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Sun Q, Li G, Zhao F, Dong M, Xie W, Liu Q, Yang W, Cui R. Role of estrogen in treatment of female depression. Aging (Albany NY) 2024; 16:3021-3042. [PMID: 38309292 PMCID: PMC10911346 DOI: 10.18632/aging.205507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/28/2023] [Indexed: 02/05/2024]
Abstract
Depression is a neurological disorder that profoundly affects human physical and mental health, resulting in various changes in the central nervous system. Despite several prominent hypotheses, such as the monoaminergic theory, hypothalamic-pituitary-adrenal (HPA) axis theory, neuroinflammation, and neuroplasticity, the current understanding of depression's pathogenesis remains incomplete. Importantly, depression is a gender-dimorphic disorder, with women exhibiting higher incidence rates than men. Given estrogen's pivotal role in the menstrual cycle, it is reasonable to postulate that its fluctuating levels could contribute to the pathogenesis of depression. Estrogen acts by binding to a diversity of receptors, which are widely distributed in the central nervous system. An abundance of research has established that estrogen and its receptors play a crucial role in depression, spanning pathogenesis and treatment. In this comprehensive review, we provide an in-depth analysis of the fundamental role of estrogen and its receptors in depression, with a focus on neuroinflammation, neuroendocrinology, and neuroplasticity. Furthermore, we discuss potential mechanisms underlying the therapeutic effects of estrogen in the treatment of depression, which may pave the way for new antidepressant drug development and alternative treatment options.
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Affiliation(s)
- Qihan Sun
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Guangquan Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Fangyi Zhao
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Mengmeng Dong
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Wei Xie
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Qianqian Liu
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Wei Yang
- Department of Neurology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
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Gillenson CJ, Bagner DM, Darcy Mahoney A, Baralt M. A Preliminary Study of Executive Functioning in Preterm-Born Children: A Bilingual Advantage. Adv Neonatal Care 2023; 23:E121-E128. [PMID: 37788334 DOI: 10.1097/anc.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Preterm-born children are at increased risk for deficits in executive function (EF). EF is a set of cognitive processes including inhibition, attention, memory, and decision-making, among others. Bilingualism, operationalized as productive capacity in 2 languages (ie, English and Spanish), may enhance EF in children born preterm and in term-born children. PURPOSE The purpose of this study was to examine the impact of bilingualism on executive functioning in bilingual and monolingual preterm and term-born children using a robust measure of bilingualism. METHODS This study examined the impact of bilingualism on EF in 17 monolingual or bilingual preterm-born children, aged 6 to 7. The preterm-born sample was also compared with a normed, term-born sample of 38 monolingual, typically developing 6- to 7-year-olds. RESULTS On the Creature Counting task of EF, bilingual preterm-born children performed with more accuracy and total switches than monolingual preterm-born children. There was no difference in accuracy between the term-born and entire preterm-born samples. The bilingual, preterm-born children performed more accurately than the term-born sample. IMPLICATIONS FOR PRACTICE AND RESEARCH This preliminarily suggests bilingualism confers an advantage to preterm-born children's EF. Further research is needed on bilingual advantage of preterm-born children.
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Affiliation(s)
- Caroline J Gillenson
- Department of Psychology and Center for Children and Families (Ms Gillenson and Dr Bagner) and Department of Modern Languages and Center for Children and Families (Dr Baralt), Florida International University, Miami; and School of Nursing, George Washington University, Washington, District of Columbia (Dr Darcy Mahoney)
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Abasilim C, Persky V, Sargis RM, Argos M, Daviglus ML, Freels S, Tsintsifas K, Day T, Cai J, Isasi CR, Peters BA, Talavera GA, Thyagarajan B, Turyk ME. Association of Acculturation and Hispanic/Latino Background with Endogenous Sex and Thyroid-Related Hormones Among Middle-Aged and Older Hispanic/Latino Adults: the HCHS/SOL Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01762-8. [PMID: 37620727 DOI: 10.1007/s40615-023-01762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Hormones are linked to cardiometabolic diseases and may be impacted by acculturation though multiple mechanisms. We evaluated associations of Hispanic/Latino background and acculturation with levels of sex- and thyroid-related hormones and the potential mediating effect of adiposity, lifestyle factors, and sleep apnea syndrome on these associations. METHODS We studied 1789 adults, aged 45-74, from a sub-cohort of the Hispanic Community Health Survey/Study of Latinos. Peri/pre-menopausal women and individuals on medications related to hormones were excluded. Our study assessed eleven sex- and thyroid-related hormones, Hispanic/Latino background, and five acculturation measures. Associations were assessed using multivariable linear and logistic regression adjusted for survey design and confounding variables. We explored potential mediation using a path analysis. RESULTS In postmenopausal women, acculturation score-MESA was associated with decreased thyroid-stimulating hormone (β = - 0.13;95%CI = - 0.22, - 0.03) while age at immigration greater than the median (vs US-born) was associated with decreased (β = - 14.6; 95%CI = - 28.2, - 0.99) triiodothyronine (T3). In men, language acculturation and acculturation score-MESA were associated with increased estradiol and sex hormone-binding globulin (SHBG) while age at immigration greater and lesser than the median (vs US-born) was associated with decreased SHBG. Hispanic/Latino background (Mexicans as reference) were selectively associated with sex- and thyroid-related hormone levels in both sexes. Current smoking and sleep apnea syndrome partially mediated the association of Cuban and Puerto Rican heritage (vs Mexican) with T3 levels in men and postmenopausal women, respectively. CONCLUSION Selected acculturation measures were associated with thyroid-related hormones in postmenopausal women and sex-related hormones in men. Understanding the mechanisms involved in the relationship of acculturation and Hispanic/Latino background with hormones warrants additional investigation.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA.
