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Dimcea DAM, Petca RC, Dumitrașcu MC, Șandru F, Mehedințu C, Petca A. Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care. Diagnostics (Basel) 2024; 14:865. [PMID: 38732283 PMCID: PMC11083152 DOI: 10.3390/diagnostics14090865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.
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Affiliation(s)
- Daiana Anne-Marie Dimcea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Dermatology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Abstract
Certain women develop depression with fluctuations in hormone levels whereas other women do not; this hormonally driven depression has been termed reproductive depression. The pathophysiology of reproductive depression differs from that of major depressive disorder, and this distinction has important clinical-including treatment-implications. Recent advances have revealed that the neurosteroid, allopregnanolone, plays a central role in reproductive depression. Appreciation of allopregnanolone's role in reproductive depression aids in selecting targeted treatments and in predicting symptom worsening during subsequent reproductive stages, and it can be used to reduce risk of relapse. This knowledge is also guiding the development of new pharmacologic treatments for reproductive depression.
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Zou H, Sun M, Liu Y, Xi Y, Xiang C, Yong C, Liang J, Huo J, Lin Q, Deng J. Relationship between Dietary Inflammatory Index and Postpartum Depression in Exclusively Breastfeeding Women. Nutrients 2022; 14:nu14235006. [PMID: 36501036 PMCID: PMC9738724 DOI: 10.3390/nu14235006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
(1) Background: Research has shown that chronic inflammation can increase the risk of depression. The dietary inflammatory index (DII) is a novel measure of dietary inflammation, which has been used to investigate the relationship between diet and mental disorders in adults. However, little research has been conducted to establish an association between dietary inflammation (as measured by DII) and postpartum depression (PPD) in exclusively breastfeeding women. (2) Methods: In this cross-sectional study, 293 women who were exclusively breastfeeding for 6 months or less were enrolled. The DII scores were evaluated using semi-quantitative Food Frequency Questionnaires (FFQ), and the Edinburgh Postpartum Depression Scale (EPDS) was used to measure depression levels of breastfeeding mothers during the six months following delivery. The participants were classified by tertiles, and the possibility of DII being associated with PPD was assessed by binary regression analysis. (3) Results: The average DII score was 2.32 ± 1.08, which ranged from -1.66 to 4.19. The rate of depression was 60.1%. Adjusted for potential risk factors such as age, educational level, occupational level, number of babies, number of caregivers, social support level, and sleep quality, the results showed that the lowest DII score was associated with a lower risk of PPD than the highest score (OR tertile Q1 vs. 3 = 0.47, 95% CI: 0.24, 0.93, p = 0.030). (4) Conclusions: In exclusive breastfeeding women, the inflammatory potential of dietary intake seems to be related to depression. Interventions to improve diet quality might consider including a dietary component that aims to lower chronic systemic inflammation to prevent PPD. However, the relationship between DII and PPD among Chinese women remains to be demonstrated in a larger population.
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Affiliation(s)
- Hanshuang Zou
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Minghui Sun
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Jining First People’s Hospital, Jining 272000, China
| | - Yan Liu
- Department of Child Care, Changsha Maternal and Child Health Care Hospital, 416 Chengnan East RD of Yuhua District, Changsha 410007, China
| | - Yue Xi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China
| | - Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Jiajing Liang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Jiaqi Huo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Correspondence: (Q.L.); (J.D.); Tel.: +86-138-7482-0173 (Q.L.); +86-135-4864-3020 (J.D.)
| | - Jing Deng
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Correspondence: (Q.L.); (J.D.); Tel.: +86-138-7482-0173 (Q.L.); +86-135-4864-3020 (J.D.)
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Borgsted C, Høgh S, Høgsted ES, Fonnesbech‐Sandberg L, Ekelund K, Albrechtsen CK, Wiis JT, Hegaard H, Cvetanovska E, Juul A, Frederiksen H, Pinborg A, Weikop P, Frokjaer V. The role of central serotonergic markers and estradiol changes in perinatal mental health. Acta Psychiatr Scand 2022; 146:357-369. [PMID: 35729864 PMCID: PMC9796905 DOI: 10.1111/acps.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Women have an increased risk for mental distress and depressive symptoms in relation to pregnancy and birth. The serotonin transporter (SERT) may be involved in the emergence of depressive symptoms postpartum and during other sex-hormone transitions. It may be associated with cerebrospinal fluid (CSF) levels of the main serotonin metabolite 5-hydroxyindolacetic acid (5-HIAA). In 100 healthy pregnant women, who were scheduled to deliver by cesarean section (C-section), we evaluated 5-HIAA and estradiol contributions to mental distress 5 weeks postpartum. METHODS Eighty-two women completed the study. CSF collected at C-section was analyzed for 5-HIAA, with high performance liquid chromatography. Serum estradiol concentrations were quantified by liquid chromatography tandem mass spectrometry before C-section and postpartum. Postpartum mental distress was evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Associations between EPDS, 5-HIAA, and Δestradiol were evaluated in linear regression models adjusted for age, parity and SERT genotype. RESULTS Higher levels of postpartum mental distress symptoms were negatively associated with a large decrease in estradiol concentrations (βΔE2 = 0.73, p = 0.007) and, on a trend level, positively associated with high antepartum 5-HIAA levels (β5-HIAA = 0.002, p = 0.06). CONCLUSION In a cohort of healthy pregnant women, postpartum mental distress was higher in women with high antepartum 5-HIAA (trend) and lower in women with a large perinatal estradiol decrease. We speculate that high antepartum 5-HIAA is a proxy of SERT levels, that carry over to the postpartum period and convey susceptibility to mental distress. In healthy women, the postpartum return to lower estradiol concentrations may promote mental well-being.
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Affiliation(s)
- Camilla Borgsted
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Mental Health Services in the Capital Region of DenmarkCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Stinne Høgh
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Emma Sofie Høgsted
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | | | - Kim Ekelund
- Department of Anaesthesiology, Juliane Marie CenterCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Charlotte Krebs Albrechtsen
- Department of Anaesthesiology, Juliane Marie CenterCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Julie Therese Wiis
- Department of AnaesthesiologyCopenhagen University Hospital ‐ HerlevHerlevDenmark
| | - Hanne Hegaard
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Eleonora Cvetanovska
- Department of Obstetrics and Gynaecology, Herlev HospitalCopenhagen University HospitalHerlevDenmark
| | - Anders Juul
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of Growth and ReproductionCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Hanne Frederiksen
- Department of Growth and ReproductionCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Anja Pinborg
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of FertilityCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Pia Weikop
- Center for Translational NeuromedicineUniversity of CopenhagenCopenhagenDenmark
| | - Vibe Frokjaer
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Mental Health Services in the Capital Region of DenmarkCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Schneider MO, Pretscher J, Goecke TW, Häberle L, Engel A, Kornhuber J, Eichler A, Ekici AB, Beckmann MW, Fasching PA, Schwenke E. Genetic variants in the genes of the sex steroid hormone metabolism and depressive symptoms during and after pregnancy. Arch Gynecol Obstet 2022; 307:1763-1770. [PMID: 35680688 DOI: 10.1007/s00404-022-06644-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/23/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to conduct an association analysis of depressive symptoms and polymorphisms in the ESR1, PGR, CYP19A1, and COMT genes in pregnant and postpartum women. METHODS The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for assessment of maternal and fetal health. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of pregnancy, visit 2 was shortly after birth, and visit 3 was 6-8 months after birth. Germline DNA and depression measurements from 361 pregnant women were available for analysis. Six single nucleotide polymorphisms (SNPs) in the above-mentioned genes were genotyped. After reconstruction of haplotypes for PGR (rs1042838 and rs10895068) and CYP19A1 (rs10046 and rs4646), a multifactorial linear mixed model was applied to the data to describe the association between haplotypes and depression values. The single SNPs for ESR1 (rs488133) and COMT (rs4680) were analyzed separately using linear mixed models analogously. RESULTS The mean antepartum EPDS measurement was 5.1, the mean postpartal measurement after 48-72 h was 3.5, and the mean value 6-8 months postpartum was 4.2. The SNPs in PGR were reconstructed into three haplotypes. The most common haplotype was GG, with 63.43% of patients carrying two copies and 33.52% carrying one copy. For haplotype GA, the group of carriers of two copies (0.28%) was combined with the carriers of one copy (9.70%). Haplotype reconstruction using CYP19A1 SNPs resulted in three haplotypes. The most common haplotype was TC, with 25.48% of patients carrying two copies and 51.52% one copy. None of the haplotype blocks and neither of the two single SNPs showed any significant associations with EPDS values. CONCLUSIONS The candidate haplotypes analyzed in PGR and CYP19A1 and single SNPs in ESR1 and COMT did not show any association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.
