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Li X, Laplante DP, Paquin V, Lafortune S, Elgbeili G, King S. Effectiveness of cognitive behavioral therapy for perinatal maternal depression, anxiety and stress: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2022; 92:102129. [DOI: 10.1016/j.cpr.2022.102129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 12/20/2022]
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Høgh S, Hegaard HK, Renault KM, Cvetanovska E, Kjærbye-Thygesen A, Juul A, Borgsted C, Bjertrup AJ, Miskowiak KW, Væver MS, Stenbæk DS, Dam VH, Binder E, Ozenne B, Mehta D, Frokjaer VG. Short-term oestrogen as a strategy to prevent postpartum depression in high-risk women: protocol for the double-blind, randomised, placebo-controlled MAMA clinical trial. BMJ Open 2021; 11:e052922. [PMID: 35763351 PMCID: PMC8719185 DOI: 10.1136/bmjopen-2021-052922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Postpartum depression affects 10%-15% of women and has a recurrence rate of 40% in subsequent pregnancies. Women who develop postpartum depression are suspected to be more sensitive to the rapid and large fluctuations in sex steroid hormones, particularly estradiol, during pregnancy and postpartum. This trial aims to evaluate the preventive effect of 3 weeks transdermal estradiol treatment immediately postpartum on depressive episodes in women at high risk for developing postpartum depression. METHODS AND ANALYSIS The Maternal Mental Health Trial is a double-blind, randomised and placebo-controlled clinical trial. The trial involves three departments of obstetrics organised under Copenhagen University Hospital in Denmark. Women who are singleton pregnant with a history of perinatal depression are eligible to participate. Participants will be randomised to receive either transdermal estradiol patches (200 µg/day) or placebo patches for 3 weeks immediately postpartum. The primary outcome is clinical depression, according to the Diagnostic and Statistical Manual of Mental Disorders-V criteria of Major Depressive Disorder with onset at any time between 0 and 6 months postpartum. Secondary outcomes include, but are not limited to, symptoms of depression postpartum, exclusive breastfeeding, cortisol dynamics, maternal distress sensitivity and cognitive function. The primary statistical analysis will be performed based on the intention-to-treat principle. With the inclusion of 220 participants and a 20% expected dropout rate, we anticipate 80% power to detect a 50% reduction in postpartum depressive episodes while controlling the type 1 error at 5%. ETHICS AND DISSEMINATION The study protocol is approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Centre for Data Protection Compliance in the Capital Region of Denmark. We will present results at scientific meetings and in peer-reviewed journals and in other formats to engage policymakers and the public. TRIAL REGISTRATION NUMBER NCT04685148.
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Affiliation(s)
- Stinne Høgh
- Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, Denmark
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Anders Juul
- Department of Growth and Reproduction, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Camilla Borgsted
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
- Department of Psychiatry, Rigshospitalet, Copenhagen, Denmark
| | | | - Kamilla Woznica Miskowiak
- Department of Psychiatry, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Elisabeth Binder
- Department of Translational Research in Psychiatry, Max-Planck-Institute for Psychiatry, Munchen, Bayern, Germany
| | - Brice Ozenne
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Divya Mehta
- Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
- Department of Psychiatry, Rigshospitalet, Copenhagen, Denmark
- Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
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Clephane K, Lorenz TK. Putative Mental, Physical, and Social Mechanisms of Hormonal Influences on Postpartum Sexuality. CURRENT SEXUAL HEALTH REPORTS 2021; 13:136-148. [DOI: 10.1007/s11930-021-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Medina J, De Guzman RM, Workman JL. Lactation is not required for maintaining maternal care and active coping responses in chronically stressed postpartum rats: Interactions between nursing demand and chronic variable stress. Horm Behav 2021; 136:105035. [PMID: 34488064 DOI: 10.1016/j.yhbeh.2021.105035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/11/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
Women who do not breastfeed or discontinue breastfeeding early are more likely to develop postpartum depression (PPD) and stress is a significant risk factor for depression, including PPD. Using a rat model, we investigated whether the absence of nursing would increase the susceptibility to chronic stress-related behavioral and neural changes during the postpartum period. Adult female rats underwent thelectomy (thel; removal of teats), sham surgery, or no surgery (control) and were paired with males for breeding. All litters were rotated twice daily until postpartum day (PD) 26. Sham rats served as surrogates for thel litters, yielding a higher nursing demand for sham rats. Concurrently, rats received either no stress or chronic variable stress until PD 25. Rats were observed for maternal behaviors and tested in a series of tasks including open field, sucrose preference, and forced swim. We used immunohistochemistry (IHC) for doublecortin (DCX; to label immature neurons) or for mineralocorticoid receptor (MR). Contrary to our expectations, non-nursing thel rats were resistant to the effects of stress in all dependent measures. Our data indicate that even in chronic adverse conditions, nursing is not required for maintaining stable care to offspring or active coping responses in an acutely stressful task. We discuss the possible role of offspring contact and consider future directions for biomedical and clinical research. In rats with high nursing demand, however, chronic stress increased immobility, hippocampal neurogenesis, and MR expression (largely in opposition to the effects of stress in rats with typical nursing demand). We discuss these patterns in the context of energetics and allostatic load. This research highlights the complexity in relationships between stress, nursing, and neurobehavioral outcomes in the postpartum period and underscores the need for additional biomedical and clinical research geared toward optimizing treatments and interventions for women with PPD, regardless of breastfeeding status. SIGNIFICANCE STATEMENT: The goal of this research was to determine how the absence of nursing and higher nursing demand impact stress-coping behaviors and neural changes associated with chronic stress in order to disentangle the complex interplay of factors that contribute to psychological illness during the postpartum period.
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Affiliation(s)
- Joanna Medina
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America
| | - Rose M De Guzman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America
| | - Joanna L Workman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America; Center for Neuroscience Research, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America.
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Gestational urinary tract infections and the risk of antenatal and postnatal depressive and anxiety symptoms: A longitudinal population-based study. J Psychosom Res 2021; 150:110600. [PMID: 34547662 DOI: 10.1016/j.jpsychores.2021.110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/28/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Urinary tract infections (UTIs) are among the most common bacterial infections in pregnant women. This is the first longitudinal study investigating the association between gestational UTIs and the risk of maternal antenatal and postnatal depressive and anxiety symptoms. METHODS Data were utilised from the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal depressive and anxiety symptoms during pregnancy and the postpartum period were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. We used logistic regression analyses to examine the associations using the recommended EPDS and CCEI cut-off scores. We also ran sensitivity analyses and repeated the analyses with the continuous scores. RESULTS More than 10,000 mothers had completed exposure and outcome measures during pregnancy and the postpartum period. After adjustments were made for a wide range of confounders, our findings showed that mothers with UTI during pregnancy were 1.72 (95% CI; 1.45-2.04) and 1.70 (95% CI: 1.44-1.99) times more likely to report antenatal depressive and anxiety symptoms compared with mothers without UTI, respectively. Mothers with UTI also had a 35% and a 28% higher risk of postnatal depressive symptoms at eight weeks and eight months, respectively, and the risk of postnatal anxiety was 55% higher in mothers who had UTI during pregnancy (aOR = 1.55; 95% CI, 1.26-1.91). CONCLUSIONS The present study found positive associations between UTI during pregnancy and antenatal and postnatal depressive and anxiety symptoms. Replication and further research determining the cause of these associations is warranted.
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Souza-Vogler SRD, Lima GMDS. The effect of kangaroo care on modulate chronic stress response in preterm infants and mothers. Stress 2021; 24:742-752. [PMID: 33843436 DOI: 10.1080/10253890.2021.1900107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To assess stress experienced during Neonatal Intensive Care Unit (NICU) stay, we analyzed fingernail Cortisol (CORT) and Dehydroepiandrosterone (DHEA) levels and ratios in mothers and preterm infants (PI); compared hormones levels/ratio (CORT and DHEA) in kangaroo care (KC) versus standard care (SC) groups and examined relationships between PI hormone levels total days spent in the NICU. Mothers and their infants were recruited in the NICU, included levels I-IV and kangaroo care unit, within one week of infant birth in hospitals in Brazil. At 3 months after birth, mothers provided 3-month growth clippings from all ten digits of their own and their infants' fingernails. CORT and DHEA were measured using enzyme immunoassays (mothers) and high-performance-liquid-chromatography-with-mass-spectrometry (infants). Sample: n = 59 mothers (KC = 30/SC = 29) and 63 infants (KC = 32/SC = 31). Data were analyzed using non-parametric/parametric comparative statistics. NICU stay ranged from 3-103 days. For mothers in Kangaroo and Standard Care the CORT, DHEA levels and DHEA:CORT ratio (DC) ratio did not differ. Infants in KC had higher DHEA (p = 0.003) and a higher DC ratio (p = 0.011) than SC infants. Even though KC infants stayed in the NICU for a greater number of days than infants in SC, they had higher mean level of DHEA, and DC ratio, suggesting that KC played a role in promoting their stress regulatory capacities and may mitigate toxic effects of chronic hypercortisolemia. However, for mothers, KC did not reduce chronic stress compared to that in women in the SC condition. Further research warranted.
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Affiliation(s)
| | - Geisy Maria de Souza Lima
- Institute of Integral Medicine Professor Fernando Figueira (IMIP), Department of Neonatology, Recife, Brazil
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57
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Prenatal maternal mental health symptoms predict infant leptin at birth. Brain Behav Immun Health 2021; 16:100317. [PMID: 34589807 PMCID: PMC8474689 DOI: 10.1016/j.bbih.2021.100317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023] Open
Abstract
Childhood obesity can be predicted by metabolic signaling at birth. Understanding what exposure factors, such as prenatal mental health, predict metabolic signaling at birth are important for understanding the etiology of childhood metabolic dysregulation. Drawing on data from the Born in Bradford (BiB) multi-ethnic birth cohort in the United Kingdom (N = 2962 dyads), this study examined associations between maternal prenatal mental health symptoms and infant leptin and adiponectin. We tested whether total maternal prenatal symptoms as well as specific symptom subscales forecasted infant cord blood levels of leptin and adiponectin. We found that higher total maternal mental health symptoms and somatic symptoms, specifically, predicted lower infant cord blood leptin. We did not find evidence that maternal prenatal mental health symptoms predicted adiponectin. Together, our findings suggest that maternal mental health symptoms may become biologically embedded through infant metabolic changes via leptin. Maternal prenatal mental health symptoms predict infant cord blood leptin at birth. Somatic maternal prenatal mental health symptoms predict infant cord blood leptin at birth. Maternal prenatal mental health symptoms do not predict infant cord blood adiponectin at birth. Maternal prenatal mental health may become biologically embedded in infants via leptin.
