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The interaction between estradiol change and the serotonin transporter gene (5-HTTLPR) polymorphism is associated with postpartum depressive symptoms

Hu, Jiajiaa,,c; Zhou, Borongc; Li, Yingtaod; Deng, Yanhuac; He, Qingd; Ye, Junweic; Ning, Yupinga,,b

doi: 10.1097/YPG.0000000000000222
Original Articles

Although estrogenic fluctuation is considered a major risk factor for postpartum depression (PPD), the effects of the interactions between the genetic background and estradiol (E2) change on PPD are not well understood. Here, a cohort study with 437 postpartum women was carried out to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and E2 change on the risk of PPD symptoms. The participants were assessed using the Edinburgh Postnatal Depression Scale and the Self-Rating Depression Scale at 1 and 6 weeks after delivery. The PCR-based restriction fragment length polymorphism method was utilized to examine the genotype distribution of the 5-HTTLPR polymorphism, and the serum levels of E2 were determined in individuals in the third trimester of pregnancy and at 1 week postpartum. A significant association was observed between E2 change and PPD susceptibility in the late postpartum period (6 weeks) [P = 0.002, odds ratio (OR) = 2.341, 95% confidence interval (CI) = 1.361–4.027], but it was not observed in the early postpartum period (1 week). There was no significant association between the 5-HTTLPR genotype and PPD risk at both the early and late postpartum periods (P > 0.05). However, the interaction between E2 change and the 5-HTTLPR polymorphism could reasonably influence PPD risk. The women who carried the SS genotype with large decreases in E2 showed a significantly higher risk for PPD at both the early (P = 0.002, OR = 2.525, 95% CI = 1.384–4.059) and late postpartum periods (P < 0.001, OR = 3.108, 95% CI = 1.562–4.436) compared with those who carried the SL/LL genotype. This study suggests that there is an association between E2 change in the perinatal period with the 5-HTTLPR genotype and the occurrence of PPD.

aThe First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China

bDepartment of Neurology, Guangzhou Medical University Affiliated Brain Hospital, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China

cDepartment of Psychiatry, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

dDepartment of Gynecology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

Received 9 August 2018 Revised 4 January 2019 Accepted 30 January 2019

Correspondence to Yuping Ning, PhD, The First School of Clinical Medicine, Southern Medical University, No.1023, South ShataiRoad, Baiyun District, Guangzhou, Guangdong, China, 510515, Tel: +86 13922214239; e-mail:

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