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Affiliation(s)
- Michael O Schneider
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Jutta Pretscher
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Tamme W Goecke
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,Department of Obstetrics, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Lothar Häberle
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anne Engel
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Eichler
- Department of of Child and Adolescent Mental Health, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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Landoni M, Missaglia S, Tavian D, Ionio C, Di Blasio P. Influence of 5-HTTLPR polymorphism on postpartum depressive and posttraumatic symptoms. Psychiatr Genet 2022; 32:9-14. [PMID: 34694246 PMCID: PMC9904440 DOI: 10.1097/ypg.0000000000000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Postpartum depression (PPD) is a multifactor disorder caused by psychological, social, and also biological factors. 5-HTTLPR polymorphism in the promoter region of serotonin transporter gene seems to influence PPD onset. In this study, we examined the effect of 5-HTTLPR polymorphism on prenatal and postnatal symptoms of depression and posttraumatic stress in women. METHODS A longitudinal design with three points - time 1 (32-40 weeks gestation); time 2 (2 or 3 weeks after birth), and time 3 (3 months after birth) - was made. A total of 141 women were recruited during childbirth preparation courses. At time 1, women completed the Beck Depression Inventory (BDI) and the Los Angeles Symptoms Checklist (LASC). At time 2, they fulfilled BDI and Edinburgh Postnatal Depression Scale (EDPS), LASC and the Perinatal Posttraumatic stress disorder (PTSD) Questionnaire (PPQ); midwives and nurses collected biological test tubes by blood sampling for the genetic analysis. At time 3, the women were reassessed for BDI, LASC, EDPS, and PPQs. Analysis of variance and moderation analysis were used to correlate genotype and psychological investigations. RESULTS Results showed that, compared with LL/LS genotypes, SS genotype moderated cognitive depressive symptoms onset at T2 and T3. Moreover, this genotype correlated, directly or indirectly, with PTSD postpartum aspects (re-experience, avoidance, and hyperarousal). DISCUSSION Findings revealed that a lower expression of serotonin transporter gene, associated with SS genotype, seems to render women more vulnerable to depressive and PTSD symptoms after childbirth.
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Affiliation(s)
| | - Sara Missaglia
- Psychology Department
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniela Tavian
- Psychology Department
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Università Cattolica del Sacro Cuore, Milan, Italy
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Worthen RJ, Beurel E. Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression. Neurobiol Dis 2022; 165:105646. [PMID: 35104645 PMCID: PMC8956291 DOI: 10.1016/j.nbd.2022.105646] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/11/2022] [Accepted: 01/27/2022] [Indexed: 12/17/2022] Open
Abstract
Postpartum depression (PPD) is the most common psychiatric complication associated with pregnancy and childbirth with debilitating symptoms that negatively impact the quality of life of the mother as well as inflict potentially long-lasting developmental impairments to the child. Much of the theoretical pathophysiology put forth to explain the emergence of PPD overlaps with that of major depressive disorder (MDD) and, although not conventionally described in such terms, can be seen as neurodegenerative in nature. Framing the disorder from the perspective of the well-established inflammatory theory of depression, symptoms are thought to be driven by dysregulation, and subsequent hyperactivation of the body's immune response to stress. Compounded by physiological stressors such as drastic fluctuations in hormone signaling, physical and psychosocial stressors placed upon new mothers lay bare a number of significant vulnerabilities, or points of potential failure, in systems critical for maintaining healthy brain function. The inability to compensate or properly adapt to meet the changing demands placed upon these systems has the potential to damage neurons, hinder neuronal growth and repair, and disrupt neuronal circuit integrity such that essential functional outputs like mood and cognition are altered. The impact of this deterioration in brain function, which includes depressive symptoms, extends to the child who relies on the mother for critical life-sustaining care as well as important cognitive stimulation, accentuating the need for further research.
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Ruiz-Segovia N, Rodriguez-Muñoz MF, Olivares ME, Izquierdo N, Coronado P, Le HN. Healthy Moms and Babies Preventive Psychological Intervention Application: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12485. [PMID: 34886212 PMCID: PMC8656746 DOI: 10.3390/ijerph182312485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
Depression is the most common psychological disorder during the perinatal period, and its negative effects extend to mothers, babies, their family and society. Scientific evidence points to the urgency of designing preventive interventions and concludes that the gestational period is the most appropriate time to implement these interventions. However, many pregnant women do not seek professional help due to a lack of knowledge about the importance of mental health, its impact, and the available intervention options, as well as a lack of time and financial resources. E-health interventions can be an efficient, cost-effective, and accessible resource for preventing postpartum depression that can circumvent the barriers that pregnant women face. This randomized clinical trial will examine the efficacy of Healthy Moms and Babies, an app aimed at preventing postpartum depressive symptomatology. The second objective of this study is to analyze the effectiveness of the tool in preventing anxious symptomatology. The primary outcome measure is the difference in the mean score between the intervention and control groups on the Patient Health Questionnaire-9 (PHQ-9) at the end of the intervention and at 3 and 6 months postpartum. The secondary outcome will be determined by using the Generalized Anxiety Disorder Screener (GAD-7) at the same time points. The research findings can be used to determine pregnant women's use of the e-health application for the prevention of postpartum depression, whether the Healthy Moms and Babies intervention app is an effective and useful resource, and what modifications will need to be made to the tool in future updates.
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Affiliation(s)
- Natalia Ruiz-Segovia
- Department of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Maria Fe Rodriguez-Muñoz
- Department of Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Maria Eugenia Olivares
- Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.E.O.); (N.I.); (P.C.)
| | - Nuria Izquierdo
- Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.E.O.); (N.I.); (P.C.)
| | - Pluvio Coronado
- Department of Gynecology and Obstetrics, Instituto de Salud de la Mujer José Botella Llusiá, Hospital Clínico San Carlos, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.E.O.); (N.I.); (P.C.)
| | - Huynh-Nhu Le
- Department of Psychology, George Washington University, Washington, DC 20052, USA;
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Navas A, Carrascosa MDC, Artigues C, Ortas S, Portells E, Soler A, Yañez AM, Bennasar-Veny M, Leiva A. Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial. J Clin Med 2021; 10:jcm10112432. [PMID: 34070842 PMCID: PMC8198819 DOI: 10.3390/jcm10112432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The global prevalence of postpartum depression is about 20%. This disease has serious consequences for women, their infants, and their families. The aim of this randomized clinical trial was to analyze the effectiveness and safety of a moderate-intensity aerobic water exercise program on postpartum depression, sleep problems, and quality of life in women at one month after delivery. Methods: This was a multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. Pregnant women (14–20 weeks gestational age) who had low risk of complications and were from five primary care centers in the area covered by the obstetrics unit of Son Llatzer Hospital (Mallorca, Spain) were invited to participate. A total of 320 pregnant women were randomly assigned to two groups, an intervention group (moderate aquatic aerobic exercise) and a control group (usual prenatal care). One month after birth, sleep quality (MOS sleep), quality of life (EQ-5D), and presence of anxiety or depression (EPDS) were recorded. Findings: Women in the intervention group were less likely to report anxiety or depression on the EQ5D (11.5% vs. 22.7%; p < 0.05) and had a lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p < 0.010). The two groups had no significant differences in other outcomes, maternal adverse events, and indicators of the newborn status. Conclusion: Moderate-intensity aquatic exercise during pregnancy decreased postpartum anxiety and depressive symptoms in mothers and was safe for mothers and their newborns.
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Affiliation(s)
- Araceli Navas
- Hospital Comarcal de Inca, Balearic Islands Health Services, 07300 Inca, Spain;
| | - María del Carmen Carrascosa
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Catalina Artigues
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Silvia Ortas
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Elena Portells
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Aina Soler
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain; (A.S.); (A.L.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Aina M. Yañez
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, 07122 Palma, Spain
- Correspondence: (A.M.Y.); (M.B.-V.); Tel.: +34-9711-72914 (A.M.Y.); Tel.: +34-9711-72367 (M.B.-V.)
| | - Miquel Bennasar-Veny
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, 07122 Palma, Spain
- Correspondence: (A.M.Y.); (M.B.-V.); Tel.: +34-9711-72914 (A.M.Y.); Tel.: +34-9711-72367 (M.B.-V.)
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain; (A.S.); (A.L.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
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Bränn E, Malavaki C, Fransson E, Ioannidi MK, Henriksson HE, Papadopoulos FC, Chrousos GP, Klapa MI, Skalkidou A. Metabolic Profiling Indicates Diversity in the Metabolic Physiologies Associated With Maternal Postpartum Depressive Symptoms. Front Psychiatry 2021; 12:685656. [PMID: 34248718 PMCID: PMC8267859 DOI: 10.3389/fpsyt.2021.685656] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Postpartum depression (PPD) is a devastating disease requiring improvements in diagnosis and prevention. Blood metabolomics identifies biological markers discriminatory between women with and those without antenatal depressive symptoms. Whether this cutting-edge method can be applied to postpartum depressive symptoms merits further investigation. Methods: As a substudy within the Biology, Affect, Stress, Imagine and Cognition Study, 24 women with PPD symptom (PPDS) assessment at 6 weeks postpartum were included. Controls were selected as having a score of ≤ 6 and PPDS cases as ≥12 on the Edinburgh Postnatal Depression Scale. Blood plasma was collected at 10 weeks postpartum and analyzed with gas chromatography-mass spectrometry metabolomics. Results: Variations of metabolomic profiles within the PPDS samples were identified. One cluster showed altered kidney function, whereas the other, a metabolic syndrome profile, both previously associated with depression. Five metabolites (glycerol, threonine, 2-hydroxybutanoic acid, erythritol, and phenylalanine) showed higher abundance among women with PPDSs, indicating perturbations in the serine/threonine and glycerol lipid metabolism, suggesting oxidative stress conditions. Conclusions: Alterations in certain metabolites were associated with depressive pathophysiology postpartum, whereas diversity in PPDS physiologies was revealed. Hence, plasma metabolic profiling could be considered in diagnosis and pathophysiological investigation of PPD toward providing clues for treatment. Future studies require standardization of various subgroups with respect to symptom onset, lifestyle, and comorbidities.
