal Depression Scale and Self-Rating Depression Scale. In the final multivariable model, independent predictors of APOs were multiparity ≥ 3 [odds ratio (OR) = 3.782, P = 0.007], PPD (OR = 2.921, P = 0.046), TSH ≥ 3 mIU/L (OR = 3.333, P = 0.019), and TPOAb ≥ 7 U/mL (OR = 3.958, P = 0.008). CONCLUSION Serum TSH and TPOAb levels were significantly elevated in mothers with PPD and correlated strongly with depressive severity. Multiparity ≥ 3, PPD, TSH ≥ 3 mIU/L, and TPOAb ≥ 7 U/mL each increase the risk of APOs.