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA.
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Maria Argos
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
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Stevenson K, Fellmeth G, Edwards S, Calvert C, Bennett P, Campbell OMR, Fuhr DC. The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Affiliation(s)
- Kerrie Stevenson
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; Institute of Health Informatics, University College London, London, UK.
| | - Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samuel Edwards
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Phillip Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany; Health Sciences, University of Bremen, Bremen, Germany
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Ruiz RJ, Grimes K, Spurlock E, Stotts A, Northrup TF, Villarreal Y, Suchting R, Cernuch M, Rivera L, Stowe RP, Pickler RH. The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:979. [PMID: 36577949 PMCID: PMC9795450 DOI: 10.1186/s12884-022-05284-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women. METHODS/DESIGN In this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is a culturally relevant, manualized, psychosocial, group intervention integrating two cognitive behavioral therapies for both pregnant Latinas and Black/African American women (total n = 221). Study inclusion criteria are: women with current pregnancy at 14-20 weeks gestation, ability to read and speak English or Spanish, self-identify as Latina of Mexican heritage or Black/African American, 18-45 years old, born in the US or Mexico, and currently living in the US. Participants must receive Medicaid or other government-supported insurance, and meet screening criteria for anxiety, depressive symptoms, or stress. Participants are randomly assigned to either the intervention (MLI) or usual care group (UCG) in groups of 6-8 participants that occur over 6 consecutive weeks. Data are collected at 3 time points: enrollment (14-20 weeks gestation), following treatment (20-26 weeks), and 6 weeks after treatment (32-36 weeks gestation). Additional outcome, mediating, and moderating data are collected from the electronic health record during pregnancy and at birth. Analyses will primarily use generalized linear mixed modeling (GLMM) to evaluate the relationships between predictors and outcomes. DISCUSSION This RCT will test the efficacy of two combined third generation cognitive behavioral therapies (the MLI), given in a group format over 6 sessions, as compared to a usual prenatal care group, for both Latina and African American pregnant women. If efficacious, it may be provided as an adjunct to routine prenatal care and improve mental health, as well as babies being born too small and too soon. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov . Bethesda (MD): National Library of Medicine. Identifier NCT05012072 , Reducing Pregnancy Risks: The Mastery Lifestyle Intervention (MLI); August 19, 2021. The trial is currently recruiting participants.
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Affiliation(s)
| | | | - Elizabeth Spurlock
- grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, Ohio, USA
| | - Angela Stotts
- grid.267308.80000 0000 9206 2401Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston Tx, USA
| | - Thomas F. Northrup
- grid.267308.80000 0000 9206 2401Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston Tx, USA
| | - Yolanda Villarreal
- grid.267308.80000 0000 9206 2401Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston Tx, USA
| | - Robert Suchting
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth), Houston, Tx, USA
| | | | - Liza Rivera
- Microgen Laboratories LLC, La Marque, Tx USA
| | | | - Rita H. Pickler
- grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, Ohio, USA
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Grant AD, Erickson EN. Birth, love, and fear: Physiological networks from pregnancy to parenthood. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100138. [PMID: 35757173 PMCID: PMC9227990 DOI: 10.1016/j.cpnec.2022.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
Pregnancy and childbirth are among the most dramatic physiological and emotional transformations of a lifetime. Despite their central importance to human survival, many gaps remain in our understanding of the temporal progression of and mechanisms underlying the transition to new parenthood. The goal of this paper is to outline the physiological and emotional development of the maternal-infant dyad from late pregnancy to the postpartum period, and to provide a framework to investigate this development using non-invasive timeseries. We focus on the interaction among neuroendocrine, emotional, and autonomic outputs in the context of late pregnancy, parturition, and post-partum. We then propose that coupled dynamics in these outputs can be leveraged to map both physiologic and pathologic pregnancy, parturition, and parenthood. This approach could address gaps in our knowledge and enable early detection or prediction of problems, with both personalized depth and broad population scale.