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Affiliation(s)
- Emma Bränn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Malavaki
- Metabolic Engineering and Systems Biology Laboratory, Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas, Patras, Greece
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institute, Stockholm, Sweden
| | - Maria-Konstantina Ioannidi
- Metabolic Engineering and Systems Biology Laboratory, Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas, Patras, Greece.,Department of Biology, University of Patras, Patras, Greece
| | - Hanna E Henriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria I Klapa
- Metabolic Engineering and Systems Biology Laboratory, Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas, Patras, Greece
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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11
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Gelabert E, Gutierrez-Zotes A, Navines R, Labad J, Puyané M, Donadon MF, Guillamat R, Mayoral F, Jover M, Canellas F, Gratacós M, Guitart M, Gornemann I, Roca M, Costas J, Ivorra JL, Subirà S, de Diego Y, Osorio FL, Garcia-Esteve L, Sanjuan J, Vilella E, Martin-Santos R. The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study. Arch Womens Ment Health 2020; 23:585-593. [PMID: 31802248 DOI: 10.1007/s00737-019-01007-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.
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Affiliation(s)
- E Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - A Gutierrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Labad
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - M Puyané
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M F Donadon
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - R Guillamat
- Departamento de Psiquiatria, Departamento de Salud Mental, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - F Mayoral
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Jover
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - F Canellas
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centro de Regulación Genómica (CRG) y UPF, Barcelona, Spain
| | - M Guitart
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - I Gornemann
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Galicia, Spain
| | - J L Ivorra
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - S Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Y de Diego
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - F L Osorio
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - L Garcia-Esteve
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Sanjuan
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain.
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil.
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12
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Interaction between the functional SNP rs2070951 in NR3C2 gene and high levels of plasma corticotropin-releasing hormone associates to postpartum depression. Arch Womens Ment Health 2020; 23:413-420. [PMID: 31388769 DOI: 10.1007/s00737-019-00989-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
Postpartum depression (PPD) is a common mood disorder that occurs after delivery with a prevalence of approximately 10%. Recent reports have related placental corticotropin-releasing hormone (pCRH) to postpartum depressive symptoms. The aim of this study was to determine whether pCRH, ACTH, and cortisol (measured 48 h after delivery) and glucocorticoid and mineralocorticoid receptor genotypes (NR3C1 and NR3C2) and their interaction are associated with PPD. A longitudinal 32-week prospective study of five hundred twenty-five Caucasian depression-free women that were recruited from obstetric units at two Spanish general hospitals immediately after delivery. Of the women included in the sample, forty-two (8%) developed PPD. A strong association between PPD and the interaction between the pCRH and NR3C2 rs2070951 genotype was observed. The mean level of pCRH in rs2070951GG carriers with PPD was 56% higher than the mean in the CG and CC genotype groups (P < 0.00005). Carriers of the rs2070951GG genotype with high levels of pCRH had a higher risk of developing PPD (OR = 1.020, 95% CI 1.007-1.034, P = 0.002). This association remained even after controlling for variables such as neuroticism, obstetric complications and the number of stressful life events during pregnancy. There is an important interaction between pCRH 48 h postpartum and the NR3C2 rs2070951GG genotype. This interaction moderately associates with the presence of PPD. These results may open a new line of research and, if confirmed in other settings, will help to identify better risk predictors and the treatment for PPD.
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13
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The interaction between estradiol change and the serotonin transporter gene (5-HTTLPR) polymorphism is associated with postpartum depressive symptoms. Psychiatr Genet 2020; 29:97-102. [PMID: 31246736 DOI: 10.1097/ypg.0000000000000222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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14
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Naguy A. Brexanolone and postpartum depression: what does it have to do with GABA? Arch Womens Ment Health 2019; 22:833-834. [PMID: 31302763 DOI: 10.1007/s00737-019-00986-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/23/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Jamal Abdul-Nassir St, Shuwaikh, Kuwait.
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15
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Le HN, Rodríguez-Muñoz MF, Soto-Balbuena C, Olivares Crespo ME, Izquierdo Méndez N, Marcos-Nájera R. Preventing perinatal depression in Spain: a pilot evaluation of Mamás y Bebés. J Reprod Infant Psychol 2019; 38:546-559. [PMID: 31729261 DOI: 10.1080/02646838.2019.1687859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioural intervention to prevent perinatal depressive symptoms in pregnant women at high risk for perinatal depression in Spain. Background: Perinatal depression (PD) can negatively affect maternal and infant outcomes. Mamás y Bebés/The Mothers and Babies Course (MBC) is an evidence-based CBT intervention aimed at teaching women at high risk for depression mood regulation skills to prevent depression in the United States, including Spanish-speaking perinatal women in the United States. However, there is limited research on preventive interventions for PD in Spain. Method: Pregnant women screened for high risk for PD were recruited in their first trimester in an obstetrics clinic at two urban hospitals in Spain. In a non-experimental design, 30 women completed eight weekly group sessions of the MBC. The Patient Health Questionnaire was the main depression outcome at four time points: pre-intervention, post-intervention, and at 3 months and 6 months postpartum. Participants completed an evaluation questionnaire at the end of each session to assess the acceptability of the intervention. Results: The MBC was effective in reducing depressive symptoms from baseline to all three time points: post-intervention, 3 and 6 months postpartum. Attendance was high (76.7% attended all eight sessions). Mothers reported positive feedback from the participating in the MBC. Conclusion: This pilot study suggests that the intervention is feasible, acceptable, and provides promising evidence for reducing depressive symptoms in urban Spanish perinatal women. Larger and rigorous randomised trials are needed to confirm these findings.
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Affiliation(s)
- Huynh-Nhu Le
- Department of Psychology, The George Washington University , Washington, DC, USA
| | - María F Rodríguez-Muñoz
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia , Madrid, Spain
| | - Cristina Soto-Balbuena
- Department of Obstetrics and Gynecology, Central University Hospital of Asturias , Oviedo, Spain
| | | | - Nuria Izquierdo Méndez
- Department of Obstetrics and Gynecology, San Carlos Clinic Hospital, Universidad Complutense , Madrid, Spain
| | - Rosa Marcos-Nájera
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia , Madrid, Spain
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16
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Imaz ML, Torra M, Soy D, García-Esteve L, Martin-Santos R. Clinical Lactation Studies of Lithium: A Systematic Review. Front Pharmacol 2019; 10:1005. [PMID: 31551795 PMCID: PMC6746934 DOI: 10.3389/fphar.2019.01005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: There is substantial evidence that postpartum prophylaxis with lithium lowers the rate of relapse in bipolar disorder. However, it is contraindicated during breastfeeding due to the high variability of the transfer into breast milk. Aims: We conducted a systematic review of the current evidence of studies assessing the transfer of lithium to lactating infants and short-term infant outcomes. Methods: An a priori protocol was designed based on PRISMA guidelines. Searches in PubMed and LactMed were conducted until September 2018. Studies assessing lithium pharmacokinetic parameters and short-term infant outcomes were included. Quality was assessed using a checklist based on international guidelines (i.e., FDA). Results: From 344 initial studies, 13 case reports/series with 39 mother-child dyads were included. Only 15% of studies complied with ≥50% of the items on the quality assessment checklist. Infants breastfeed a mean (SD) of 58.9 (83.3) days. Mean maternal lithium dose was 904 (293) mg/day, corresponding lithium plasma/serum concentration was 0.73(0.26) mEq/L, and breast milk concentration was 0.84(0.14) mEq/L. Mean infant lithium plasma/serum concentration was 0.23(0.26) mEq/L. Twenty-six (80%) infants had concentrations ≤0.30 mEq/L without adverse effects. Eight (20%) showed a transient adverse event (i.e., acute toxicity or thyroid alterations). All of them were also prenatally exposed to lithium monotherapy or polytherapy. Conclusion: The current evidence comes from studies with a degree of heterogeneity and of low-moderate quality. However, it identifies areas of improvement for future clinical lactation studies of lithium and provides support for some clinical recommendations.
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Affiliation(s)
- Maria Luisa Imaz
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mercè Torra
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Hospital Clínic, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lluïsa García-Esteve
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Yun H, Park ES, Choi S, Shin B, Yu J, Yu J, Amarasekara DS, Kim S, Lee N, Choi JS, Choi Y, Rho J. TDAG51 is a crucial regulator of maternal care and depressive-like behavior after parturition. PLoS Genet 2019; 15:e1008214. [PMID: 31251738 PMCID: PMC6599150 DOI: 10.1371/journal.pgen.1008214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Postpartum depression is a severe emotional and mental disorder that involves maternal care defects and psychiatric illness. Postpartum depression is closely associated with a combination of physical changes and physiological stress during pregnancy or after parturition in stress-sensitive women. Although postpartum depression is relatively well known to have deleterious effects on the developing fetus, the influence of genetic risk factors on the development of postpartum depression remains unclear. In this study, we discovered a novel function of T cell death-associated gene 51 (TDAG51/PHLDA1) in the regulation of maternal and depressive-like behavior. After parturition, TDAG51-deficient dams showed impaired maternal behavior in pup retrieving, nursing and nest building tests. In contrast to the normal dams, the TDAG51-deficient dams also exhibited more sensitive depressive-like behaviors after parturition. Furthermore, changes in the expression levels of various maternal and depressive-like behavior-associated genes regulating neuroendocrine factor and monoamine neurotransmitter levels were observed in TDAG51-deficient postpartum brain tissues. These findings indicate that TDAG51 plays a protective role against maternal care defects and depressive-like behavior after parturition. Thus, TDAG51 is a maternal care-associated gene that functions as a crucial regulator of maternal and depressive-like behavior after parturition. Postpartum depression is a severe emotional and mental disease that can affect women typically after parturition. However, the genetic risk factors associated with the development of postpartum depression are still largely unknown. We discovered a novel function of T cell death-associated gene 51 (TDAG51) in the regulation of maternal behavior and postpartum depression. We report that TDAG51 deficiency induces depressive-like and abnormal maternal behavior after parturition. The loss of TDAG51 in postpartum brain tissues induces changes in the expression levels of various maternal and depressive-like behavior-associated genes that regulate the levels of neuroendocrine factors and monoamine neurotransmitters. TDAG51 is a maternal care-associated gene that functions as a crucial regulator of maternal and depressive-like behavior after parturition.
