Prenatal inflammation and postpartum anxiety: Findings from a prospective pregnancy cohort in New York City

Background Inflammatory processes have been implicated in perinatal mood disorders. Yet, evidence linking prenatal inflammatory markers to postpartum anxiety is limited. We investigated whether third trimester inflammatory markers were associated with postpartum anxiety symptoms. Methods Participants were drawn from Generation C, a prospective pregnancy cohort established in New York City (April 2020–February 2022). Prenatal inflammatory markers (IL-6, IL-17A, IL-1β, and C-reactive protein [CRP]) were measured from routine clinical blood samples collected ≥28 weeks' gestation and > 7 days before delivery. Postpartum anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire completed within 24 weeks postpartum. Multivariable quantile regression models (50th, 75th, and 90th percentiles) examined associations between log2-transformed inflammatory markers and postpartum GAD-7 scores, adjusting for sociodemographic, clinical, and pandemic-related factors, including a history of anxiety and/or depression. Missing data were imputed and p -values were adjusted for multiple testing using the false discovery rate (FDR). Results The analytic sample included 237 participants. After FDR correction, none of the inflammatory markers were associated with postpartum GAD-7 scores at any quantile. A history of anxiety or depression was consistently associated with higher postpartum anxiety symptoms across all quantiles (β range 3.6–4.9; all p < 0.01). Conclusions Third trimester circulating IL-1β, IL-6, IL-17A, and CRP were not associated with postpartum anxiety symptom burden in this population-based cohort. A history of anxiety/depression remained the strongest risk factor for postpartum anxiety symptoms. These findings suggest that late-pregnancy systemic inflammatory markers may have limited utility for identifying postpartum anxiety risk in general obstetric populations.