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58
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Chalfun G, Reis MM, de Oliveira MBG, de Araújo Brasil A, Dos Santos Salú M, da Cunha AJLA, Prata-Barbosa A, de Magalhães-Barbosa MC. Perinatal stress and methylation of the NR3C1 gene in newborns: systematic review. Epigenetics 2021; 17:1003-1019. [PMID: 34519616 DOI: 10.1080/15592294.2021.1980691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Adverse experiences in the perinatal period have been associated with the methylation of the human glucocorticoid receptor gene (NR3C1) and long-term diseases. We conducted a systematic review on the association between adversities in the perinatal period and DNA methylation in the 1 F region of the NR3C1 gene in newborns. We explored the MEDLINE, Web of Science, Scopus, Scielo, and Lilacs databases without time or language limitations. Two independent reviewers performed the selection of articles and data extraction. A third participated in the methodological quality assessment and consensus meetings at all stages. Finally, ten studies were selected. Methodological quality was considered moderate in six and low in four. Methylation changes were reported in 41 of the 47 CpG sites of exon 1 F. Six studies addressed maternal conditions during pregnancy: two reported methylation changes at the same sites (CpG 10, 13, 20, 21 and 47), and four at one or more sites from CpG 35 to 39. Four studies addressed neonatal parameters and morbidities: methylation changes at the same sites 4, 8, 10, 16, 25, and 35 were reported in two. Hypermethylation associated with stressful conditions prevailed. Hypomethylation was more often associated with protective conditions (maternal-foetal attachment during pregnancy, breast milk intake, higher birth weight or Apgar). In conclusion, methylation changes in several sites of the 1 F region of the NR3C1 gene in newborns and very young infants were associated with perinatal stress, but more robust and comparable results are needed to corroborate site-specific associations.
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Affiliation(s)
- Georgia Chalfun
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
| | - Marcelo Martins Reis
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | | | - Aline de Araújo Brasil
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | - Margarida Dos Santos Salú
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | - Antônio José Ledo Alves da Cunha
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
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McDonald SE, Tomlinson CA, Applebaum JW, Moyer SW, Brown SM, Carter S, Kinser PA. Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10114. [PMID: 34639416 PMCID: PMC8508333 DOI: 10.3390/ijerph181910114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.
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Affiliation(s)
- Shelby E. McDonald
- Children, Families, and Animals Research (CFAR) Group, LLC, Richmond, VA 23223, USA
| | - Camie A. Tomlinson
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer W. Applebaum
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL 32611, USA;
| | - Sara W. Moyer
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.W.M.); (P.A.K.)
| | - Samantha M. Brown
- School of Social Work, Colorado State University, Fort Collins, CO 80523, USA;
| | - Sue Carter
- The Kinsey Institute, Indiana University, Bloomington, IN 47405, USA;
| | - Patricia A. Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.W.M.); (P.A.K.)
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Battulga B, Benjamin MR, Chen H, Bat-Enkh E. The Impact of Social Support and Pregnancy on Subjective Well-Being: A Systematic Review. Front Psychol 2021; 12:710858. [PMID: 34566789 PMCID: PMC8459714 DOI: 10.3389/fpsyg.2021.710858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Subjective well-being (SWB) has a protective role in mental health maintenance and is prone to change during short stressful moments, such as pregnancy. Longstanding research suggests that social support (SS) from the partner and family members of pregnant women directly or indirectly acts as a buffer against negative mental outcomes. For happier pregnancies, it is important to understand how SS and pregnancy affect the SWB. Objective: This review aims to examine the extended association of being pregnant and SS on the SWB of pregnant women. Methods: A systematic review was conducted in PubMed, ScienceDirect, and Google Scholar. Articles published in peer-reviewed journals were included regardless of the year and if they had assessed the impact of at least one SWB or SS outcome among healthy pregnant women. The tools of the National Heart, Lung, and Blood Institute were used for quality assessment. Results: Thirty-four studies that assessed the domains of SWB measurements, such as happiness, quality of life (QoL), life satisfaction, positive and negative effects, and well-being, were included and its association with either pregnancy or SS was summarized. Variable results, such as life satisfaction, happiness, and mental component of QoL, were found to be high during pregnancy, but positive emotion and physical components of QoL had decreased. Almost universally, SS during pregnancy was found to have a positive association with all measurements of SWB. Conclusion: This study had found that, despite some arising trends, pregnancy itself does not necessarily have similar impacts on SWB across healthy pregnant women. However, SS had a significant effect on SWB.
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Affiliation(s)
- Buyantungalag Battulga
- Department of Psychology, Southwest University, Chongqing, China
- Department of Agricultural and Applied Economics, Mongolian University of Life Science, Ulaanbaatar, Mongolia
| | | | - Hong Chen
- Department of Psychology, Southwest University, Chongqing, China
| | - Enkhmandakh Bat-Enkh
- School of Politics and Public Administration, Southwest University, Chongqing, China
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Geo-SPS: bipartite graph representation for GeoSpatial prenatal survey data. Neural Comput Appl 2021. [DOI: 10.1007/s00521-021-06371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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An approach to assess stress in response to drive hunts using cortisol levels of wild boar (Sus scrofa). Sci Rep 2021; 11:16381. [PMID: 34385546 PMCID: PMC8361105 DOI: 10.1038/s41598-021-95927-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Hunting can easily be linked to stress in wildlife. Drive hunts performed two to three times in one area during the respective hunting period, are thought to decrease the pressure hunting places on wildlife. Nevertheless, the expression of cortisol—one of the main mammalian stress hormones—is considered to have negative impacts on animals’ well-being if expressed excessively, which may occur during some (especially repeated) hunting events. We explored the effect of drive hunts on cortisol levels in wild boar in Lower Saxony, Germany, compared these cortisol levels to reference values given by a similar study, and investigated the effect of age, sex, and pregnancy. Blood collected from wild boar shot on drive hunts was analysed using a radioimmunoassay. As expected, we observed elevated cortisol levels in all samples, however, we still found significant differences between age groups and sexes, as well as an influence of pregnancy on cortisol levels. The effect of drive hunts on cortisol levels appears to be weaker than predicted, while the effects of other variables, such as sex, are distinct. Only half of the evaluated samples showed explicitly increased cortisol levels and no significant differences were found between sampling months and locations. Group living animals and pregnant females showed significantly higher cortisol levels. The impact of hunting is measurable but is masked by natural effects such as pregnancy. Thus, we need more information on stress levels in game species.
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The impact of maternal prenatal mental health disorders on stillbirth and infant mortality: a systematic review and meta-analysis. Arch Womens Ment Health 2021; 24:543-555. [PMID: 33386983 DOI: 10.1007/s00737-020-01099-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023]
Abstract
Evidence about the association between maternal mental health disorders and stillbirth and infant mortality is limited and conflicting. We aimed to examine whether maternal prenatal mental health disorders are associated with stillbirth and/or infant mortality. MEDLINE, Embase, PsycINFO, and Scopus were searched for studies examining the association of any maternal prenatal (occurring before or during pregnancy) mental health disorder(s) and stillbirth or infant mortality. A random-effects meta-analysis was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). The between-study heterogeneity was quantified using the I2 statistic. Subgroup analyses were performed to identify the source of heterogeneity. Of 4487 records identified, 28 met our inclusion criteria with 27 contributing to the meta-analyses. Over 60% of studies examined stillbirth and 54% of them evaluated neonatal or infant mortality. Thirteen studies investigated the association between maternal depression and anxiety and stillbirth/infant mortality, pooled OR, 1.42 (95% CI, 1.16-1.73; I2, 76.7%). Another 13 studies evaluated the association between severe maternal mental illness and stillbirth/infant mortality, pooled OR, 1.47 (95% CI, 1.28-1.68; I2, 62.3%). We found similar results for the association of any maternal mental health disorders and stillbirth/infant mortality (OR, 1.59; 95% CI, 1.43-1.77) and in subgroup analyses according to types of fetal/infant mortality. We found no significant evidence of publication bias. Maternal prenatal mental health disorders appear to be associated with a moderate increase in the risk of stillbirth and infant mortality, although the mechanisms are unclear. Efforts to prevent and treat these disorders may reduce the scale of stillbirth/infant deaths.
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Baba S, Ikehara S, Eshak ES, Ueda K, Kimura T, Iso H. Association between mode of delivery and postpartum depression: The Japan Environment and Children's Study (JECS): a prospective cohort study. J Epidemiol 2021; 33:209-216. [PMID: 34334503 PMCID: PMC10043157 DOI: 10.2188/jea.je20210117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) has been associated with adverse health outcomes including maternal suicide. Mode of delivery has been suggested to be a risk factor for PPD, but no large cohort study has examined the association between mode of delivery and PPD. We aimed to examine the association between mode of delivery and risks of PPD at 1 and 6 months after childbirth. METHODS In a nationwide study of 89,954 mothers with a live singleton birth, we examined the association between mode of delivery and risks of PPD. PPD was measured by the Edinburgh Postnatal Depression Scale (≥13) at 1 and 6 months after childbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) of PPD were calculated using multivariable logistic regression analyses after adjustment of antenatal physical, socioeconomic, and mental factors. RESULTS Among 89,954 women, 3.7% and 2.8% had PPD at 1 and 6 months after childbirth, respectively. Compared with unassisted vaginal delivery, cesarean section (CS) was marginally associated with PPD at 1 month, but not at 6 months; adjusted ORs were 1.10 (95% CI, 1.00-1.21) and 1.01 (95% CI, 0.90-1.13), respectively. The association with PPD at 1 month was evident in women with antenatal psychological distress: adjusted OR was 1.15 (95% CI, 1.03-1.28). The observed associations were attenuated after adjusting for infant feeding method. CONCLUSIONS Women who had antenatal psychological distress and underwent CS delivery may be regarded as a target for monitoring PPD.