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Affiliation(s)
- Hyeongseok Yun
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Eui-Soon Park
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Seunga Choi
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Bongjin Shin
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jungeun Yu
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jiyeon Yu
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | | | - Sumi Kim
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Nari Lee
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jong-Soon Choi
- Division of Life Science, Korea Basic Science Institute, Daejeon, Korea
| | - Yongwon Choi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jaerang Rho
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
- * E-mail:
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18
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Elwood J, Murray E, Bell A, Sinclair M, Kernohan WG, Stockdale J. A systematic review investigating if genetic or epigenetic markers are associated with postnatal depression. J Affect Disord 2019; 253:51-62. [PMID: 31029013 DOI: 10.1016/j.jad.2019.04.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 03/08/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postnatal depression (PND) is common, affects the health of the mother, the development of the infant and places a large financial burden on services. Genetic and epigenetic biomarkers for PND could potentially improve the accuracy of current antenatal screening approaches. The aim of this systematic review is to report on the evidence for an association between genetic or epigenetic factors and postnatal depression. METHOD A systematic search of five databases (Medline, EMBASE, PILOT, PsychINFO and SCOPUS) was carried out using the following (MeSh) terms and keywords: postpartum, depression, postnatal depression, genetics, genetic polymorphisms and epigenetics. Inclusion criteria were applied and quality of studies was assessed using guidelines from the HuGE Review Handbook (Little and Higgins, 2006). RESULTS Following removal of duplicate articles, 543 remained; of these 37 met the inclusion criteria. Positive associations have been reported between PND and polymorphisms in the HMNC1, COMT, MAOT, PRKCB, ESR1, SLC6A4 genes in the presence of stressful life events, the BDNF gene when the postnatal period occurs during autumn and winter months and the OXT and OXTR genes in the presence of childhood adversity experienced by the mother. Epigenetic interactions with genotype, estrogen, and childhood adversity were identified that are predictive of PND. LIMITATIONS The number of studies investigating some of the markers was small and grey literature was not included. CONCLUSION This review highlights the importance of examining the interaction between epigenetic, genetic, hormonal and environmental factors in order to fully understand the risk factors for PND and to improve the accuracy of current antenatal and early postnatal screening procedures. Women susceptible to PND appear to have heightened epigenetic sensitivity to the physiological changes of childbirth or to environmental factors conferred by genotype.
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Affiliation(s)
- Judith Elwood
- Centre for Maternal, Fetal and Infant Research Ulster University, Shore Road, Co. Antrim, N. Ireland BT370Q, United Kingdom.
| | - Elaine Murray
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, United Kingdom
| | - Aleeca Bell
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, United States
| | - Marlene Sinclair
- Centre for Maternal, Fetal and Infant Research Ulster University, Shore Road, Co. Antrim, N. Ireland BT370Q, United Kingdom
| | - W George Kernohan
- Managing Chronic Illness Research Centre, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Janine Stockdale
- School of Nursing and Midwifery, Queen's University Belfast, United Kingdom
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Pawluski JL, Li M, Lonstein JS. Serotonin and motherhood: From molecules to mood. Front Neuroendocrinol 2019; 53:100742. [PMID: 30878665 PMCID: PMC6541513 DOI: 10.1016/j.yfrne.2019.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
Emerging research points to a valuable role of the monoamine neurotransmitter, serotonin, in the display of maternal behaviors and reproduction-associated plasticity in the maternal brain. Serotonin is also implicated in the pathophysiology of numerous affective disorders and likely plays an important role in the pathophysiology of maternal mental illness. Therefore, the main goals of this review are to detail: (1) how the serotonin system of the female brain changes across pregnancy and postpartum; (2) the role of the central serotonergic system in maternal caregiving and maternal aggression; and (3) how the serotonin system and selective serotonin reuptake inhibitor medications (SSRIs) are involved in the treatment of maternal mental illness. Although there is much work to be done, studying the central serotonin system's multifaceted role in the maternal brain is vital to our understanding of the processes governing matrescence and the maintenance of motherhood.
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Affiliation(s)
- Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, F-35000 Rennes, France.
| | - Ming Li
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308, USA.
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI 48824, USA.
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Epigenetic variation at the SLC6A4 gene promoter in mother-child pairs with major depressive disorder. J Affect Disord 2019; 245:716-723. [PMID: 30447571 DOI: 10.1016/j.jad.2018.10.369] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/05/2018] [Accepted: 10/31/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Genetic and epigenetic variations of the serotonin transporter gene (SLC6A4) have been related to the etiology of depression. The 5-HTTLPR polymorphism at the SLC6A4 promoter region has two variants, a short allele (S) and a long allele (L), in which the S allele results in lower gene transcription and has been associated with depression. The short S-allele of 5-HTTLPR polymorphism of this gene has been associated with depression. In addition to molecular mechanisms, exposure to early life risk factors such as maternal depression seems to affect the development of depression in postnatal life. The present study investigated the association of 5-HTTLPR polymorphism and CpG DNA methylation (5mC) levels of an AluJb repeat element at the SLC6A4 promoter region in mother-child pairs exposed to maternal depression. METHODS We analyzed DNA samples from 60 subjects (30 mother-child pairs) split into three groups, with and without major depression disorder (DSM-IV) among children and mothers. The genotyping of 5-HTTLPR polymorphism and quantification of 5mC levels was performed by qualitative PCR and methylation-sensitive restriction enzyme digestion, and real-time quantitative PCR (MSRED-qPCR), respectively. RESULTS The sample analyzed presented a higher frequency of S allele of 5-HTTLPR (67.5%). Despite the high frequency of this allele, we did not find statistically significant differences between individuals carrying at least one S allele between the depression and healthy control subjects, or among the mother-child pair groups with different patterns of occurrence of depression. In the group where the mother and child were both diagnosed with depression, we found a statistically significant decrease of the 5mC level at the SLC6A4 promoter region. LIMITATIONS The limitations are the relatively small sample size and lack of gene expression data available for comparison with methylation data. CONCLUSION In this study, we demonstrated a repeat element specific 5mC level reduction in mother-child pairs, concordant for the diagnosis of depression.
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Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol 2019; 52:165-180. [PMID: 30552910 PMCID: PMC6370514 DOI: 10.1016/j.yfrne.2018.12.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.
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Affiliation(s)
- Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, USA.
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22
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McEvoy K, Osborne LM, Nanavati J, Payne JL. Reproductive Affective Disorders: a Review of the Genetic Evidence for Premenstrual Dysphoric Disorder and Postpartum Depression. Curr Psychiatry Rep 2017; 19:94. [PMID: 29082433 DOI: 10.1007/s11920-017-0852-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review and summarize the literature exploring the genetic basis for premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD). RECENT FINDINGS There is more evidence for a genetic basis for PPD than for PMDD, but only when PPD is defined as beginning in the immediate postpartum time period. Familial, genome-wide linkage and association studies, and candidate gene studies, most in the past 10 years, have examined the genetic etiology of reproductive affective disorders, including PMDD and PPD. The most commonly studied genes include SERT, COMT, MAOA, BDNF, and ESR1 and 2. This qualitative review of the recent literature finds limited evidence so far for the genetic basis for PMDD, with both familial and candidate gene studies having negative or conflicting results. Evidence is stronger for the genetic basis for PPD, with positive associations found in family studies and in several genes associated with major depression as well as genes involved in estrogen signaling but only when PPD onset is shortly after delivery. Epigenetic biomarkers on genes responsive to estrogen have also been found to predict PPD. Our findings underscore the need for additional studies with larger samples, as well as the crucial importance of timing in the definition of PPD for genetic studies.
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Affiliation(s)
- Katherine McEvoy
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Lauren M Osborne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Julie Nanavati
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.
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de la Fe Rodríguez-Muñoz M, Le HN, de la Cruz IV, Crespo MEO, Méndez NI. Feasibility of screening and prevalence of prenatal depression in an obstetric setting in Spain. Eur J Obstet Gynecol Reprod Biol 2017; 215:101-105. [DOI: 10.1016/j.ejogrb.2017.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 04/24/2017] [Accepted: 06/04/2017] [Indexed: 01/07/2023]
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Pharmacologically Induced Sex Hormone Fluctuation Effects on Resting-State Functional Connectivity in a Risk Model for Depression: A Randomized Trial. Neuropsychopharmacology 2017; 42:446-453. [PMID: 27649641 PMCID: PMC5399242 DOI: 10.1038/npp.2016.208] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/26/2016] [Accepted: 09/11/2016] [Indexed: 02/07/2023]
Abstract
Women are at relatively greater lifetime risk for depression than men. This elevated risk in women is partly due to heightened risk during time periods characterized by marked fluctuations in sex hormones, including postpartum and perimenopausal periods. How sex hormone fluctuations contribute to heightened risk is not fully understood but may involve intrinsic functional connectivity. We induced a biphasic ovarian sex hormone fluctuation using the gonadotropin-releasing hormone agonist (GnRHa) goserelin to determine, with a randomized placebo-controlled design, intervention effects on or GnRHa-provoked depressive symptoms associations with change in resting-state functional connectivity (rs-FC) in 58 healthy women for six seeds (amygdala, hippocampus, anterior cingulate cortex, dorsal raphe, median raphe, and posterior cingulate cortex). GnRHa intervention did not significantly affect rs-FC in any seeds. Considering the GnRHa group only, the emergence of depressive symptoms following intervention was positively associated with amygdala-right temporal cortex and negatively associated with hippocampus-cingulate rs-FC. A test for mediation suggested that rs-FC changes in these networks marginally mediated the association between decrease in estradiol and increase in depressive symptoms in the GnRHa group (p=0.07). Our findings provide novel evidence-linking changes in rs-FC networks, the emergence of depressive symptoms and sex hormone fluctuations. Notably, we observed evidence that changes in rs-FC may represent a key neurobiological intermediary between molecular changes induced by hormone fluctuations and the emergence of depressive symptoms. Taken together, our findings indicate that sex hormone fluctuations may contribute to heightened risk for developing depressive symptoms by affecting intrinsic functional connectivity of key limbic brain structures.
