Antenatal depression is a risk factor for preterm delivery, low birth weight, impaired growth among infants, decreased appetite, insomnia, and easy fatigability in mothers [1, 2]. It is also associated with a high risk of postpartum depression [3, 4]. A structured interview study by Kitamura et al. [5] reported a 5.6% prevalence of antenatal depression in Japan, making it the most prevalent mental disorder during pregnancy. A meta-analysis of perinatal depression in Japanese women by Tokumitsu et al. [6] showed a prevalence of 14.0% in the first 3–6 months of pregnancy, 16.3% from 6 months to delivery, 15.1% from 0–1 month postpartum, 11.6% from 1–2 months postpartum, 11.5% from 3–6 months postpartum, and 11.5% from 6 months to 1 year postpartum. This suggests a relatively high risk of antenatal depression postpartum. Therefore, identifying risk factors and taking preventive measures is crucial to prevent antenatal depression.

Risk factors for antenatal depression include various psychosocial factors; however, an association with changes in sex hormone levels has been reported [7]. Sex hormone changes can impact various physical disorders associated with menstruation, with premenstrual syndrome (PMS) and premenstrual dysphoric mood disorder (PMDD) being the most represented [8]. The International Classification of Diseases [9] defines PMS as "characterized by specific environmental, metabolic, or behavioral factors that occur during the luteal phase of the menstrual cycle, which leads to cyclic emotional, physical, or behavioral symptoms that interfere with an individual’s lifestyle." The American Psychiatric Association’s diagnostic criteria (DSM-5) [10] defines PMDD as “mood instability, irritability, discomfort, or anxiety that recurs during the premenstrual phase of the menstrual cycle and resolves before or immediately after the start of menstruation, occurring during most menstrual cycles in the past year.”

Estrogen and progesterone are involved in the regulation of mood-related biological systems, neural networks, and behavior; therefore, changes in their levels are thought to induce depressive symptoms [11]. A decreased level of allopregnanolone, a metabolite of progesterone, has been associated with depressive symptoms during pregnancy and the postpartum period [12, 13]. Previous studies show that allopregnanolone levels do not differ between patients with PMS and healthy individuals in the follicular phase; however, they are significantly lower in the PMS group during the luteal phase [14]. Similarly, allopregnanolone levels are reportedly lower in the PMDD group compared with healthy individuals during the luteal phase [14, 15]. These findings suggest a potential common mechanism underlying the onset of PMS, PMDD, and perinatal depression.

A systematic review of risk factors for postpartum depression by Gastaldon et al. [16] showed that the risk of developing postpartum depression was approximately double in women with a history of PMS. Sylvén et al. [17] also found a significant association between a history of PMS or PMDD and postpartum depression.

Antenatal depression may be associated with a history of PMS or PMDD; however, only a few studies have reported this. Pataky et al. [18] reported an approximately three-fold increased risk of depression at 32–42 weeks of pregnancy among individuals with a history of PMS or PMDD. Tokumitsu et al. [6] also reported a high prevalence of antenatal depression from the sixth month of pregnancy. Evidence suggests that interventions for women at risk of antenatal depression effectively prevent postnatal depression and improve pregnancy outcomes [19]. Therefore, we believe that early evaluation of at-risk individuals is necessary.

Thus, in this study, we aimed to determine the relationship between a history of PMS or PMDD and depression during the second trimester of pregnancy.

The results of this study indicate a significant association between PMS and PMDD and antenatal depression.

Pataky et al. [18] reported that a history of PMS or PMDD approximately triples the risk of depression during late pregnancy (32–42 weeks), and the present study showed a similar OR of 2.31 for PMS and 3.54 for PMDD, with a different association from that in early pregnancy. This suggests a need for earlier intervention. Regarding postpartum depression, Cao et al. [11] found that changes in estrogen and progesterone can cause depressive symptoms, and women sensitive to hormonal fluctuations may develop both PMS or PMDD and postpartum depression, as the sudden drop in hormone levels occurs during the luteal phase and after birth. Yang et al. reported that using the Swedish nationwide registers, a bidirectional association was observed between premenstrual disorders and pre- and postpartum depression. These findings suggest that a history of premenstrual disorders influences susceptibility to postpartum depression and vice versa, supporting a common etiology for both disorders [28]. The decline during pregnancy is less rapid than in the postpartum period; however, a study by Fan et al. [7] investigating the association between sex hormones and psychological distress during pregnancy reported that estrogen and progesterone blood levels were negatively correlated with the development of depression.

Furthermore, lower serum allopregnanolone levels were associated with the development of depressive symptoms during late pregnancy (37–40 weeks age of gestation) [29]. Allopregnanolone has sedative and anxiolytic effects and has also been negatively associated with the development of PMS or PMDD and postpartum depression [12, 13]. A history of PMS or PMDD may affect sex hormone levels during pregnancy, resulting in depressive symptoms; however, these levels were not measured in the present study. Thus, the association between sex hormone levels in patients with PMS or PMDD during pregnancy and depression should be investigated in the future.

Evidence suggests that interventions targeting antenatal depression risk can prevent postnatal depression and improve pregnancy outcomes [19]. This observation is supported by a systematic review and meta-analysis [30]. Therefore, the early identification of prenatal depression can mitigate its incidence and associated pregnancy outcomes, underscoring the importance of routine screening, diagnosis, and timely treatment during pregnancy [31]. However, failure to address antenatal depression promptly may escalate into postpartum depression [32]. Therefore, early identification of at-risk cases during pregnancy is crucial for safeguarding mothers from postpartum depression. Furthermore, it has been reported that PMS history also affects mother-infant bonding [33]. Thus, the results of this study may help identify at-risk cases.

This study has some limitations. First, this study used the results of the EPDS to assess risk factors for antenatal depression; however, the EPDS is a screening test for perinatal depression and is not used for the final diagnosis of perinatal depression. Second, there may have been a selection bias and issues with data reliability due to the web-based nature of the survey. For example, there may have been an information bias, such as recall bias, because the survey was self-administered and included questions about past information. Third, PMDD and PMS were assessed using questionnaires rather than being diagnosed through interviews. Finally, this was a cross-sectional study, and future longitudinal studies are necessary.

In conclusion, we found that having PMDD or PMS was significantly associated with maternal antenatal depression. Our findings suggest that screening for a history of PMS or PMDD during early antenatal interviews by healthcare providers, including sexual and reproductive health practitioners, may be useful in identifying patients for mental health care services to prevent perinatal depression during early pregnancy.