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Affiliation(s)
- Sachiko Baba
- Bioethics and Public Policy, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Public Health, Faculty of Medicine, Minia University
| | | | - Tadashi Kimura
- Obstetrics and Gynecology, Osaka University Graduate School of Medicine
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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Moog NK, Nolvi S, Kleih TS, Styner M, Gilmore JH, Rasmussen JM, Heim CM, Entringer S, Wadhwa PD, Buss C. Prospective association of maternal psychosocial stress in pregnancy with newborn hippocampal volume and implications for infant social-emotional development. Neurobiol Stress 2021; 15:100368. [PMID: 34355050 PMCID: PMC8319845 DOI: 10.1016/j.ynstr.2021.100368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Maternal psychosocial stress during pregnancy can impact the developing fetal brain and influence offspring mental health. In this context, animal studies have identified the hippocampus and amygdala as key brain regions of interest, however, evidence in humans is sparse. We, therefore, examined the associations between maternal prenatal psychosocial stress, newborn hippocampal and amygdala volumes, and child social-emotional development. In a sample of 86 mother-child dyads, maternal perceived stress was assessed serially in early, mid and late pregnancy. Following birth, newborn (aged 5–64 postnatal days, mean: 25.8 ± 12.9) hippocampal and amygdala volume was assessed using structural magnetic resonance imaging. Infant social-emotional developmental milestones were assessed at 6- and 12-months age using the Bayley-III. After adjusting for covariates, maternal perceived stress during pregnancy was inversely associated with newborn left hippocampal volume (β = −0.26, p = .019), but not with right hippocampal (β = −0.170, p = .121) or bilateral amygdala volumes (ps > .5). Furthermore, newborn left hippocampal volume was positively associated with infant social-emotional development across the first year of postnatal life (B = 0.01, p = .011). Maternal perceived stress was indirectly associated with infant social-emotional development via newborn left hippocampal volume (B = −0.34, 95% CIBC [-0.97, −0.01]), suggesting mediation. This study provides prospective evidence in humans linking maternal psychosocial stress in pregnancy with newborn hippocampal volume and subsequent infant social-emotional development across the first year of life. These findings highlight the importance of maternal psychosocial state during pregnancy as a target amenable to interventions to prevent or attenuate its potentially unfavorable neural and behavioral consequences in the offspring. Maternal perceived stress predicted smaller neonatal left hippocampal volume (HCV). Neonatal left HCV was positively associated with infant social-emotional function. Variation in HCV may mediate maternal stress-related effects on child mental health.
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Affiliation(s)
- Nora K Moog
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Saara Nolvi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Turku Institute for Advanced Studies, Department of Psychology and Speech-Language Pathology, University of Turku, Finland
| | - Theresa S Kleih
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Styner
- Departments of Psychiatry and Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jerod M Rasmussen
- Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Christine M Heim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Biobehavioral Health, Pennsylvania State University, College of Health and Human Development, University Park, PA, USA
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Pathik D Wadhwa
- Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA.,Departments of Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA
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66
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Manu H, Lee S, Keyes MC, Cairns J, Baidoo SK. Behavioral and stress responses to feeding time in pregnant sows under limit-fed regime. J Anim Sci 2021; 99:6218080. [PMID: 33834214 PMCID: PMC8158425 DOI: 10.1093/jas/skab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/05/2021] [Indexed: 01/12/2023] Open
Abstract
We investigated the effect of feeding time on behavior and stress responses in pregnant sows under isocaloric conditions. Twenty-four sows were balanced for parity and randomly assigned to 1 of 3 feeding times. Corn-soybean meal-based diet was fed once at: 0730 (Control, T1), 1130 (T2), and 1530 hours (T3). On average, sows received 7,062 kcal ME/d from 2.20 kg of diet formulated to contain SID Lys/ME of 1.71 g/Mcal. The study was conducted for 28 d (21 d acclimation to the feeding regime and 7 d data collection). Saliva samples were collected every 2 hr for 12 hr in stalls on day 52 of pregnancy. Behavior data were collected 24 hr for 7 d from day 53 of gestating by affixing a remote insights ear tag to each sow. Each sow had 120,960 data points categorized into: "Active," "Feed," or "Dormant". Due to housing constraint, all sows were housed in individual stalls in the same barn presenting a potential limitation of the study. Data were analyzed using PROC MIXED and GLIMMIX procedures of SAS 9.4 for cortisol and behavior data, respectively. Sow was the experimental unit. The area under the curve (AUC) is quantitative evaluation of response as threshold varies over all possible values. A 12-hr cortisol total AUC for sows fed once daily at 1130 hours was reduced relative to sow group fed at 1530 hours (P = 0.046) but similar compared with the control sows (P = 0. 323). The control sows (0730 hours) had reduced total (P < 0.001) and feeding (P = 0.001) activity AUCs relative to sows on 1130 hours but did not differ compared with sows on 1530 hours feeding schedules (P > 0.100). Sows on 1130 hours feeding schedule had greater feed anticipatory activity, 24-hr total activity count, total (P < 0.001) and feeding (P < 0.001) activity AUC compared with sows fed daily at 1530 hours. In conclusion, feeding pregnant sows earlier in the morning (0730 hours) appears to minimize sows' behavior but similar cortisol response. Sows on 1130 hours feeding schedule had greater activities but reduced cortisol concentration, suggesting that elevated sow activity might not necessarily indicate activation of hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Hayford Manu
- Southern Research and Outreach Center, University of Minnesota, Waseca, MN, USA
| | - Suhyup Lee
- Department of Swine and Poultry Science, Korea National College of Agriculture and Fisheries, Jeonju 54874, South Korea
| | - Mike C Keyes
- Remote Insights Management Solutions (RIMS) Inc., Minneapolis, MN, USA
| | - Jim Cairns
- Remote Insights Management Solutions (RIMS) Inc., Minneapolis, MN, USA
| | - Samuel K Baidoo
- Southern Research and Outreach Center, University of Minnesota, Waseca, MN, USA
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A biopsychosocial perspective on maternal parenting in the first two years of infant life. Behav Brain Res 2021; 411:113375. [PMID: 34023309 DOI: 10.1016/j.bbr.2021.113375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022]
Abstract
Guided by a biopsychosocial perspective of mothering, this study investigated the interplay among biological (maternal cortisol reactivity), psychological (maternal depressive symptoms), and social (infant emotion and regulation) factors in contributing to early changes in maternal parenting. Participants were 1292 low-income, mother-infant pairs, assessed when the infants were 6-months (T1), 15-months (T2), and 24-months old (T3). Maternal parenting was observed at all assessment points. At T1, infant emotion expression and orienting towards mothers were observed, when maternal cortisol reactivity was assessed. Mothers reported their depressive symptoms at T1. Exploratory factor analysis revealed two parenting factors across time points: positive engagement and negative intrusiveness. Second-order latent growth curve models revealed interactions among maternal cortisol reactivity, depressive symptoms, and child negative emotion/orienting at T1 in predicting intercepts and slopes of two parenting factors. T1 maternal cortisol reactivity was associated with a higher positive engagement intercept for infants having high negative emotion at T1, but a lower positive engagement intercept for infants with low negative emotion at T1, under low T1 maternal depressive symptoms. T1 maternal cortisol reactivity was also related to a lower negative intrusiveness intercept for infants showing high orienting at T1. Longitudinally, maternal cortisol reactivity at T1 predicted a faster decline in positive engagement when infants showed high negative emotion at T1, but a slower decline when infants were less negative at T1. This study reveals a bivalent adaptation process in maternal sensitivity and enhances the current understanding of how biopsychosocial factors contribute to maternal parenting in low-income families.
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Romijn M, van Tilburg LJL, Hollanders JJ, van der Voorn B, de Goede P, Dolman KM, Heijboer AC, Broekman BFP, Rotteveel J, Finken MJJ. The Association between Maternal Stress and Glucocorticoid Rhythmicity in Human Milk. Nutrients 2021; 13:nu13051608. [PMID: 34064929 PMCID: PMC8151700 DOI: 10.3390/nu13051608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic stress is often accompanied by alterations in the diurnal rhythm of hypothalamus–pituitary–adrenal activity. However, there are limited data on the diurnal rhythmicity of breast milk glucocorticoids (GCs) among women with psychological distress. We compared mothers who sought consultation at an expertise center for pregnant women with an increased risk of psychological distress with control mothers for GC diurnal rhythmicity in milk and saliva obtained at the same time. Methods: We included 19 mothers who sought consultation at the psychiatry–obstetric–pediatric (POP) outpatient clinic and 44 control mothers. One month postpartum, mothers collected on average eight paired milk and saliva samples during a 24 h period. GC levels were measured using liquid chromatography–tandem mass spectrometry. GC rhythmicity parameters were determined with specialized software. Results: For both milk and saliva, no group differences regarding GC rhythms were found. Milk cortisol area under the curve with respect to the ground was lower in the POP group than in the control group (p = 0.02). GC levels in human milk and saliva were highly correlated within each group (p < 0.001). Conclusion: Although there were no differences between groups in GC rhythmicity, the total amount of milk cortisol was lower in the POP group. Long-term follow-up is needed to address the impact of vertical transmission of breast milk GCs.
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Affiliation(s)
- Michelle Romijn
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)20-444-3137
| | - Luca J. L. van Tilburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Jonneke J. Hollanders
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Bibian van der Voorn
- Department of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands;
| | - Paul de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, 1105 AZ Amsterdam, The Netherlands;
| | - Koert M. Dolman
- Department of Pediatrics, Onze Lieve Vrouwe Gasthuis (OLVG), 1006 AE Amsterdam, The Netherlands;
| | - Annemieke C. Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Birit F. P. Broekman
- Department of Psychiatry, VU University Medical Centre, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Martijn J. J. Finken
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
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Galbally M, Watson SJ, Lappas M, de Kloet ER, van Rossum E, Wyrwoll C, Mark P, Lewis AJ. Fetal programming pathway from maternal mental health to infant cortisol functioning: The role of placental 11β-HSD2 mRNA expression. Psychoneuroendocrinology 2021; 127:105197. [PMID: 33743501 DOI: 10.1016/j.psyneuen.2021.105197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023]
Abstract
Placental 11β-HSD2 has been a focus of research for understanding potential fetal programming associated with maternal emotional disorders. This study examined the pathway from antenatal mental health via placental 11β-HSD2 mRNA to cortisol regulation in the infant offspring. This study reports on data obtained from 236 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). At term, placental tissue was collected within 30 min of birth from 52 participants meeting current criteria for a depressive disorder, and 184 control participants. Depressive disorders were diagnosed using the SCID-IV. In addition, antidepressant use, depressive and anxiety symptoms were measured in early and late pregnancy. Placental 11β-HSD2 mRNA expression was measured using qRT-PCR. Infant salivary cortisol samples were taken at 12 months of age. Women on antidepressant medication and with higher trait anxiety had higher placental 11β-HSD2 expression compared to women not taking medication. Furthermore, the offspring of women taking an antidepressant and who also had a current depressive disorder and high trait anxiety had high cortisol reactivity at 12 months of age and this was mediated through 11β-HSD2 mRNA expression. In contrast, offspring of women not taking antidepressant medication with depressive disorder and high anxiety there was low cortisol reactivity observed. Our findings suggest that the relationship between maternal antenatal depression and anxiety and infant cortisol reactivity is mediated through placental 11β-HSD2 mRNA expression. Furthermore, the direction differed for women taking antidepressants, where infant cortisol reactivity was high whereas when compared to those with unmedicated depression and anxiety, where infant cortisol reactivity was low.