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25
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Santucci AK, Singer LT, Wisniewski SR, Luther JF, Eng HF, Sit DK, Wisner KL. One-Year Developmental Outcomes for Infants of Mothers With Bipolar Disorder. J Clin Psychiatry 2017; 78:1083-1090. [PMID: 28068465 PMCID: PMC7296817 DOI: 10.4088/jcp.15m10535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Few data about the development of infants born to women with bipolar disorder have been published. We hypothesized that infants of women with bipolar disorder (by DSM-IV criteria) treated with psychotropics (BD+) or untreated with psychotropics (BD-) would demonstrate poorer cognitive and behavioral development than infants of controls. On the basis of previous studies, we expected that psychotropic-exposed infants of women in the BD+ group would have poorer neuromotor performance during infancy. METHODS This longitudinal study included 197 mother-infant dyads recruited to participate between July 2006 and March 2011: 81 with prenatal maternal bipolar disorder without psychotropic treatment (BD-, n = 27) or bipolar disorder with psychotropic exposure (BD+, n = 54) and 116 in which infants were exposed to neither bipolar disorder nor psychotropics. Maternal psychopathology and pharmacotherapy exposure assessments were completed at 20, 30, and 36 prenatal weeks and 12, 26, and 52 weeks postpartum. Infants were evaluated with the Bayley Scales of Infant Development, Second Edition, which included the psychomotor (Psychomotor Development Index [PDI]), cognitive (Mental Development Index [MDI]), and behavioral (Behavioral Rating Scale [BRS]) components. RESULTS Neither prenatal exposure to BD- or BD+ significantly impacted overall PDI (P = .2449), MDI (P = .7886), or BRS (P = .6072) scores. However, we observed a significant effect of BD+ exposure-by-time interaction for the BRS Motor Quality index (F₂₄₅ = 3.16, P = .0441), with BD+ exposed infants less likely to be above the 75th percentile at the 52-week assessment (mean = 11.5%) compared with BD- (mean = 40.0%) and nonexposed infants (mean = 48.4%). CONCLUSIONS We found no significant impact of prenatal BD- or BD+ exposure on infant PDI, MDI, or overall BRS scores at 12, 26, or 52 weeks of age, with most scores remaining within normal limits. Consistent with previous studies, we found a specific effect of prenatal BD+ exposure on quality of motor functioning at 1 year. However, the majority of infants were within normal limits on this developmental outcome. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00585702.
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Affiliation(s)
- Aimee K. Santucci
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee,Corresponding author: Aimee K. Santucci, PhD, St Jude Children’s Research Hospital, Epidemiology, 262 Danny Thomas Pl, Memphis, TN 38105 ()
| | - Lynn T. Singer
- Departments of Pediatrics, Psychiatry, Psychology, and Environmental Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Stephen R. Wisniewski
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James F. Luther
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather F. Eng
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy K. Sit
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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Gutiérrez-Zotes A, Labad J, Martín-Santos R, García-Esteve L, Gelabert E, Jover M, Guillamat R, Mayoral F, Gornemann I, Canellas F, Gratacós M, Guitart M, Roca M, Costas J, Ivorra JL, Navinés R, de Diego-Otero Y, Vilella E, Sanjuan J. Coping strategies for postpartum depression: a multi-centric study of 1626 women. Arch Womens Ment Health 2016; 19:455-61. [PMID: 26399872 DOI: 10.1007/s00737-015-0581-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/14/2015] [Indexed: 01/27/2023]
Abstract
The transition to motherhood is stressful as it requires several important changes in family dynamics, finances, and working life, along with physical and psychological adjustments. This study aimed at determining whether some forms of coping might predict postpartum depressive symptomatology. A total of 1626 pregnant women participated in a multi-centric longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the structured Diagnostic Interview for Genetic Studies (DIGS). The brief Coping Orientation for Problem Experiences (COPE) scale was used to measure coping strategies 2-3 days postpartum. Some coping strategies differentiate between women with and without postpartum depression. A logistic regression analysis was used to explore the relationships between the predictors of coping strategies and major depression (according to DSM-IV criteria). In this model, the predictor variables during the first 32 weeks were self-distraction (OR 1.18, 95 % CI 1.04-1.33), substance use (OR 0.58, 95 % CI 0.35-0.97), and self-blame (OR 1.18, 95 % CI 1.04-1.34). In healthy women with no psychiatric history, some passive coping strategies, both cognitive and behavioral, are predictors of depressive symptoms and postpartum depression and help differentiate between patients with and without depression.
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Affiliation(s)
- Alfonso Gutiérrez-Zotes
- Clínica Psiquiátrica Universitaria - Hospital Universitari Institut Pere Mata, Research Department, IISPV, Universitat Rovira i Virgili, CIBERSAM, Ctra. De l'Institut Pere Mata s/n, 43206, Reus, Spain.
| | - Javier Labad
- Clínica Psiquiátrica Universitaria - Hospital Universitari Institut Pere Mata, Research Department, IISPV, Universitat Rovira i Virgili, CIBERSAM, Ctra. De l'Institut Pere Mata s/n, 43206, Reus, Spain
| | - Rocío Martín-Santos
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Neuroscience Program, IMIM-Parc de Salut Mar, Autonoma University of Barcelona, RTA, Barcelona, Spain.,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Luisa García-Esteve
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Neuroscience Program, IMIM-Parc de Salut Mar, Autonoma University of Barcelona, RTA, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonoma University of Barcelona, Bellaterra, Spain
| | - Manuel Jover
- Hospital Clinic, University of Valencia, CIBERSAM, Valencia, Spain
| | - Roser Guillamat
- Corporación Sanitaria Parc Taulí, Sabadell, Autonoma University of Barcelona, Barcelona, Spain
| | - Fermín Mayoral
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Isolde Gornemann
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | - Mónica Gratacós
- Centre for Genomic Regulation (CRG) and UPF, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Montserrat Guitart
- Corporación Sanitaria Parc Taulí, Sabadell, Autonoma University of Barcelona, Barcelona, Spain
| | - Miguel Roca
- Institut Universitari d'Investigació en Ciències de la Salut, RediAPP, Palma de Mallorca, Spain
| | - Javier Costas
- Complexo Hospitalario Universitario de Santiago (CHUS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Servizo Galego de Saúde (SERGAS), Reus, Spain
| | - Jose Luis Ivorra
- Hospital Clinic, University of Valencia, CIBERSAM, Valencia, Spain
| | - Ricard Navinés
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Neuroscience Program, IMIM-Parc de Salut Mar, Autonoma University of Barcelona, RTA, Barcelona, Spain.,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Yolanda de Diego-Otero
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Elisabet Vilella
- Clínica Psiquiátrica Universitaria - Hospital Universitari Institut Pere Mata, Research Department, IISPV, Universitat Rovira i Virgili, CIBERSAM, Ctra. De l'Institut Pere Mata s/n, 43206, Reus, Spain
| | - Julio Sanjuan
- Hospital Clinic, University of Valencia, CIBERSAM, Valencia, Spain
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Abstract
This article is part of a Special Issue "Parental Care". The postpartum period involves some truly transformational changes in females' socioemotional behaviors. For most female laboratory rodents and women, these changes include an improvement in their affective state, which has positive consequences for their ability to sensitively care for their offspring. There is heterogeneity among females in the likelihood of this positive affective change, though, and some women experience elevated anxiety or depression (or in rodents anxiety- or depression-related behaviors) after giving birth. We aim to contribute to the understanding of this heterogeneity in maternal affectivity by reviewing selected components of the scientific literatures on laboratory rodents and humans examining how mothers' physical contact with her infants, genetics, history of anxiety and depression and early-life and recent-life experiences contribute to individual differences in postpartum affective states. These studies together indicate that multiple biological and environmental factors beyond female maternal state shape affective responses during the postpartum period, and probably do so in an interactive manner. Furthermore, the similar capacity of some of these factors to modulate anxiety and depression in human and rodent mothers suggests cross-species conservation of mechanisms regulating postpartum affectivity.
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Affiliation(s)
- Daniella Agrati
- Department of Physiology and Nutrition, Facultad de Ciencias, Universidad de la Republica, Montevideo, Uruguay.
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
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Martin-Santos R, Egmond E, Cavero M, Mariño Z, Subira S, Navines R, Forns X, Valdes M. Chronic hepatitis C, depression and gender: a state of art. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-05-2015-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose
– The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender.