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Affiliation(s)
- Azure D. Grant
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, United States
- Levels Health Inc., 228 Park Ave. South, PMB 63877, New York, NY, 10003, United States
| | - Elise N. Erickson
- Oregon Health and Science University, Portland, OR, 97239, United States
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Acculturation and biological stress markers: A systematic review. Psychoneuroendocrinology 2021; 132:105349. [PMID: 34246155 PMCID: PMC8527572 DOI: 10.1016/j.psyneuen.2021.105349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The association of acculturation with health among immigrant populations is believed to be mediated, in part, by acculturation-related stress and stress biology. OBJECTIVES To review and qualitatively synthesize empirical findings on the relationship of acculturation with stress-related inflammatory and endocrine biomarkers and composite allostatic load (AL) scores. METHODS A literature search was performed in the PubMed and PsycInfo databases. Article titles, abstracts or full-texts were screened and checked for match with the search criteria. Studies were eligible if they empirically tested the relationship between acculturation and inflammatory/endocrine stress biomarkers or composite AL scores, and were published in the English language. RESULTS Among the 41 articles identified as relevant and included in this review, the majority were published after 2010, included adult Hispanic U.S.-based populations, used cross-sectional study designs, operationalized acculturation as a unidimensional construct, and varied considerably in the selection of covariates in the analyses. Acculturation was significantly associated with stress biomarkers in 29 studies, but the direction of effects varied across studies. Specifically, acculturation, operationalized as a higher orientation towards the host culture, was associated with inflammatory biomarkers in 10 of 14 studies, with endocrine stress biomarkers in 12 of 20 studies, and with composite AL scores in 7 of 8 studies. Overall, language-based proxy measures of acculturation were related to higher levels of stress-related inflammatory and endocrine biomarkers and to lower levels of AL scores, whereas nativity-, generation status- and length of stay-based proxy measures of acculturation were related to higher levels of inflammatory biomarkers and AL score. DISCUSSION The majority of studies reported associations between measures of acculturation and stress biomarkers, however the directions of effects varied across studies. We suggest this heterogeneity may, in part, be a function of limitations imposed by cross-sectional research designs and unidimensional measures of acculturation measures, and we highlight the need for longitudinal studies and use of multidimensional measures of acculturation to better uncover the biobehavioral mechanisms and pathways linking acculturation with health outcomes.
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Ruiz RJ, Newman M, Suchting R, Pasillas RM, Records K, Stowe RP, Moore TA. Pregnant Mexican American Biopsychosocial/Cultural risks for adverse infant outcomes. Nurs Open 2020; 8:709-720. [PMID: 33570300 PMCID: PMC7877225 DOI: 10.1002/nop2.676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/09/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Aims To test a model of psychosocial/cultural/biological risk factors for poor birth outcomes in Latina pregnant women. Design An observational study measuring acculturation, progesterone, cortisol, cotinine, age, marital status, income, stress, depressive symptoms and coping. We tested a structural equation model to predict risk. Methods We obtained a convenience sample (N = 515) of low medical risk pregnant Mexican American Hispanic women at 22–24 weeks of gestation. Bilingual research nurses collected data from blood, urine and questionnaires. Self‐report measures were the Beck Depression Inventory‐II, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans‐II and the Brief Cope. We measured progesterone and cortisol in plasma and cotinine levels in urine by enzyme‐linked immunoassays. Results A PLS‐SEM model revealed that Mexican American Hispanic pregnant women who were younger, single, lower income, more acculturated and who had greater negative coping, stress and depression were most at risk for having earlier and smaller babies.