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Affiliation(s)
- Megan Galbally
- Psychology, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia; King Edward Memorial Hospital, Subiaco, Australia.
| | - Stuart J Watson
- Psychology, Murdoch University, Australia; School of Medicine, University of Notre Dame, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - E Ron de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Caitlin Wyrwoll
- School of Human Sciences, The University of Western Australia, Australia
| | - Peter Mark
- School of Human Sciences, The University of Western Australia, Australia
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Götz DP, Hosomi JK, de Morais MM, Nakamura MU. Usual-Risk Pregnant Women's Health-Related Quality of Life through Pregnancy and Puerperium with Anthroposophical Prenatal Care: A Retrospective Study. Complement Med Res 2021; 28:427-434. [PMID: 33827089 DOI: 10.1159/000512671] [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: 04/23/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pregnancy is a physiological event that can lead to a decrease in quality of life. Symptoms within this period lack riskless treatment options. However, the anthroposophical integrative view points out the stimulation of vital energy recuperation as a possible inducer of changes in health perception for pregnant women. OBJECTIVE The aim was to observe the health-related quality of life variation in women during pregnancy and puerperium. The evaluation was based on the Medical Outcomes Study 36-Item Short-Form (SF-36). METHOD This is a retrospective longitudinal study of SF-36 questionnaires administered at 3 different time points: at the first appointment, at an appointment between the 36th ± 1 week of pregnancy and at another appointment within the puerperium period. RESULTS Sixty-five patients completed the 3 questionnaires within the period of the study. The 8 domains of SF-36 and women's behaviors throughout the prenatal and puerperal care period were analyzed. Quality of life decreased by the third trimester, with recuperation in the puerperium. Physical components were reduced significantly, while emotional and social components did not change significantly. Scores in mental health and vitality, as well as general health status, were higher in puerperium. CONCLUSION Multiprofessional intervention broadened by the anthroposophical perspective fosters the health-related quality of life of women through gestation and puerperium.
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Affiliation(s)
- Daniel Pereira Götz
- Núcleo de Medicina Antroposófica (NUMA), Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Jorge Kioshi Hosomi
- Núcleo de Medicina Antroposófica (NUMA), Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Moacyr Mendes de Morais
- Núcleo de Medicina Antroposófica (NUMA), Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Mary Uchiyama Nakamura
- Núcleo de Medicina Antroposófica (NUMA), Federal University of São Paulo, UNIFESP, São Paulo, Brazil
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Mirhosseini S, Abbasi A, Norouzi N, Mobaraki F, Basirinezhad MH, Mohammadpourhodki R. Effect of aromatherapy massage by orange essential oil on post-cesarean anxiety: a randomized clinical trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:579-583. [PMID: 33781003 DOI: 10.1515/jcim-2020-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many women in recent years have been willing to undergo puncture surgery for childbirth, which, like other surgeries, has physical and psychological side effects such as incision, infertility, chronic pain, and anxiety. Therefore, it is important to reduce and improve these side effects. The aim of this study was to determine the effect of foot massage with orange essential oil on anxiety in women undergoing cesarean section. METHODS This randomized clinical trial study was conducted in 2019 on 80 women referred to Bahar Shahroud Hospital after cesarean section surgery. The samples were divided into two groups by intervention (foot massage with orange essential oil) and control (foot massage without orange essential oil). The Spielberger scale was used to determine anxiety scores after cesarean section. In the intervention group, the feet were massaged with orange essential oil, and in the control group, the orange essential oil massage was performed without oil. Anxiety before, immediately after, and 60 min after the intervention was measured and evaluated in both groups. Data analysis was performed using descriptive and inferential statistics. Significant levels were considered for all statistical tests (p<0.05). RESULTS The anxiety score before the intervention in the two groups of intervention and control was 57.12 ± 3.12 and 57.07 ± 3.54, respectively, which were not significantly different, but immediately after the intervention, the anxiety scores in both groups decreased significantly so that there was a further decrease in the intervention group (52.10 ± 4.75 and 56.02 ± 3.77), 1 h after the intervention, the anxiety score in the intervention group decreased compared to the previous stage and increased in the control group (50.40 ± 3.74 and 56.85 ± 4.27). CONCLUSIONS Foot massage with orange essential oil can probably be effective as a proper nursing intervention in reducing anxiety after cesarean section surgery.
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Affiliation(s)
- Seyedmohammad Mirhosseini
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Abbasi
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nastaran Norouzi
- Imam Hossein Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fatemeh Mobaraki
- Imam Hossein Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics,School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mohammadpourhodki
- Kashmar Center of Higher Health Education, Mashhad University of Medical Sciences, Mashhad, Iran
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Shimon-Raz O, Salomon R, Bloch M, Aisenberg Romano G, Yeshurun Y, Ulmer Yaniv A, Zagoory-Sharon O, Feldman R. Mother brain is wired for social moments. eLife 2021; 10:e59436. [PMID: 33764299 PMCID: PMC8026217 DOI: 10.7554/elife.59436] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 03/22/2021] [Indexed: 12/30/2022] Open
Abstract
Reorganization of the maternal brain upon childbirth triggers the species-typical maternal social behavior. These brief social moments carry profound effects on the infant's brain and likely have a distinct signature in the maternal brain. Utilizing a double-blind, within-subject oxytocin/placebo administration crossover design, mothers' brain was imaged twice using fMRI while observing three naturalistic maternal-infant contexts in the home ecology; 'unavailable', 'unresponsive', and 'social', when mothers engaged in synchronous peek-a-boo play. The social condition elicited greater neural response across the human caregiving network, including amygdala, VTA, hippocampus, insula, ACC, and temporal cortex. Oxytocin impacted neural response primarily to the social condition and attenuated differences between social and non-social stimuli. Greater temporal consistency emerged in the 'social' condition across the two imaging sessions, particularly in insula, amygdala, and TP. Findings describe how mother's brain varies by caregiving experiences and gives salience to moments of social synchrony that support infant development and brain maturation.
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Affiliation(s)
- Ortal Shimon-Raz
- IDC Herzliya, Bar Ilan UniversityRamat GanIsrael
- Department of Psychology, Bar Ilan UniversityRamat GanIsrael
| | - Roy Salomon
- Gonda Brain Research Center, Bar Ilan UniversityRamat GanIsrael
| | - Miki Bloch
- Department of Psychiatry, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Gabi Aisenberg Romano
- Department of Psychiatry, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Yaara Yeshurun
- School of Psychological Sciences, Tel Aviv UniversityTel AvivIsrael
| | - Adi Ulmer Yaniv
- IDC Herzliya, Bar Ilan UniversityRamat GanIsrael
- Gonda Brain Research Center, Bar Ilan UniversityRamat GanIsrael
| | | | - Ruth Feldman
- IDC Herzliya, Bar Ilan UniversityRamat GanIsrael
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Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052733. [PMID: 33800371 PMCID: PMC7967460 DOI: 10.3390/ijerph18052733] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women's health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.
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Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci 2021; 15:635304. [PMID: 33643013 PMCID: PMC7907173 DOI: 10.3389/fnhum.2021.635304] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding these effects is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk.
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Affiliation(s)
- Eamon Fitzgerald
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Michelle Z. L. Kee
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Michael J. Meaney
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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75
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Wdowiak A, Makara-Studzińska M, Raczkiewicz D, Janczyk P, Słabuszewska-Jóźwiak A, Wdowiak-Filip A, Studzińska N. Effect of Excessive Body Weight and Emotional Disorders on the Course of Pregnancy and Well-Being of a Newborn before and during COVID-19 Pandemic. J Clin Med 2021; 10:jcm10040656. [PMID: 33572044 PMCID: PMC7916002 DOI: 10.3390/jcm10040656] [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] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022] Open
Abstract
This study aimed to evaluate whether excessive body weight and the COVID-19 pandemic affect depression, and subsequently whether depression, excessive body weight, and the COVID-19 pandemic affect the course of pregnancy, as well as the well-being of a newborn. The research material included data retrieved from the medical records of 280 pregnant women who were provided with care by medical facilities in Lublin (100 women with normal weight, 100 overweight women, 50 with Class I and 30 with Class II obesity). They completed a Beck depression inventory (BDI) in pregnancy twice, in order to assess the risk of occurrence of postpartum depression. Pre-pregnancy BMI positively correlated with the severity of depression, both at 10–13 weeks of pregnancy (p < 0.001), and at 32 weeks of pregnancy (p < 0.001). The higher the pre-pregnancy BMI, on average the higher the severity of depression. The severity of depression was significantly higher during the pandemic than before it in women with normal body weight before pregnancy (p < 0.001), as well as in those overweight (p < 0.001) and with Class II obesity (p = 0.015). Excessive body weight before pregnancy leads to depressive disorders during pregnancy, increases the risk of preterm delivery, and exerts a negative effect on the state of a newborn. Depressive symptoms among pregnant, overweight and obese women intensified during the COVID-19 pandemic.