Design/methodology/approach
– CHC and its treatment options were reviewed examining their relationship with depression and gender.
Findings
– CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results.
Originality/value
– The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.
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Nephew BC, Murgatroyd C, Pittet F, Febo M. Brain Reward Pathway Dysfunction in Maternal Depression and Addiction: A Present and Future Transgenerational Risk. ACTA ACUST UNITED AC 2015; 1:105-116. [PMID: 27617302 PMCID: PMC5013732 DOI: 10.17756/jrds.2015-017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Two research areas that could benefit from a greater focus on the role of the reward pathway are maternal depression and maternal addiction. Both depression and addiction in mothers are mediated by deficiencies in the reward pathway and represent substantial risks to the health of offspring and future generations. This targeted review discusses maternal reward deficits in depressed and addicted mothers, neural, genetic, and epigenetic mechanisms, and the transgenerational transmission of these deficits from mother to offspring. Postpartum depression and drug use disorders may entail alterations in the reward pathway, particularly in striatal and prefrontal areas, which may affect maternal attachment to offspring and heighten the risk of transgenerational effects on the oxytocin and dopamine systems. Alterations may involve neural circuitry changes, genetic factors that impact monoaminergic neurotransmission, as well as growth factors such as BDNF and stress-associated signaling in the brain. Improved maternal reward-based preventative measures and treatments may be specifically effective for mothers and their offspring suffering from depression and/or addiction.
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Affiliation(s)
- Benjamin C Nephew
- Department of Biomedical Sciences, Section of Neuroscience and Reproductive Biology, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | | | - Florent Pittet
- Department of Biomedical Sciences, Section of Neuroscience and Reproductive Biology, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Marcelo Febo
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
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Clark CT, Sit DK, Driscoll K, Eng HF, Confer AL, Luther JF, Wisniewski SR, Wisner KL. DOES SCREENING WITH THE MDQ AND EPDS IMPROVE IDENTIFICATION OF BIPOLAR DISORDER IN AN OBSTETRICAL SAMPLE? Depress Anxiety 2015; 32:518-26. [PMID: 26059839 PMCID: PMC4588053 DOI: 10.1002/da.22373] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period. METHODS Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4-6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID). RESULTS Positive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion. CONCLUSION Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
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Affiliation(s)
- Crystal T. Clark
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dorothy K.Y. Sit
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kara Driscoll
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heather F. Eng
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Andrea L. Confer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - James F. Luther
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Stephen R. Wisniewski
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
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31
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Gutiérrez-Zotes A, Labad J, Martín-Santos R, García-Esteve L, Gelabert E, Jover M, Guillamat R, Mayoral F, Gornemann I, Canellas F, Gratacós M, Guitart M, Roca M, Costas J, Luis Ivorra J, Navinés R, de Diego-Otero Y, Vilella E, Sanjuan J. Coping strategies and postpartum depressive symptoms: A structural equation modelling approach. Eur Psychiatry 2015; 30:701-8. [PMID: 26141375 DOI: 10.1016/j.eurpsy.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.
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Affiliation(s)
- A Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
| | - J Labad
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martín-Santos
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain
| | - L García-Esteve
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - E Gelabert
- Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | - M Jover
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
| | - R Guillamat
- Corporación Sanitaria Parc Taulí, Sabadell, Autonomous University of Barcelona, Barcelona, Spain
| | - F Mayoral
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - I Gornemann
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - F Canellas
- Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centre for Genomic Regulation (CRG) and UPF, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Guitart
- Corporación Sanitaria Parc Taulí, Sabadell, Autonomous University of Barcelona, Barcelona, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, RediAPP, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - J Luis Ivorra
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
| | - R Navinés
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain
| | - Y de Diego-Otero
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - J Sanjuan
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
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Couto TCE, Brancaglion MYM, Alvim-Soares A, Moreira L, Garcia FD, Nicolato R, Aguiar RALP, Leite HV, Corrêa H. Postpartum depression: A systematic review of the genetics involved. World J Psychiatry 2015; 5:103-111. [PMID: 25815259 PMCID: PMC4369539 DOI: 10.5498/wjp.v5.i1.103] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/21/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms “postpartum depression” and “genetics”. Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.
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Stone SL, Diop H, Declercq E, Cabral HJ, Fox MP, Wise LA. Stressful events during pregnancy and postpartum depressive symptoms. J Womens Health (Larchmt) 2015; 24:384-93. [PMID: 25751609 DOI: 10.1089/jwh.2014.4857] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Understanding the influence of perinatal stressors on the prevalence of postpartum depressive symptoms (PDS) and help-seeking for PDS using surveillance data can inform service provision and improve health outcomes. METHODS We used Massachusetts Pregnancy Risk Assessment Monitoring System (MA-PRAMS) 2007-2010 data to evaluate associations between selected perinatal stressors and PDS and with subsequent help-seeking behaviors. We categorized 12 stressors into 4 groups: partner, traumatic, financial, and emotional. We defined PDS as reporting "always" or "often" to any depressive symptoms on PRAMS Phase 5, or to a composite score ≥10 on PRAMS Phase 6 depression questions, compared with women reporting "sometimes," "rarely" or "never" to all depressive symptoms. The median response time to MA-PRAMS survey was 3.2 months (interquartile range, 2.9-4.0 months). We estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using modified Poisson regression models, controlling for socioeconomic status indicators, pregnancy intention and prior mental health visits. RESULTS Among 5,395 participants, 58% reported ≥1 stressor (partner=26%, traumatic=16%, financial=29% and emotional=30%). Reporting of ≥1 stressor was associated with increased prevalence of PDS (PR=1.68, 95% CI: 1.42-1.98). The strongest association was observed for partner stress (PR=1.90, 95% CI: 1.51-2.38). Thirty-eight percent of mothers with PDS sought help. Mothers with partner-related stressors were less likely to seek help, compared with mothers with other grouped stressors. CONCLUSIONS Women who reported perinatal common stressors-particularly partner-related stressors-had an increased prevalence of PDS. These data suggest that women should be routinely screened during pregnancy for a range of stressors and encouraged to seek help for PDS.
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Affiliation(s)
- Sarah Lederberg Stone
- 1 Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts
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Jiménez-Serrano S, Tortajada S, García-Gómez JM. A Mobile Health Application to Predict Postpartum Depression Based on Machine Learning. Telemed J E Health 2015; 21:567-74. [PMID: 25734829 DOI: 10.1089/tmj.2014.0113] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a disorder that often goes undiagnosed. The development of a screening program requires considerable and careful effort, where evidence-based decisions have to be taken in order to obtain an effective test with a high level of sensitivity and an acceptable specificity that is quick to perform, easy to interpret, culturally sensitive, and cost-effective. The purpose of this article is twofold: first, to develop classification models for detecting the risk of PPD during the first week after childbirth, thus enabling early intervention; and second, to develop a mobile health (m-health) application (app) for the Android(®) (Google, Mountain View, CA) platform based on the model with best performance for both mothers who have just given birth and clinicians who want to monitor their patient's test. MATERIALS AND METHODS A set of predictive models for estimating the risk of PPD was trained using machine learning techniques and data about postpartum women collected from seven Spanish hospitals. An internal evaluation was carried out using a hold-out strategy. An easy flowchart and architecture for designing the graphical user interface of the m-health app was followed. RESULTS Naive Bayes showed the best balance between sensitivity and specificity as a predictive model for PPD during the first week after delivery. It was integrated into the clinical decision support system for Android mobile apps. CONCLUSIONS This approach can enable the early prediction and detection of PPD because it fulfills the conditions of an effective screening test with a high level of sensitivity and specificity that is quick to perform, easy to interpret, culturally sensitive, and cost-effective.
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Affiliation(s)
- Santiago Jiménez-Serrano
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
| | - Salvador Tortajada
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
- 2 Joint Research Unit in Biomedical Engineering-eRPSS (ICT Applied to Healthcare Process Re-engineering), Health Research Institute Hospital La Fe, Valencia , Spain
| | - Juan Miguel García-Gómez
- 1 Biomedical Informatics Group, Institute for the Applications of Advanced Information and Communication Technologies (ITACA), Polytechnic University of Valencia , Valencia, Spain
- 2 Joint Research Unit in Biomedical Engineering-eRPSS (ICT Applied to Healthcare Process Re-engineering), Health Research Institute Hospital La Fe, Valencia , Spain
- 3 Biomedical Imaging Research Group (GIBI230), Health Research Institute Hospital La Fe, Valencia , Spain
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The Influence of genetic factors on peripartum depression: A systematic review. J Affect Disord 2015; 172:265-73. [PMID: 25451426 DOI: 10.1016/j.jad.2014.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND This systematic review aimed to explore the potential influence of genetic factors on the symptoms of peripartum depression and to critically analyze the methodologies employed by the examined studies. METHODS A systematic review of the literature indexed prior to July 2014 identified 200 articles. After applying the inclusion and exclusion criteria, 39 papers were included. RESULTS The papers predominantly featured a molecular genetic approach (n=35), and the majority examined polymorphisms (n=27). Most studies used samples of Caucasians living in high income countries. The results suggest that the influence of genetic factors become more consistent when methodological variations among the studies are considered. Environmental stressors are also important variables that influence the relationship between genetic factors and peripartum depressive states. In addition, differences in the influence of genetic factors were observed depending upon the precise time point during pregnancy or the postpartum period that was examined in the studies. The late stages of pregnancy and the early postpartum period were times of greater genetic vulnerability. LIMITATIONS This study was limited by the small number of papers reviewed and by the lack of information regarding whether the effects of genetics on peripartum depression are specific to certain ethnicities and/or stressors. CONCLUSIONS Genetic studies of perinatal depression reinforce a pathophysiological role of the hormonal changes inherent in the childbirth period. However, the distinction between depressive episodes that begin during pregnancy from those that begin during the postpartum period can still be useful to improve our understanding of the physiopathology of depressive disorders.