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Affiliation(s)
| | - Matt Newman
- Serenity Research & Consulting, LLC, Austin, TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Kathie Records
- School of Nursing, The University of Northern Colorado, Greeley, CO, USA
| | | | - Tiffany A Moore
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
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Shay M, MacKinnon AL, Metcalfe A, Giesbrecht G, Campbell T, Nerenberg K, Tough S, Tomfohr-Madsen L. Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis. Psychol Med 2020; 50:2128-2140. [PMID: 32912348 DOI: 10.1017/s0033291720003062] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP. METHODS A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP. RESULTS In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54]. CONCLUSIONS When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
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Affiliation(s)
- Matthew Shay
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Anna L MacKinnon
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gerald Giesbrecht
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Insan N, Slack E, Heslehurst N, Rankin J. Antenatal depression and anxiety and early pregnancy BMI among White British and South Asian women: retrospective analysis of data from the Born in Bradford cohort. BMC Pregnancy Childbirth 2020; 20:502. [PMID: 32873239 PMCID: PMC7466782 DOI: 10.1186/s12884-020-03097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal obesity has severe physical impacts such as increased chances of pre-eclampsia and gestational diabetes. However, mental health impacts are given less attention within antenatal care. Evidence suggests that women with obesity carry increased risk of maternal depression and anxiety, however, this association is not well researched amongst South Asian women in the UK who are vulnerable to both. The aim of this study was to investigate the association between antenatal depression and anxiety and early pregnancy BMI, within and between White British and South Asian women, using data from the Born in Bradford cohort. METHODS Depression and anxiety were assessed using the General Health Questionnaire (GHQ); a GHQ score of > 0 for the depression subscale and > 6 for anxiety. Mother's BMI was stratified into six World Health Organisation BMI categories (underweight, recommended, overweight or obese class 1-3). To determine associations, univariate and multivariate logistic regression models (adjusting for maternal age, education, deprivation and smoking) were used. RESULTS There were 7824 women included (3514 White British and 4310 South Asian). South Asian women were more likely to have depression than White British (43.3% vs 36.1% p < 0.0001) and less likely to have anxiety (45.3% vs 48.4% p < 0.01). There were no significant associations between BMI and depression or anxiety in South Asian women. White British women with an overweight BMI had higher odds of anxiety compared with women with a recommended BMI (Adjusted Odds Ratio 1.25, 95% Confidence Interval 1.05-1.47). No significant associations were observed for other BMI categories. Smoking was a risk factor for antenatal depression (AOR 1.32, 95% CI 1.12-1.56; AOR 2.08, 95% CI 1.49-2.91) and anxiety (AOR 1.34, 95% CI 1.14-1.57; (AOR 2.87, 95% CI 2.02-4.07) in both White British and South Asian women, respectively. CONCLUSIONS Although South Asian women have a higher prevalence of depression than White women in this cohort, the known associations between maternal obesity and anxiety do not appear to be present. More studies are needed using validated depression tools for South Asian pregnant women. Mental health screening during antenatal care is important for South Asian women, with factors such as smoking considered.
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Affiliation(s)
- Nafisa Insan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Emma Slack
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
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11
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Scholaske L, Buss C, Wadhwa PD, Entringer S. Acculturation and interleukin (IL)-6 concentrations across pregnancy among Mexican-American women. Brain Behav Immun 2018; 73:731-735. [PMID: 30086398 PMCID: PMC6369138 DOI: 10.1016/j.bbi.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The process of acculturation (post-migration acquisition of host culture and/or loss of heritage culture) likely represents a key mediator of the observed post-migration decline in health that is evident among immigrant populations such as Mexican Americans. The observations that migrant health declines progressively as not only a function of length of stay in the U.S. but also across generations, and that this inter-generational decline in health is evident as early as at the time of birth itself, supports the concept of fetal programming of acculturation's effects. However, the underlying mechanisms remain to be elucidated. Inflammation during pregnancy represents a candidate pathway of particular interest for 2 reasons: it represents a key biological mediator of the psychosocial and/or behavioral sequelae of acculturation on health, and it represents a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent birth and child developmental and health outcomes. Therefore, the aim of this study was to examine the relationship between acculturation and inflammation across pregnancy in a population of Mexican-American women. Specifically, we tested the hypothesis that a higher level of acculturation is associated with higher circulating concentrations across pregnancy of the pro-inflammatory cytokine interleukin-6 (IL-6). METHODS 75 pregnant first- or second-generation Mexican-American women constituted the study population. Acculturation was quantified using a commonly-used and previously validated measure - the Acculturation Rating Scale for Mexican Americans (ARSMA). Maternal blood samples were collected during early, mid and late pregnancy for analysis of circulating IL-6 concentrations. RESULTS Hierarchical linear models indicated a significantly and positive main effect of acculturation on IL-6 concentrations across pregnancy after adjusting for key covariates including gestational age(s) at blood sampling, socioeconomic status, pre-pregnancy BMI, and presence of obstetric risk conditions. CONCLUSIONS Maternal inflammation during pregnancy may represent a biological pathway of interest in the context of the inter-generational effects of acculturation from a mother to her as-yet-unborn child.