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Affiliation(s)
- Artur Wdowiak
- Diagnostic Techniques Unit, Medical University of Lublin, ul. Staszica 4/6, 20-081 Lublin, Poland;
| | - Marta Makara-Studzińska
- Department of Health Psychology, Jagiellonian University Medical College, ul. Kopernika 25, 31-501 Kraków, Poland;
| | - Dorota Raczkiewicz
- Department of Medical Statistics, Center of Postgraduate Medical Education, School of Public Health, Kleczewska 61/63, 01-826 Warsaw, Poland;
| | - Paula Janczyk
- Nursing and Midwifery Institute, Jagiellonian University Medical College, Kopernika 25, 31-501 Kraków, Poland;
| | - Aneta Słabuszewska-Jóźwiak
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Żelazna 90, 01-813 Warsaw, Poland
- Correspondence: ; Tel.: +48-504187297
| | - Anita Wdowiak-Filip
- Department of Dermatology, Venerology and Pediatric Dermatology, Medical University of Lublin, Radziwiłłowska 13, 20-080 Lublin, Poland;
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76
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Psarraki EE, Kokka I, Bacopoulou F, Chrousos GP, Artemiadis A, Darviri C. Is there a relation between major depression and hair cortisol? A systematic review and meta-analysis. Psychoneuroendocrinology 2021; 124:105098. [PMID: 33310696 DOI: 10.1016/j.psyneuen.2020.105098] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Literature supports a causal role of stress in major depressive disorder (MDD). Hair cortisol concentration (HCC) has been widely used as a measure of long-term stress. Although elevated HCC has been observed in healthy people experiencing chronic stress, findings regarding individuals with mental disorders have been complicated. This review attempts to systematically present all the published research on major depression and HCC. An extensive search of databases was performed to identify articles that investigated this question. The initial search retrieved 142 studies, of which, 16 original articles were included in this review. Results were contradictory; most of the studies showed no significant HCC differences between MDD patients and controls, while others indicated either higher or lower HCC in MDD patients than controls. Higher HCC was reported in first depressive episode compared to recurrent MDD and controls; patients with comorbid MDD and anxiety disorder had higher HCC than controls. No significant HCC difference was found between patients with melancholic or atypical depression and controls. Findings concerning HCC in postpartum depression were inconsistent. A meta-analysis of the data extracted from seven studies of the sample was performed to quantify the degree of cortisol change in MDD patients vs. controls. A random effects model revealed no significant hair cortisol concentrations difference between depressed patients and healthy controls (SMD: -0.02, 95% CI: -0.36 to 0.32). Significant heterogeneity was identified across included studies (P = 0.002, I2 = 71%). The disagreement among studies' results indicates that there is room for improvement in this research field. Confounding factors independent of depression should be taken into consideration.
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Affiliation(s)
- Evgenia E Psarraki
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | - Ioulia Kokka
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece; Outpatient Specialty Clinic for Sexual Health, First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sophias Ave, 11528 Athens, Greece
| | - Flora Bacopoulou
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece; Center for Adolescent Medicine, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Goudi, 11527 Athens, Greece; University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, 1 Thivon Street, Goudi, 11527 Athens, Greece
| | - George P Chrousos
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece; Center for Adolescent Medicine, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Goudi, 11527 Athens, Greece; University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, 1 Thivon Street, Goudi, 11527 Athens, Greece
| | - Artemios Artemiadis
- Department of Neurology, Medical School, University of Cyprus, Shakolas Educational Center, Old Road Nikosia-Limmasol 215/6, 2029 Aglantzia, Nicosia, Cyprus
| | - Christina Darviri
- Postgraduate Program "The Science of Stress and Health Promotion", School of Medicine, National and Kapodistrian University of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece
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77
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Mariño-Narvaez C, Puertas-Gonzalez JA, Romero-Gonzalez B, Peralta-Ramirez MI. Giving birth during the COVID-19 pandemic: The impact on birth satisfaction and postpartum depression. Int J Gynaecol Obstet 2021; 153:83-88. [PMID: 33368216 PMCID: PMC9087776 DOI: 10.1002/ijgo.13565] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
Objective To understand how giving birth during the coronavirus disease 2019 (COVID‐19) pandemic affected women based on birth parameters (gestational age, type of birth and body weight at birth), satisfaction with childbirth, and development of postpartum depression. Methods This is a cross‐sectional study of 162 Spanish women. They were divided into two groups: those who gave birth before the pandemic (n = 82; from September 1, 2019 to March 1, 2020) and during the pandemic (n = 75; from April 1, 2020 to July 1, 2020). They were assessed using psychological instruments for postpartum childbirth satisfaction and postpartum depression. Results It was found that women who gave birth during the pandemic suffered higher levels of stress during childbirth (U = 2652.50; P = 0.040) and gave a worse rating of the quality of care received (U = 2703.50; P = 0.041). In addition, the percentage of postpartum depression was much higher in women who gave birth during the pandemic (χ2 = 4.31; P = 0.038). Conclusion Giving birth during the COVID‐19 pandemic could have an impact on greater dissatisfaction with childbirth, as well as increasing the risk of postpartum depression. Women who gave birth during the pandemic showed higher dissatisfaction with childbirth and more postpartum depression symptoms than those who gave birth before the pandemic.
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Affiliation(s)
- Carolina Mariño-Narvaez
- Mind, Brain and Behavior Research Center (CIMCYC), Granada, Spain.,Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | - Jose A Puertas-Gonzalez
- Mind, Brain and Behavior Research Center (CIMCYC), Granada, Spain.,Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Mind, Brain and Behavior Research Center (CIMCYC), Granada, Spain.,Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | - Maria Isabel Peralta-Ramirez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
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78
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Lindberg M, Nolvi S, Härkönen J, Aatsinki AK, Karlsson L, Karlsson H, Uusitupa HM. Associations between maternal socioeconomic, psychosocial and seasonal factors, infant characteristics and human milk cortisol concentrations. Am J Hum Biol 2021; 33:e23561. [PMID: 33398927 DOI: 10.1002/ajhb.23561] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/21/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Glucocorticoids are one component of human milk (HM) potentially affecting offspring development. Previous studies have identified various maternal, obstetric and socioeconomic characteristics that are associated with HM cortisol concentration but the literature is still scarce concerning these determinants in human populations. We aimed to identify which factors are linked with HM cortisol concentration at 2 months postpartum. METHODS We analyzed data from 340 lactating Finnish mothers using ordinary least squares regression with log-transformed HM cortisol concentration as the dependent variable. Potential predictors included obstetric and maternal factors (maternal age, parity status, delivery mode, gestational age, pre-pregnancy obesity, and smoking in pregnancy), socioeconomic status (education and socioeconomic class), subjective economic well-being, maternal psychosocial factors (postpartum depression and anxiety symptoms), infant sex and age, and HM sample characteristics (time of the day and season of the year at sample collection). RESULTS The strongest and most robust predictors were season of the year of sample collection and parity status. HM cortisol concentration was significantly higher for primiparas than multiparas. HM samples collected in summer showed significantly higher cortisol concentrations than those collected in winter, spring or autumn. CONCLUSIONS The findings suggest that parity and season of the year at sample collection may be important factors to control for when examining HM cortisol. The strongest and most robust associations were related to maternal and sample characteristics and not to socioeconomic and psychosocial distress. This may be related to the fact that the study was conducted in a low-risk population.
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Affiliation(s)
- Matti Lindberg
- Department of Social Research, University of Turku, Turku, Finland
| | - Saara Nolvi
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Turku, Finland.,Department of Medical Psychology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Turku Institute for Advanced Studies, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Juho Härkönen
- Department of Political and Social Sciences, European University Institute, Florence, Italy.,Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Anna-Katariina Aatsinki
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Henna-Maria Uusitupa
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Turku, Finland
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79
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Kim P. How stress can influence brain adaptations to motherhood. Front Neuroendocrinol 2021; 60:100875. [PMID: 33038383 PMCID: PMC7539902 DOI: 10.1016/j.yfrne.2020.100875] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Research shows that a woman's brain and body undergo drastic changes to support her transition to parenthood during the perinatal period. The presence of this plasticity suggests that mothers' brains may be changed by their experiences. Exposure to severe stress may disrupt adaptive changes in the maternal brain and further impact the neural circuits of stress regulation and maternal motivation. Emerging literature of human mothers provides evidence that stressful experience, whether from the past or present environment, is associated with altered responses to infant cues in brain circuits that support maternal motivation, emotion regulation, and empathy. Interventions that reduce stress levels in mothers may reverse the negative impact of stress exposure on the maternal brain. Finally, outstanding questions regarding the timing, chronicity, types, and severity of stress exposure, as well as study design to identify the causal impact of stress, and the role of race/ethnicity are discussed.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, CO, United States.
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80
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Bais B, Hoogendijk WJG, Lambregtse-van den Berg MP. Light therapy for mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:49-61. [PMID: 34266611 DOI: 10.1016/b978-0-12-819973-2.00004-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this chapter, light therapy for mood disorders is discussed, including mood disorders during and after pregnancy. In the introduction, we discuss the symptomatology, etiology, and treatment of a specific type of mood disorder, seasonal affective disorder, since it kick-started the first clinical trials with light therapy. Second, we elaborate on the pathophysiology of mood disorders, in particular in the peripartum period. Next, we present an overview of the proposed working mechanisms of light therapy, followed by a discussion of the clinical trials that have followed after the initial research in seasonal affective disorder. Finally, we also focus on the limitations of these trials, such as considerable heterogeneity among studies and many methodological shortcomings. This is complemented by a number of suggestions for future research. Further studies are needed, which stems from the fact that the results have not always been consistent. Despite this, light therapy may be a promising treatment option for various types of mood disorders, since it shows a significant reduction in symptoms in many patients with few adverse effects.
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Affiliation(s)
- Babette Bais
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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81
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Moyer SW, Kinser PA. A Comprehensive Conceptual Framework to Guide Clinical Practice and Research About Mental Health During the Perinatal Period. J Perinat Neonatal Nurs 2021; 35:46-56. [PMID: 33528187 DOI: 10.1097/jpn.0000000000000535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.
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82
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Ghimire U, Papabathini SS, Kawuki J, Obore N, Musa TH. Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction- an updated meta-analysis. Early Hum Dev 2021; 152:105243. [PMID: 33190020 DOI: 10.1016/j.earlhumdev.2020.105243] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022]
Abstract
AIM Depression during pregnancy is a significant cause of adverse birth outcomes, and its prevalence has increased in recent years. This study aimed to give an updated quantification of the risk of preterm birth (PTB), low birth weight (LBW) and intrauterine growth restriction (IUGR) that is associated with antenatal depression. METHOD The search was done in different databases, including Web of Science, Scopus and PubMed, from January 2010 to March 2020, and only English-language articles were considered. We only included studies that assessed depression during pregnancy and those that reported data on antenatal depression with at least one adverse birth outcome (PTB, LBW, or IUGR). The quality of studies was assessed using an adaptation of the Newcastle-Ottawa scale assessment tool. The analysis was conducted using STATA (version 12), pooled effect sizes were calculated using the random-effects model and heterogeneity was tested for using the I2 statistic. RESULTS The analysis included 23 studies of PTB, LBW and IUGR. There was a significant risk of PTB (RR = 1.35, 95% CI 1.19-1.52), LBW (RR = 1.86, 95% CI 1.32-2.62) and IUGR (RR = 4.39, 95% CI 2.45-7.86). Control for confounders, time of assessing depression, among others altered the risk of LBW due to depression. In addition, depressed women in developing countries had a higher risk of PTB (RR = 2.07, 95% CI 1.13-3.81). CONCLUSION This study identifies a significant risk of PTB, LBW and IUGR due to antennal depression and recognises a need for targeted preventive interventions such as prompt screening to improve and promote maternal mental health care.
