Neurosteroid Levels in Pregnancy and Its Implications for Mental Health: A Literature Review.

Background: Perinatal mood disorders are being increasingly recognised and may have deleterious outcomes for the mother and offspring, underlining the importance of understanding their pathophysiology. Neurosteroids can alter the excitability of neurons through rapid non-genomic actions. Here, we review the changes in neurosteroids across pregnancy and their impact on maternal mental health.

Summary: Among the neurosteroids, the most studied is allopregnanolone, followed by 5-DHP in pregnancy. Predominantly, allopregnanolone is shown to be increased across pregnancy with a drop in the post-partum levels. With respect to the mood changes in pregnancy and the role of neurosteroids, there are conflicting reports about pregnanolone and its isomers. However, a few studies reported that lower allopregnanolone levels during mid-pregnancy seem to be associated with an increased risk for postpartum depression (PPD).

Key message: Thus, while there are reports that have examined individual neurosteroids across pregnancy, studies with serial measurements that include comprehensively all neurosteroids throughout pregnancy and their temporal relationship to mood are needed. Such studies will pave the way for a better understanding of the neurobiology of mood disorders in pregnancy. Additionally, it will facilitate the development of novel antenatal tests for potential predictive biomarkers, thus improving clinical decision-making, patient management and evolving appropriate preventive lifestyle interventions/therapeutic measures.