Enhanced niacin skin flushing response in perinatal compared to non-perinatal depression

doi:10.5498/wjp.119399

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Sep 19, 2026; 16(9): 119399
Published online Sep 19, 2026. doi: 10.5498/wjp.119399

Enhanced niacin skin flushing response in perinatal compared to non-perinatal depression

Ya-Nan Huang, Yan-Yan Xie, Shu-Hui Li, Xiao Yu, Jun Li

Ya-Nan Huang, Jun Li, Department of Psychosomatic Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China

Yan-Yan Xie, Department of Psychiatry, Shanghai Xuhui Mental Health Center, Shanghai 200232, China

Shu-Hui Li, Bio-X Institutes, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200030, China

Xiao Yu, Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China

Co-first authors: Ya-Nan Huang and Yan-Yan Xie.

Author contributions: Huang YN and Xie YY made equal contributions to this study as co-first authors; Huang YN designed the study, performed the research, collected the data, and wrote the manuscript; Xie YY provided clinical advice on the study design, verified, and organized the data, and drafted the manuscript; Li SH developed the statistical methodology, interpreted the data, performed the statistical analysis, and prepared all figures and tables; Yu X assisted in data collection and organization; Li J reviewed and finalized the manuscript; and all authors have read and approved the final version of the manuscript.

AI contribution statement: No AI tools were used in this study.

Supported by Science and Technology Commission of Changning District, Shanghai, No. CNKW2022Y36.

Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Shanghai Changning Maternity and Infant Health Hospital (Approval No. CNFBLLKT-2023-005).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: There are no conflicts of interest to report.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: The dataset that support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Jun Li, Associate Chief Physician, Department of Psychosomatic Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 XianXia Road, Changning District, Shanghai 200336, China. drlijun1983@163.com

Received: March 17, 2026
Revised: May 8, 2026
Accepted: June 4, 2026
Published online: September 19, 2026
Processing time: 159 Days and 21.9 Hours

Abstract

BACKGROUND

Perinatal depression (PND) accounts for a substantial proportion of maternal morbidity, yet its diagnosis still depends entirely on clinical symptoms, with no biological measure available in routine practice. How PND differs from non-perinatal depressive disorder (DD) at a biological level remains unclear, and no objective marker exists to differentiate them clinically. The niacin skin flushing response (NSFR) is a functional biological marker linked to lipid metabolism and inflammatory pathways. This study examined whether NSFR can differentiate PND from DD and explored associated clinical and dietary factors.

AIM

To clarify whether NSFR can be used as a specific biomarker to discriminate between PND and DD.

METHODS

One hundred and twenty-three treatment-naive first-episode patients were enrolled from Shanghai Changning Maternity and Infant Health Hospital: 67 with PND and 56 with DD. Clinical severity was assessed with the Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale and Edinburgh Postnatal Depression Scale (EPDS). Each participant completed an NSFR test and a food frequency questionnaire. Between-group comparisons and correlation analyses were conducted.

RESULTS

Compared with the DD group, the PND group showed significantly elevated NSFR scores (P < 0.001), with more pronounced NSFR elevation in severe PND cases (P = 0.035). Within the PND group, postpartum depression severity (EPDS) was inversely associated with NSFR intensity (r = -0.539, P = 0.014), symptom severity in patients with DD did not show any meaningful association with NSFR. Depressive and anxiety symptoms correlated positively with gestational age and the interval between delivery and consultation (all P < 0.05), and were more severe postpartum than prenatally (P < 0.05). Higher intake of dark and light vegetables and eggs was associated with milder postpartum depression (all P < 0.05), whereas greater poultry intake correlated with more pronounced depressive symptoms (r = 0.358, P = 0.008) and anxiety (r = 0.341, P = 0.011).

CONCLUSION

A hyperactive NSFR distinguishes PND from DD, with specific risk and dietary factors identified. NSFR represents a promising biomarker for differentiating these conditions.

Keywords: Perinatal depression; Niacin skin flushing response; Non-perinatal depression; Nutrition; Biomarker

Core Tip: Perinatal depression (PND) is associated with a hyperactive niacin skin flushing response (NSFR) compared to non-perinatal depressive disorder (DD). NSFR may be useful as a biomarker for distinguishing PND from DD. Advanced maternal age, later pregnancy and postpartum stages, delayed help-seeking, and high poultry intake are identified as risk factors for PND, whereas vegetable and egg intake appear to have a protective effect against postpartum depressive symptoms.