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Affiliation(s)
- Upama Ghimire
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China.
| | - Shireen Salome Papabathini
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Joseph Kawuki
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China; Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Nathan Obore
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Taha Hussein Musa
- Key Laboratory of Environmental Medicine Engineering, Department Epidemiology and Health Statistics, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China; Biomedical Research Institute, Darfur College, Nyala, Sudan
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83
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Luong-Thanh BY, Nguyen LH, Murray L, Eisner M, Valdebenito S, Hoang TD, Phuc Do H, Vo TV. Depression and its associated factors among pregnant women in central Vietnam. Health Psychol Open 2021; 8:2055102920988445. [PMID: 33598304 PMCID: PMC7841685 DOI: 10.1177/2055102920988445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To date, little attention has been given to prenatal depression, especially in low and middle-income countries. The aim of this research was to assess the prevalence of depression and its associated factors amongst pregnant women in a central Vietnamese city. This cross-sectional study included 150 pregnant women from 29 to 40 weeks of gestation, from eight wards of Hue city, via quota sampling from February to May 2019. We employed the Patient Health Questionnaire (PHQ-9) to assess depression. Findings suggest the need to provide routine screening of pregnant women in primary care for depressive symptoms and other mental health problems.
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Affiliation(s)
- Bao-Yen Luong-Thanh
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Lan Hoang Nguyen
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Linda Murray
- College of Health Sciences, Massey University, New Zealand
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Tuyen Dinh Hoang
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Huyen Phuc Do
- School of Public Health and Social Work, Queensland University of Technology (QUT), Australia
| | - Thang Van Vo
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
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84
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Bais B, Kamperman AM, Bijma HH, Hoogendijk WJ, Souman JL, Knijff E, Lambregtse-van den Berg MP. Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial. BMJ Open 2020; 10:e038030. [PMID: 33115894 PMCID: PMC7594358 DOI: 10.1136/bmjopen-2020-038030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Approximately 11%-13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy. DESIGN Randomised, double-blind controlled trial. SETTING Primary and secondary care in The Netherlands, from November 2016 to March 2019. PARTICIPANTS 67 pregnant women (12-32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders). INTERVENTIONS Participants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models. RESULTS Median depression scores decreased by 40.6%-53.1% in the BLT group and by 50.9%-66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings. CONCLUSIONS Depressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof. TRIAL REGISTRATION NUMBER NTR5476.
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Affiliation(s)
- Babette Bais
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Astrid M Kamperman
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Hilmar H Bijma
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Witte Jg Hoogendijk
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan L Souman
- Lighting Applications, Signify NV, Eindhoven, Noord-Brabant, The Netherlands
| | - Esther Knijff
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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85
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Qiu W, Hodges TE, Clark EL, Blankers SA, Galea LAM. Perinatal depression: Heterogeneity of disease and in animal models. Front Neuroendocrinol 2020; 59:100854. [PMID: 32750403 DOI: 10.1016/j.yfrne.2020.100854] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Perinatal depression (PND) can have either an antepartum or postpartum onset. Although the greatest risk factor for PND is previous depression history,de novoPND occurs with the majority of cases occurring in the postpartum. Timing of depression can impact etiology, prognosis, and response to treatment. Thus, it is crucial to study the impact of the heterogeneity of PND for better health outcomes. In this review, we outline the differences between antepartum and postpartum depression onset of PND. We discuss maternal physiological changes that differ between pregnancy and postpartum and how these may differentially impact depression susceptibility. We highlight changes in the maternal steroid and peptide hormone levels, immune signalling, serotonergic tone, metabolic factors, brain morphology, and the gut microbiome. Finally, we argue that studying the heterogeneity of PND in clinical and preclinical models can lead to improved knowledge of disease etiopathology and treatment outcomes.
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Affiliation(s)
- Wansu Qiu
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Travis E Hodges
- Department of Psychology, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Emily L Clark
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Samantha A Blankers
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Liisa A M Galea
- Graduate Program in Neuroscience, University of British Columbia, Canada; Department of Psychology, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada.
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Prenatal IL-6 levels and activation of the tryptophan to kynurenine pathway are associated with depressive but not anxiety symptoms across the perinatal and the post-partum period in a low-risk sample. Brain Behav Immun 2020; 89:175-183. [PMID: 32531426 DOI: 10.1016/j.bbi.2020.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 01/06/2023] Open
Abstract
Depression and anxiety symptoms are highly prevalent among women during pregnancy and post-partum. Previous studies suggest that one of the pathophysiological underpinnings could be an enhanced metabolism of tryptophan (Trp) into kynurenine (Kyn) due to increased inflammation. However, the longitudinal changes in the Kyn pathway and the complex interplay with inflammation and stress in women with perinatal depressive or anxiety symptoms are incompletely understood. We examined a cohort of healthy women at 34-36 gestational weeks. One hundred and ten women were assessed for salivary cortisol and 97 participants were also assessed for serum levels of Trp, Kyn and Interleukin 6 (IL-6). Women filled in two screening questionnaires for depressive (Edinburgh Postnatal Depression Scale (EPDS)) and anxiety (State Trait Anxiety Inventory subscale (STAI-S)) symptoms at 34-36 gestational weeks, delivery, 3 and 12 months postpartum. Unexpectedly, lower prenatal Kyn levels were associated with higher depressive symptoms in late pregnancy. Furthermore, prenatal Trp levels and the Kyn/Trp ratio moderate the association between IL-6 levels and depressive symptoms during the perinatal and the post-partum period. We found no interactions between Trp and Kyn biomarkers and cortisol on depressive symptoms. The observed associations were more robustly found for depressive symptoms, whereas weak and non-significant effects were found for the trajectory of anxiety symptoms. Overall, our data support the involvement of the Trp to Kyn pathway and inflammation in the course of depressive but not anxiety symptoms in women from late pregnancy until one-year post-partum, providing new evidence on the mechanisms regulating emotions during pregnancy and after delivery in a low-risk sample.
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87
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Nazzari S, Fearon P, Rice F, Ciceri F, Molteni M, Frigerio A. The biological underpinnings of perinatal depressive symptoms: A multi-systems approach. J Affect Disord 2020; 274:1004-1012. [PMID: 32663926 DOI: 10.1016/j.jad.2020.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/29/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Well-established evidence exists of an association between depressive symptoms and alterations in the stress and inflammatory response systems; however, the picture is far less coherent during the perinatal period. This study combines the assessment of multiple stress and inflammatory biomarkers in late pregnancy and after delivery in order to investigate cross-sectional and prospective associations with perinatal depressive symptoms. METHODS One-hundred-ten healthy women were assessed in late pregnancy (mean gestational age=34.76; SD=1.12) and 89 were re-evaluated after delivery (mean hours after delivery=52.36; SD=19.70) for depressive and anxiety symptoms through the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. Serum Interleukin-6 (IL-6), C-Reactive Protein (CRP) and diurnal salivary cortisol levels were measured on both occasions, while diurnal salivary alpha amylase (sAA) levels were assessed in late pregnancy. RESULTS Using Hierarchical Linear Models, higher depressive symptoms were found to be associated with higher IL-6 levels, lower morning cortisol levels and a flatter cortisol diurnal slope during pregnancy, while adjusting for potential confounders. No significant associations were found after delivery or with change in biomarker levels from pre- to post-partum. Furthermore, preliminary evidence of a positive association between inflammation and stress markers in women with higher antenatal depressive symptoms was found. LIMITATIONS The sample was relatively small and highly selected, thus limiting generalizability of the findings. CONCLUSIONS Results emphasize the need for an integrated multi-systems approach to the understanding of the biological underpinnings of perinatal depression and suggest that the stress-immune interactions represent a promising avenue for future endeavor.
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Affiliation(s)
- S Nazzari
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - P Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - F Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, United Kingdom
| | - F Ciceri
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - M Molteni
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - A Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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88
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Khoury JE, Bosquet Enlow M, Patwa MC, Lyons-Ruth K. Hair cortisol in pregnancy interacts with maternal depressive symptoms to predict maternal disrupted interaction with her infant at 4 months. Dev Psychobiol 2020; 62:768-782. [PMID: 32037544 PMCID: PMC7415595 DOI: 10.1002/dev.21950] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
Disrupted maternal interaction in early infancy is associated with maladaptive child outcomes. Thus, identifying early risk factors for disrupted interaction is an important challenge. Research suggests that maternal depressive symptoms and maternal cortisol dysregulation are associated with disrupted maternal interaction, but both factors have rarely been considered together as independent or interactive predictors of disrupted interaction. In a sample of 51 women, hair cortisol concentrations (HCC) and depressive symptoms were assessed during pregnancy, and depressive symptoms were assessed again at 4-month postpartum. Maternal disrupted interaction was assessed during the Still-Face Paradigm at 4 months. Results indicated that HCC and depressive symptoms interacted to predict both maternal withdrawing and inappropriate/intrusive interaction. Withdrawing interaction was associated with high levels of HCC in pregnancy in the context of high depressive symptoms at 4 months; inappropriate/intrusive interaction was associated with high levels of HCC in the context of low depressive symptoms. Thus, high HCC potentiated both forms of disrupted interaction. Results raised questions about the meaning of very low reported depressive symptoms, and underscored the importance of chronic stress physiology and maternal depressed mood as risk factors for distinct forms of maternal disrupted interaction, both of which are deleterious for infant development.