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Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annu Rev Clin Psychol 2015; 11:99-137. [PMID: 25822344 PMCID: PMC5659274 DOI: 10.1146/annurev-clinpsy-101414-020426] [Citation(s) in RCA: 405] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.
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Affiliation(s)
- Ilona S Yim
- Department of Psychology and Social Behavior, University of California, Irvine, California 92697;
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Maladaptive family dysfunction and parental death as risk markers of childhood abuse in women. SPANISH JOURNAL OF PSYCHOLOGY 2014; 17:E91. [PMID: 26054253 DOI: 10.1017/sjp.2014.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2-3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327-10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480-9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000-6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175-7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168-5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.
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Perani CV, Slattery DA. Using animal models to study post-partum psychiatric disorders. Br J Pharmacol 2014; 171:4539-55. [PMID: 24527704 DOI: 10.1111/bph.12640] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/09/2014] [Accepted: 01/31/2014] [Indexed: 12/24/2022] Open
Abstract
The post-partum period represents a time during which all maternal organisms undergo substantial plasticity in a wide variety of systems in order to ensure the well-being of the offspring. Although this time is generally associated with increased calmness and decreased stress responses, for a substantial subset of mothers, this period represents a time of particular risk for the onset of psychiatric disorders. Thus, post-partum anxiety, depression and, to a lesser extent, psychosis may develop, and not only affect the well-being of the mother but also place at risk the long-term health of the infant. Although the risk factors for these disorders, as well as normal peripartum-associated adaptations, are well known, the underlying aetiology of post-partum psychiatric disorders remains poorly understood. However, there have been a number of attempts to model these disorders in basic research, which aim to reveal their underlying mechanisms. In the following review, we first discuss known peripartum adaptations and then describe post-partum mood and anxiety disorders, including their risk factors, prevalence and symptoms. Thereafter, we discuss the animal models that have been designed in order to study them and what they have revealed about their aetiology to date. Overall, these studies show that it is feasible to study such complex disorders in animal models, but that more needs to be done in order to increase our knowledge of these severe and debilitating mood and anxiety disorders.
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Affiliation(s)
- C V Perani
- Department of Behavioural and Molecular Neurobiology, University of Regensburg, Regensburg, Germany
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39
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Kim DR, Epperson CN, Weiss AR, Wisner KL. Pharmacotherapy of postpartum depression: an update. Expert Opin Pharmacother 2014; 15:1223-34. [PMID: 24773410 DOI: 10.1517/14656566.2014.911842] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Postpartum depression (PPD) is a common and serious illness that affects up to 14% of women in the first month after childbirth. We present an update on the pharmacologic treatment of PPD, although there continues to be a lack of large, randomized controlled trials (RCTs). AREAS COVERED A review of the literature on the use of antidepressants, hormonal supplements and omega-3 fatty acids for the prevention and the treatment of PPD published since the original review in 2009 and the authors' opinion on the current status of the pharmacological treatment of PPD are covered. An electronic search was performed by using PubMed, Medline and PsychINFO. Inclusion criteria were: i) empirical articles in peer-reviewed English-language journals; ii) well-validated measures of depression; and iii) a uniform scoring system for depression among the sample. EXPERT OPINION Since the last Expert Opinion review, four antidepressant treatment studies and one prevention study of PPD have been published. Six RCTs evaluating the use of omega-3 fatty acids (four for prevention and two for treatment) have been published. There continues to be lack of data regarding the pharmacotherapy of PPD. However, serotonin reuptake inhibitors should be considered first-line for women with PPD after it has been determined that the proper diagnosis is not bipolar disorder. It is important to individualize treatment for women with PPD and consider the risks and benefits of treatment while breastfeeding.
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Affiliation(s)
- Deborah R Kim
- University of Pennsylvania, Perelman School of Medicine, Penn Center for Women's Behavioral Wellness, Department of Psychiatry , Philadelphia, PA 19104 , USA
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Systematic review of gamma-aminobutyric-acid inhibitory deficits across the reproductive life cycle. Arch Womens Ment Health 2014; 17:87-95. [PMID: 24420415 DOI: 10.1007/s00737-013-0403-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
Deficiencies in the inhibitory functioning of gamma-aminobutyric acid (GABA) have been implicated in the pathophysiology of depressive disorders. Reproductive life cycle events, including menstruation, pregnancy, and menopause, are consistently associated with increased psychopathology, in particular mood disorders. Given that GABA-inhibitory activity may be modulated directly or indirectly by estrogen, progesterone, and their metabolites receptors, it has been hypothesized that GABA deficits may be evident during these reproductive periods. We aimed to compare GABA function among women during these "high-risk" reproductive periods to GABA function among women at other time periods. We conducted a systematic review of studies comparing women during reproductive life stages associated with depressive disorder risk (luteal phase of the menstrual cycle, perinatal period, and menopausal transition) to women at other time periods. The study outcome was GABA function. The review included 11 studies, 9 focused on the menstrual cycle, and 2 focused on the perinatal period. GABA-inhibitory function fluctuated across the menstrual cycle, with differing patterns in women with and without depressive disorders. GABA-inhibitory function was reduced in pregnancy and early postpartum compared to the nonpregnant state. Key limitations were the absence of studies evaluating the menopausal transition, and the heterogeneity of GABA outcome measures. GABA-inhibitory function fluctuates across the menstrual cycle and is reduced perinatally. This has potential implications for a role of GABAergically mediated interventions in the prevention and treatment of menstrual cycle-related and perinatal depressive disorders.
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Alharbi AA, Abdulghani HM. Risk factors associated with postpartum depression in the Saudi population. Neuropsychiatr Dis Treat 2014; 10:311-6. [PMID: 24570584 PMCID: PMC3933724 DOI: 10.2147/ndt.s57556] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Postpartum depression (PPD) is one of the major psychological disorders worldwide that affects both mother and child. The aim of this study was to correlate the risk of PPD with obstetric and demographic variables in Saudi females. MATERIALS AND METHODS Data were collected by interviewing females 8-12 weeks postpartum. PPD symptoms were defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 10 or higher. Variables included in this study were age, education, occupation, parity, baby's sex, pregnancy period, delivery type, hemoglobin level, anemia, and iron pills taken during pregnancy. RESULTS Of the 352 postpartum females, the prevalence of PPD symptom risk was 117 (33.2%). Among the PPD symptomatic females, 66 (39.8%) had low hemoglobin levels, and 45 (40.5%) females were anemic during pregnancy (P≤0.05). These results suggest that early postpartum anemia, indicated by low hemoglobin level, is a significant risk factor for PPD (adjusted odds ratio 1.70, 95% confidence interval 1.05-2.74; P=0.03). Other variables, including age, parity, education, occupation, and delivery type, were not significantly correlated (P=0.15-0.95), but marginally indicative of the risk of depressive symptoms. CONCLUSION Low hemoglobin level and anemia during pregnancy were risk factors for PPD in Saudi females. Many other factors may be considered risk factors, such as age, occupation, and parity. Anemic women need more attention and to be checked regarding their PPD, and treated if necessary.
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Affiliation(s)
- Abeer A Alharbi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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De Crescenzo F, Perelli F, Armando M, Vicari S. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. J Affect Disord 2014; 152-154:39-44. [PMID: 24139299 DOI: 10.1016/j.jad.2013.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/22/2013] [Accepted: 09/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The treatment of postpartum depression with selective serotonin reuptake inhibitors (SSRIs) has been claimed to be both efficacious and well tolerated, but no recent systematic reviews have been conducted. METHODS A qualitative systematic review of randomized clinical trials on women with postpartum depression comparing SSRIs to placebo and/or other treatments was performed. A comprehensive literature search of online databases, the bibliographies of published articles and grey literature were conducted. Data on efficacy, acceptability and tolerability were extracted and the quality of the trials was assessed. RESULTS Six randomised clinical trials, comprising 595 patients, met quality criteria for inclusion in the analysis. Cognitive-behavioural intervention, psychosocial community-based intervention, psychodynamic therapy, cognitive behavioural therapy, a second-generation tricyclic antidepressant and placebo were used as comparisons. All studies demonstrated higher response and remission rates among those treated with SSRIs and greater mean changes on depression scales, although findings were not always statistically significant. Dropout rates were high in three of the trials but similar among treatment and comparison groups. In general, SSRIs were well tolerated and trial quality was good. LIMITATIONS There are few trials, patients included in the trials were not representative of all patients with postpartum depression, dropout rates in three trials were high, and long-term efficacy and tolerability were assessed in only two trials. CONCLUSIONS SSRIs appear to be efficacious and well tolerated in the treatment of postpartum depression, but the available evidence fails to demonstrate a clear superiority over other treatments.
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Affiliation(s)
- Franco De Crescenzo
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy.