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89
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Meyer JS, Novak MA. Assessment of prenatal stress-related cortisol exposure: focus on cortisol accumulation in hair and nails. Dev Psychobiol 2020; 63:409-436. [PMID: 32783213 DOI: 10.1002/dev.22021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/02/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
Prenatal stress adversely affects offspring development. Although cortisol is hypothesized to be a key mediator of stress-induced developmental deficits, determining the amount of fetal cortisol exposure produced by maternal stress has proved challenging. Current approaches, such as measuring cortisol concentrations in maternal plasma, saliva, or urine, amniotic fluid, fetal plasma, or cord blood, all have significant limitations for assessing cumulative fetal cortisol exposure over time. A recently emerging approach is to measure cortisol concentrations in maternal hair and/or newborn hair or nail samples. Maternal hair cortisol potentially shows long-term production across each trimester of pregnancy, whereas neonatal hair or nail cortisol is thought to reflect mainly third trimester hormone accumulation. This review first describes fetal adrenocortical development, placental cortisol metabolism, and the various sources of fetal cortisol exposure across pregnancy. We then summarize the results obtained from "classical" methods of assessing prenatal cortisol exposure prior to the advent of hair and nail cortisol measurement. Lastly, we discuss the initial development and validation of the hair cortisol methodology, its subsequent application to studies of chronic stress, and recent findings regarding maternal and neonatal hair or nail cortisol concentrations in relation to prenatal stress and other variables of interest.
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Affiliation(s)
- Jerrold S Meyer
- Department of Psychological and Brain Sciences, Neuroscience and Behavior Program, University of Massachusetts, Amherst, MA, USA
| | - Melinda A Novak
- Department of Psychological and Brain Sciences, Neuroscience and Behavior Program, University of Massachusetts, Amherst, MA, USA
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90
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Leff-Gelman P, Flores-Ramos M, Carrasco AEÁ, Martínez ML, Takashima MFS, Coronel FMC, Labonne BF, Dosal JAZ, Chávez-Peón PB, Morales SG, Camacho-Arroyo I. Cortisol and DHEA-S levels in pregnant women with severe anxiety. BMC Psychiatry 2020; 20:393. [PMID: 32758184 PMCID: PMC7409431 DOI: 10.1186/s12888-020-02788-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance; several studies have reported increased cortisol levels during chronic stress and a weak counter-regulation by DHEA-S. During pregnancy, scarce information about this system is available, although cortisol and DHEA-S play an important role in the initiation and acceleration of labor. We conducted the present study in order to determine both cortisol and DHEA-S levels during the last trimester of pregnancy in patients exhibiting severe anxiety. METHODS Pregnant women during the 3rd trimester of pregnancy were evaluated by using the self-reported version of the Hamilton Anxiety Rating Scale (HARS). According to the scores obtained from the psychometric scale, participants were divided into two groups: 1) patients exhibiting a cutoff score > 15 were considered with severe anxiety (ANX) (n = 101), and control pregnant subjects (CTRL) (n = 44) with a cutoff score < 5. Morning cortisol, DHEA-S and Cortisol/DHEA-S index were measured in all participants. Comparisons between groups were performed; additionally, correlations between clinical variables, biochemical data and HARS were calculated. RESULTS Cortisol levels were significantly higher in the ANX group (p < 0.001), whereas those of DHEA-S were significantly lower in the same group (p < 0.01) when compared to healthy pregnant subjects. An increased cortisol/DHEA-S index was observed in the ANX group (p < 0.05). A significant association between cortisol and HARS scores (p = 0.03), was observed even after adjusting by gestational weeks (p = 0.004). CONCLUSIONS Our data support that the cortisol/DHEA-S index is higher in pregnant women with high anxiety levels as compared with healthy pregnant women.
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Affiliation(s)
| | - Mónica Flores-Ramos
- grid.419154.c0000 0004 1776 9908Instituto Nacional de Psiquiatría, 14370 CDMX Mexico City, Mexico ,grid.418270.80000 0004 0428 7635Consejo Nacional de Ciencia y Tecnología/CONACyT, 03940 CDMX Mexico City, Mexico
| | | | - Margarita López Martínez
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | | | - Fausto Manuel Cruz Coronel
- grid.414716.10000 0001 2221 3638Hospital General de México, Dr. Eduardo Liceaga, 06720 CDMX Mexico City, Mexico
| | - Blanca Farfán Labonne
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | | | | | - Saul Garza Morales
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | - Ignacio Camacho-Arroyo
- grid.9486.30000 0001 2159 0001Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, 04510 CDMX Mexico City, Mexico
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91
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Manu H, Lee S, Keyes MC, Cairns J, Baidoo SK. Behavioral and cortisol responses to feeding frequency in pregnant sows under isocaloric intake. J Anim Sci 2020; 98:skaa226. [PMID: 32681641 PMCID: PMC7431211 DOI: 10.1093/jas/skaa226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/13/2020] [Indexed: 01/21/2023] Open
Abstract
The study focused on behavioral and cortisol responses to feeding frequency in pregnant sows under isocaloric intake. Twenty-four sows [(Landrace × Yorkshire); BW 216.70 ± 3.98 kg; parity 3.04 ± 0.53] were balanced for parity and randomly assigned to 1 of 3 feeding frequency regimes. Sows were fed corn-soybean meal-based diet 1× [0730 (Control), T1], 2× [half ration at 0730 and 1530 hours, T2], or 3× [one-third portion at 0730, 1130, and 1530 hours, T3] from days 30 to 60 of gestation. Sows received 7055 kcal ME/d during gestation from 2.21 kg of diet formulated to contain SID Lys/ME of 1.71 g/Mcal. Saliva samples were collected every 2 hr from 0630 to 1830 hours on day 52 and assayed for cortisol using ELISA procedure. Behavior data were collected for 7 d from day 53 of gestation by affixing a remote insights ear tag to each sow. Each sow had 120,960 data points categorized into: "Active", "Feed," or "Dormant". Because of housing constraint, all sows were housed in individual stalls in the same room presenting a potential limitation of the study. The data were analyzed using PROC MIXED and GLIMMIX procedures of SAS 9.4 for cortisol and behavior count data, respectively. Sow was the experimental unit. The area under the curve (AUC) is quantitative evaluation of response as threshold varies over all possible values. The T2 sows had reduced 12-hr cortisol AUC compared with control sows (P = 0.024) and T3 sows (P = 0.004), respectively. The T2 sows had lower 3 hr (P = 0.039) and 5 hr (P = 0.015) postfeeding cortisol AUC compared with control sows. Feed anticipatory activity (FAA), 24-hr total activity, and feeding activities (eating and/or sham chewing) were reduced for T2 sows relative to the control and T3 sows (P < 0.01). Consequently, T2 sows had lower 24-hr total activity (P < 0.001) and feeding activities (P < 0.001) AUC compared with both the control and T3 sows, respectively. The T3 sows had greater FAA (P < 0.001) and 24-hr total activity AUC (P = 0.010) compared with control sows. Our data although inconclusive due to small sample size, twice daily feeding appears to be the threshold that reduces sows' total activity AUC, feeding activity AUC, and activation of hypothalamic-pituitary-adrenal axis, reduced hunger, and exhibit potential to improve sow welfare in relation to once and thrice daily feeding regimes under isocaloric intake per kilogram live metabolic weight.
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Affiliation(s)
- Hayford Manu
- Southern Research and Outreach Center, University of Minnesota, Waseca, MN
| | - Suhyup Lee
- Department of Swine and Poultry Science, Korea National College of Agriculture and Fisheries, Jeonju, Korea
| | | | | | - Samuel K Baidoo
- Southern Research and Outreach Center, University of Minnesota, Waseca, MN
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92
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Apter-Levy Y, Zagoory-Sharon O, Feldman R. Chronic Depression Alters Mothers' DHEA and DEHA-to-Cortisol Ratio: Implications for Maternal Behavior and Child Outcomes. Front Psychiatry 2020; 11:728. [PMID: 32793012 PMCID: PMC7387697 DOI: 10.3389/fpsyt.2020.00728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/10/2020] [Indexed: 02/02/2023] Open
Abstract
Maternal depression is a major public health problem that typically occurs in the period surrounding childbirth. The neurobiological mechanisms underlying maternal depression have been the focus of increasing research and studies pointed to the crucial role of the HPA axis in this disorder. However, most studies focused on cortisol expression and regulation while recent attention has shifted to include the sulfate steroids DHEA and DHEA-S. A community cohort of 1,983 women with no comorbid risk was recruited at birth and depression was assessed periodically across the first postpartum year. At 6 years, 156 families were re-visited: 46 mothers were defined as chronically-depressed and 103 controls reported no depression from birth to six years. Mothers and children were diagnosed by structured psychiatric interviews and mother-child interactions were observed. Maternal diurnal cortisol (CT) and dehydroepiandrosterone (DHEA) were assessed. Depressed mothers had lower levels of DHEA (AUCg), flattened DHEA diurnal variability (AUCi), and smaller DHEA-to-CT Ratio. Regression analysis demonstrated that maternal sensitivity during mother-child interaction was independently predicted by maternal depression, DHEA levels, child CT, and child social withdrawal. Results underscore the need for multi-level understanding of the dynamic interplay between maternal psychopathology, mother-child relationship, and pituitary-adrenal-cortex-to-medulla balance in studying the cross generational transfer of psychiatric vulnerability from depressed mothers to their children.
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Affiliation(s)
| | | | - Ruth Feldman
- The Center for Developmental Social Neuroscience, Interdisciplinary Center Herzliya, Herzliya, Israel
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93
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Romero-Gonzalez B, Caparros-Gonzalez RA, Cruz-Martinez M, Gonzalez-Perez R, Gallego-Burgos JC, Peralta-Ramirez MI. Neurodevelopment of high and low-risk pregnancy babies at 6 months of age. Midwifery 2020; 89:102791. [PMID: 32645601 DOI: 10.1016/j.midw.2020.102791] [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: 10/04/2019] [Revised: 06/06/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. STUDY DESIGN Longitudinal design SETTING: Spain PARTICIPANTS: A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. MEASUREMENT AND FINDINGS The average amount of cortisol in pregnant mothers' hair was determined in both groups. Following their birth, the babies' neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. KEY CONCLUSIONS These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies' neurodevelopment, including that of babies born from high-risk pregnancies. IMPLICATIONS FOR RESEARCH It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.