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Pinsonneault JK, Sullivan D, Sadee W, Soares CN, Hampson E, Steiner M. Association study of the estrogen receptor gene ESR1 with postpartum depression--a pilot study. Arch Womens Ment Health 2013; 16:499-509. [PMID: 23917948 PMCID: PMC3833886 DOI: 10.1007/s00737-013-0373-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/09/2013] [Indexed: 12/17/2022]
Abstract
Perinatal mood disorders, such as postpartum depression (PPD), are costly for society, with potentially serious consequences for mother and child. While multiple genes appear to play a role in PPD susceptibility, the contributions of specific genetic variations remain unclear. Previously implicated as a candidate gene, the estrogen receptor alpha gene (ESR1) is a key player in mediating hormonal differences during pregnancy and the postpartum period. This study addresses genetic factors in perinatal mood disorders, testing nine polymorphisms in ESR1. Two hundred fifty-seven postpartum women were screened for mood disorders, including 52 women with PPD and 32 without any symptoms of mood disorders. We detected a significant association for the upstream TA microsatellite repeat with Edinburgh Postnatal Depression Scale scores (p = 0.007). The same variant was also associated with the occurrence of PPD. Separately, 11 candidate functional polymorphisms in 7 additional genes were genotyped to investigate gene-gene interaction with the ESR1 TA repeat, identifying a potential interaction with the serotonin transporter. Our results support a role for ESR1 in the etiology of PPD, possibly through the modulation of serotonin signaling. Our findings for ESR1 could have broad implications for other disorders and therapies that involve estrogens.
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Affiliation(s)
- Julia K. Pinsonneault
- Department of Pharmacology and Program in Pharmacogenomics, The Ohio State University
| | - Danielle Sullivan
- Department of Pharmacology and Program in Pharmacogenomics, The Ohio State University,The Department of Biostatistics, College of Public Health, The Ohio State University
| | - Wolfgang Sadee
- Department of Pharmacology and Program in Pharmacogenomics, The Ohio State University
| | - Claudio N. Soares
- Women's Health Concerns Clinic, St. Joseph's Healthcare, Department of Psychiatry & Behavioral Neurosciences and Obstetrics & Gynecology, McMaster University
| | - Elizabeth Hampson
- Department of Psychology and Graduate Program in Neuroscience, University of Western Ontario
| | - Meir Steiner
- Women's Health Concerns Clinic, St. Joseph's Healthcare, Department of Psychiatry & Behavioral Neurosciences and Obstetrics & Gynecology, McMaster University
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Associations Between Variations in TPH1 , TPH2 and SLC6A4 Genes and Postpartum Depression: A Study in the Jordanian Population. Balkan J Med Genet 2013; 16:41-8. [PMID: 24265583 PMCID: PMC3835295 DOI: 10.2478/bjmg-2013-0016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In this study, we investigated the association between
tryptophan hydroxylase-1 (TPH1
) (218A>C),
tryptophan hydroxylase-2
(
TPH2
) (1463G>A) and
serotonin carrier family 6, member 4 (SLC6A4)
[long (L)
vs.
short (S)] gene polymorphisms with post-partum depression (PPD) in women from Jordan. A total of 370 postpartum (130 depressed and 240 non depressed) women volunteered for the study. Genotyping was carried out using restriction fragment length polymorphism (RFLP) for
TPH1
, amplification refractory mutation system (ARMS) for
TPH2
and polymerase chain reaction (PCR) for
SLC6A4
S and L. The Edinburgh postnatal depression scale was used to screen postpartum women. Both S and L alleles of
SLC6A4
are common in Jordanian women (about 51.0 and 49.0%, respectively), while allele
TPH1
-218C is more common (64.0%) than allele A (37.0%). Regarding
TPH2
, allele A is absent from the examined women. None of the examined polymorphisms were found to be associated with PPD (
p
>0.05). However, depression history, pregnancy problems and economic status were found to be significantly associated with PPD (
p
<0.05). The results suggest that
TPH1
,
TPH2
and
SLC6A4
S and L polymorphisms do not seem to be important in Jordan for predisposing to PPD.
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Kim S, Soeken TA, Cromer SJ, Martinez SR, Hardy LR, Strathearn L. Oxytocin and postpartum depression: delivering on what's known and what's not. Brain Res 2013; 1580:219-32. [PMID: 24239932 DOI: 10.1016/j.brainres.2013.11.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 12/20/2022]
Abstract
The role of oxytocin in the treatment of postpartum depression has been a topic of growing interest. This subject carries important implications, given that postpartum depression can have detrimental effects on both the mother and her infant, with lifelong consequences for infant socioemotional and cognitive development. In recent years, oxytocin has received attention for its potential role in many neuropsychiatric conditions beyond its well-described functions in childbirth and lactation. In the present review, we present available data on the clinical characteristics and neuroendocrine foundations of postpartum depression. We outline current treatment modalities and their limitations, and proceed to evaluate the potential role of oxytocin in the treatment of postpartum depression. The aim of the present review is twofold: (a) to bring together evidence from animal and human research concerning the role of oxytocin in postpartum depression, and (b) to highlight areas that deserve further research in order to bring a fuller understanding of oxytocin's therapeutic potential. This article is part of a Special Issue entitled Oxytocin and Social Behav.
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Affiliation(s)
- Sohye Kim
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Timothy A Soeken
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Sara J Cromer
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Sheila R Martinez
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA
| | - Leah R Hardy
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA
| | - Lane Strathearn
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; The Meyer Center for Developmental Pediatrics, Texas Children's Hospital, 8080 N. Stadium Drive, Houston, TX 77054, USA.
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Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES). Arch Gynecol Obstet 2013; 289:755-63. [DOI: 10.1007/s00404-013-3046-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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O'Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol 2013; 28:3-12. [PMID: 24140480 DOI: 10.1016/j.bpobgyn.2013.09.002] [Citation(s) in RCA: 560] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/11/2013] [Indexed: 02/08/2023]
Abstract
Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder. Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20% during pregnancy and the first 3 months postpartum. Postpartum blues are a common but lesser manifestation of postpartum affective disturbance. Perinatal psychiatric disorders impair a woman's function and are associated with suboptimal development of her offspring. Risk factors include past history of depression, anxiety, or bipolar disorder, as well psychosocial factors, such as ongoing conflict with the partner, poor social support, and ongoing stressful life events. Early symptoms of depression, anxiety, and mania can be detected through screening in pregnancy and the postpartum period. Early detection and effective management of perinatal psychiatric disorders are critical for the welfare of women and their offspring.
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Affiliation(s)
- Michael W O'Hara
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA.
| | - Katherine L Wisner
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
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Skalkidou A, Hellgren C, Comasco E, Sylvén S, Sundström Poromaa I. Biological aspects of postpartum depression. ACTA ACUST UNITED AC 2013. [PMID: 23181531 DOI: 10.2217/whe.12.55] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In comparison with the vast epidemiological literature on postpartum depression (PPD), relatively few studies have examined the biological aspects of the disorder. However, research into the biological mechanisms of PPD is a challenging task, as normal pregnancy and the postpartum period cause adaptive endocrine changes, which would otherwise be considered pathological in nonpregnant women. This review focuses on the adaptive changes of childbearing and nursing, which ultimately may put women at increased risk of PPD. In light of the normal physiology, the authors also attempt to describe the current evidence of the biological changes associated with the development of depression in the postpartum period, including ovarian steroids, the hypothalamic-pituitary-adrenal axis, the serotonergic neurotransmitter system, the thyroid system and inflammatory markers. In addition, current knowledge on candidate genes associated with PPD is reviewed.
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Affiliation(s)
- Alkistis Skalkidou
- Department of Women's & Children's Health, Uppsala University, 751 85, Uppsala, Sweden
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Wisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, Eng HF, Luther JF, Wisniewski SR, Costantino ML, Confer AL, Moses-Kolko EL, Famy CS, Hanusa BH. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70:490-8. [PMID: 23487258 PMCID: PMC4440326 DOI: 10.1001/jamapsychiatry.2013.87] [Citation(s) in RCA: 658] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. OBJECTIVES To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. DESIGN Sequential case series of women who recently gave birth. SETTING Urban academic women's hospital. PARTICIPANTS During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. MAIN OUTCOMES AND MEASURES A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. RESULTS Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. CONCLUSIONS AND RELEVANCE The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00282776.
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Affiliation(s)
- Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Pinheiro RT, Coelho FMDC, Silva RAD, Pinheiro KAT, Oses JP, Quevedo LDÁ, Souza LDDM, Jansen K, Zimmermann Peruzatto JM, Manfro GG, Giovenardi M, Almeida S, Lucion AB. Association of a serotonin transporter gene polymorphism (5-HTTLPR) and stressful life events with postpartum depressive symptoms: a population-based study. J Psychosom Obstet Gynaecol 2013; 34:29-33. [PMID: 23394411 DOI: 10.3109/0167482x.2012.759555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We conducted a cross-sectional study nested within a cohort study with 276 postpartum women to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and the stressful life events (SLE) on the risk of postpartum depression (PPD) symptoms in a community sample. Participants were assessed between 45 and 90 days after delivery with the Edinburgh Postnatal Depression Scale (EPDS) and the Mini International Neuropsychiatric Interview (MINI). Data regarding socio-demographic variables, alcohol consumption, tobacco smoking and SLE occurring during pregnancy, were also collected. In the adjusted analysis, the women carrying the long (L) allele (LL) who experienced SLE showed higher prevalence ratios (PR) for PPD symptoms (EPDS ≥13) than those with two copies of the short (S) allele (SL) (PR = 9.91; 95% confidence interval: 1.70-57.87). In contrast, a trend of association was found between prior history of major depressive disorder (MDD) and the S allele carrier status (p = 0.07). No association was found between the formal diagnosis of current MDD and the 5-HTTLPR genotypes. In line with previous reports, we find in this sample that the L allele carrier status was associated with a heighten risk of depressive symptoms in postpartum when SLE were experienced during pregnancy.
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