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Affiliation(s)
- Borja Romero-Gonzalez
- Mind, Brain and Behaviour Centre (CIMCYC). Faculty of Psychology, University of Granada, Granada, Spain; Personality, Assessment and Psychological Treatment Department, Faculty of Psychology, University of Granada, Granada, Spain
| | | | - Milagros Cruz-Martinez
- Obstetrics and Gynaecology Department, University Hospital San Cecilio, Granada, Granada, Spain
| | - Raquel Gonzalez-Perez
- Department of Pharmacology, CIBERehd, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | | - Maria Isabel Peralta-Ramirez
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology, University of Granada, Granada, Spain
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94
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Fekadu Dadi A, Miller ER, Woodman RJ, Azale T, Mwanri L. Effect of antenatal depression on adverse birth outcomes in Gondar town, Ethiopia: A community-based cohort study. PLoS One 2020; 15:e0234728. [PMID: 32555631 PMCID: PMC7299401 DOI: 10.1371/journal.pone.0234728] [Citation(s) in RCA: 7] [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: 10/18/2019] [Accepted: 06/01/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The impact of antenatal depression on pregnancy outcomes has been well investigated in developed countries, but few studies have been conducted in low-income countries. As depression is significantly affected by socio-economic and cultural factors, it would be difficult to generalize evidence from high-income countries to low-income countries. We conducted a community-based cohort study to estimate the incidence of adverse birth outcomes and the direct and indirect pathways via which depression and other psychosocial risk factors may impact such birth outcomes within Gondar town, Ethiopia. METHODS The study followed 916 pregnant women who were screened for antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS). We also assessed the incidence of preterm births, Low Birth Weight (LBW) and stillbirths. Modified Poisson regression was used to estimate the relative risk of predictors on adverse birth outcomes and a Generalized Structural Equation Model (GSEM) was used to estimate the direct and indirect effect of antenatal depression and other psychological risk factors on adverse birth outcomes. RESULTS The cumulative incidence of stillbirth, LBW and preterm was 1.90%, 5.25%, and 16.42%, respectively. The risk of preterm birth was 1.61, 1.46, 1.49, and 1.77 times higher among participants who identified as Muslim, reported being fearful of delivery, were government employee's, and who had no antenatal care services, respectively. Partner support moderated the association between depression, preterm birth, and LBW. Depression had no direct effect on birth outcomes but indirectly affected preterm birth via partner support. Religion had both direct and indirect effects on preterm birth, while occupation and fear of delivery had direct effects. The risk of LBW was 9.44 and 2.19 times higher among preterm births and those who had exposure to tobacco, respectively. Stress coping was indirectly associated, and preterm birth and tobacco exposure were directly associated with LBW. The risk of stillbirth was 3.22 times higher in women with antenatal depression and 73% lower in women with higher coping abilities. CONCLUSIONS There was a high incidence of all adverse birth outcomes in Gondar Town. Depression and psychosocial risk factors had important indirect negative effects on risk, while partner support provided a positive indirect effect on the incidence of adverse birth outcomes. Interventions that focus on increasing partner engagement and participation in antenatal support may help reduce adverse birth outcomes by enhancing maternal resilience.
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Affiliation(s)
- Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia
| | - Emma R. Miller
- Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia
| | - Richard J. Woodman
- Center for Epidemiology and Biostatistics, Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia
| | - Telake Azale
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia
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95
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Epstein CM, Houfek JF, Rice MJ, Weiss SJ, French JA, Kupzyk KA, Hammer SJ, Pullen CH. Early life adversity and depressive symptoms predict cortisol in pregnancy. Arch Womens Ment Health 2020; 23:379-389. [PMID: 31289940 PMCID: PMC7913604 DOI: 10.1007/s00737-019-00983-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
Evidence suggests that exposure to early life adversity (ELA) programs the hypothalamic-pituitary-adrenal (HPA) axis to influence responses to later adversity and predisposes women to depression. However, few studies have examined whether ELA moderates the HPA cortisol response to adulthood adversity and depressive symptoms in pregnant women. The aims of this study were to determine (a) whether ELA, adulthood adversity, and depressive symptoms differentially predict patterns of cortisol and (b) whether ELA moderates the relationship of adulthood adversity or depressive symptoms to cortisol. This was a descriptive, cross-sectional study of pregnant women (N = 58, mean = 26.5 weeks gestation). Participants completed the Stress and Adversity Inventory and Edinburgh Depression Scale and collected salivary cortisol five times per day for 3 days to assess cortisol awakening response (CAR), diurnal cortisol slope, and cortisol area under the curve (AUC). ELA predicted a larger CAR, while depressive symptoms predicted a blunted CAR and higher cortisol AUC. Adulthood adversity predicted a blunted CAR and steeper diurnal slope, but only in women with high ELA. ELA also moderated the effect of depressive symptoms on diurnal slope. Early adversity and depressive symptoms appear to have significant effects on the HPA axis during pregnancy, with early adversity also moderating effects of depressive symptoms and adulthood adversity on cortisol regulation. Early adversity may be an important factor in identifying unique HPA phenotypes and risk for HPA axis dysregulation in pregnancy.
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Affiliation(s)
- Crystal Modde Epstein
- UCSF School of Nursing, 2 Koret Way, San Francisco, CA, 94143, USA. .,UNMC College of Nursing, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA.
| | - Julia F Houfek
- UNMC College of Nursing, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
| | - Michael J Rice
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 East 19th Ave, Ed 2 North Bldg, Aurora, CO, 80045, USA
| | - Sandra J Weiss
- UCSF School of Nursing, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Jeffrey A French
- Department of Psychology, University of Nebraska at Omaha, 6001 Dodge St Allwine Hall 419, Omaha, NE, 68182, USA
| | - Kevin A Kupzyk
- UNMC College of Nursing, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
| | - Sharon J Hammer
- UNMC College of Medicine, S 42nd St & Emile St, Omaha, NE, 68198, USA
| | - Carol H Pullen
- UNMC College of Nursing, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
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96
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Werner A, Wu C, Zachariae R, Nohr EA, Uldbjerg N, Hansen ÅM. Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum-A randomized controlled trial. PLoS One 2020; 15:e0230704. [PMID: 32357152 PMCID: PMC7194394 DOI: 10.1371/journal.pone.0230704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. Methods In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. Findings During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). Conclusion Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.
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Affiliation(s)
- Anette Werner
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Chunsen Wu
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Robert Zachariae
- Department of Oncology, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Denmark
- Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Ellen A. Nohr
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Niels Uldbjerg
- Department of Gynecology and Obstetrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
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97
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Almanza-Sepulveda ML, Fleming AS, Jonas W. Mothering revisited: A role for cortisol? Horm Behav 2020; 121:104679. [PMID: 31927022 DOI: 10.1016/j.yhbeh.2020.104679] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
This selective review first describes the involvement of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy and the postpartum period, and the relation between peripartum HPA axis function and maternal behavior, stress reactivity and emotional dysregulation in human mothers. To provide experimental background to this correlational work, where helpful, animal studies are also described. It then explores the association between HPA axis function in mothers and their infants, under ongoing non-stressful conditions and during stressful challenges, the moderating role of mothers' sensitivity and behavior in the mother-child co-regulation and the effects of more traumatic risk factors on these relations. The overarching theme being explored is that the HPA axis - albeit a system designed to function during periods of high stress and challenge - also functions to promote adaptation to more normative processes, shown in the new mother who experiences both high cortisol and enhanced attraction and attention to and recognition of, their infants and their cues. Hence the same HPA system shows positive relations with behavior at some time points and inverse ones at others. However, the literature is not uniform and results vary widely depending on the number, timing, place, and type of samplings and assessments, and, of course, the population being studied and, in the present context, the state, the stage, and the stress levels of mother and infant.
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Affiliation(s)
- Mayra L Almanza-Sepulveda
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Alison S Fleming
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
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98
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Deems NP, Leuner B. Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease. Front Neuroendocrinol 2020; 57:100820. [PMID: 31987814 PMCID: PMC7225072 DOI: 10.1016/j.yfrne.2020.100820] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.
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Affiliation(s)
- Nicholas P Deems
- The Ohio State University, Department of Psychology, Columbus, OH, USA
| | - Benedetta Leuner
- The Ohio State University, Department of Psychology, Columbus, OH, USA.
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99
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Peñalver Bernabé B, Maki PM, Dowty SM, Salas M, Cralle L, Shah Z, Gilbert JA. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology (Berl) 2020; 237:915-941. [PMID: 32065252 DOI: 10.1007/s00213-019-05436-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
Perinatal depression is the most common complication of pregnancy and affects the mother, fetus, and infant. Recent preclinical studies and a limited number of clinical studies have suggested an influence of the gut microbiome on the onset and course of mental health disorders. In this review, we examine the current state of knowledge regarding genetics, epigenetics, heritability, and neuro-immuno-endocrine systems biology in perinatal mood disorders, with a particular focus on the interaction between these factors and the gut microbiome, which is mediated via the gut-brain axis. We also provide an overview of experimental and analytical methods that are currently available to researchers interested in elucidating the influence of the gut microbiome on mental health disorders during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Peñalver Bernabé
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shannon M Dowty
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariana Salas
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Lauren Cralle
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Zainab Shah
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jack A Gilbert
- Scripts Oceanographic Institute, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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100
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Conradt E, Shakiba N, Ostlund B, Terrell S, Kaliush P, Shakib JH, Crowell SE. Prenatal maternal hair cortisol concentrations are related to maternal prenatal emotion dysregulation but not neurodevelopmental or birth outcomes. Dev Psychobiol 2020; 62:758-767. [PMID: 32002996 DOI: 10.1002/dev.21952] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/18/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
Hair cortisol concentrations measured during pregnancy have emerged as a novel biomarker for prenatal stress exposure. However, associations between prenatal stress and distress, broadly defined, and hair cortisol concentrations during pregnancy are inconsistent. We examined relations among hair cortisol concentrations during the third trimester with (a) emotion dysregulation and (b) detailed measures of maternal prenatal stress. We also examined the predictive validity of maternal hair cortisol during pregnancy for adverse newborn health outcomes. Cortisol concentrations were derived from 6 cm of hair during the third trimester of pregnancy. Mothers reported on their emotion dysregulation and stress at this time. A standardized newborn neurobehavioral exam was conducted shortly after birth and newborn birth weight and gestational age were assessed from medical records. All hypotheses were preregistered on the Open Science Framework (osf.io/279ng). High levels of emotion dysregulation, but not stress, were predictive of high hair cortisol concentrations. Maternal prenatal BMI mediated the relation between maternal prenatal emotion dysregulation and hair cortisol concentrations. There was no association between hair cortisol and infant birth outcomes. This research supports the notion that transdiagnostic markers of psychopathology are important correlates of hair cortisol concentrations during pregnancy.
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Affiliation(s)
- Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brendan Ostlund
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Parisa Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
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