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Affiliation(s)
- Laura Scholaske
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Luisenstrasse 57, 10117 Berlin, Germany
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Luisenstrasse 57, 10117 Berlin, Germany; Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States
| | - Pathik D Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States.
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Luisenstrasse 57, 10117 Berlin, Germany; Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, CA 92697, United States.
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12
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Fox M, Thayer ZM, Ramos IF, Meskal SJ, Wadhwa PD. Prenatal and Postnatal Mother-to-Child Transmission of Acculturation's Health Effects in Hispanic Americans. J Womens Health (Larchmt) 2018; 27:1054-1063. [PMID: 29608128 DOI: 10.1089/jwh.2017.6526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hispanic Americans consistently exhibit an intergenerational increase in the prevalence of many noncommunicable chronic physical and mental disorders. METHODS We review and synthesize evidence suggesting that a constellation of prenatal and postnatal factors may play crucial roles in explaining this trend. We draw from relevant literature across several disciplines, including epidemiology, anthropology, psychology, medicine (obstetrics, neonatology), and developmental biology. RESULTS Our resulting model is based on evidence that among women, the process of postmigration cultural adjustment (i.e., acculturation) is associated, during pregnancy and after delivery, with psychological and behavioral states that can affect offspring development in ways that may alter susceptibility to noncommunicable chronic disease risk in subsequent-generation Hispanic Americans. We propose one integrated process model that specifies the biological, behavioral, psychological, and sociocultural pathways by which maternal acculturation may influence the child's long-term health. We synthesize evidence from previous studies to describe how acculturation among Hispanic American mothers is associated with alterations to the same biobehavioral systems known to participate in the processes of prenatal and postnatal developmental programming of disease risk. In this manner, we focus on the concepts of biological and cultural mother-to-child transmission across the prenatal and postnatal life phases. We critique and draw from previous hypotheses that have sought to explain this phenomenon (of declining health across generations). We offer recommendations for examining the transgenerational effects of acculturation. CONCLUSION A life course model with a greater focus on maternal health and well-being may be key to understanding transgenerational epidemiological trends in minority populations, and interventions that promote women's wellness may contribute to the elimination or reduction of health disparities.
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Affiliation(s)
- Molly Fox
- 1 Department of Anthropology, UCLA , Los Angeles, California.,2 Department of Psychiatry and Biobehavioral Sciences, UCLA , Los Angeles, California
| | - Zaneta M Thayer
- 3 Department of Anthropology, Dartmouth College , Hanover, New Hampshire
| | - Isabel F Ramos
- 4 Department of Psychology, UCLA , Los Angeles, California
| | - Sarah J Meskal
- 5 Department of Institute for Society and Genetics, UCLA , Los Angeles, California
| | - Pathik D Wadhwa
- 6 Department of Psychiatry & Human Behavior, UC Irvine , Irvine, California.,7 Department of Pediatrics, UC Irvine , Irvine, California.,8 Department of Obstetrics & Gynecology, UC Irvine , Irvine, California.,9 Department of Epidemiology, UC Irvine , Irvine, California.,10 Department of Development, Health and Disease Research Program, UC Irvine , Irvine, California
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13
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Depression During Pregnancy and Adverse Birth Outcomes Among Predominantly Puerto Rican Women. Matern Child Health J 2018; 21:942-952. [PMID: 27995411 DOI: 10.1007/s10995-016-2195-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a population who experiences disparities in adverse birth outcomes and one of the highest infant mortality rates in the United States. Methods Proyecto Buena Salud (PBS) was a prospective cohort study conducted from 2006 to 2011 at a large tertiary care center in Western Massachusetts. Caribbean Islander (i.e., Puerto Rican and Dominican Republic) women were interviewed in early, mid and late pregnancy. Among 1262 participants, associations between depression, assessed using the Edinburgh Postnatal Depression Scale, and risk of preterm birth and small-for-gestational age (SGA) were evaluated. Results Women with at least probable minor depression [odds ratio (OR) = 1.77 (95% confidence interval (CI) = 1.02, 3.07)] or probable major depression [OR = 1.82 (95% CI = 1.01, 3.25)] in mid-pregnancy had an increased risk of SGA compared to non-depressed women in adjusted analyses. Borderline significant associations were observed between increasing levels of depressive symptom scores in early and mid-pregnancy [OR = 1.05 (95% CI = 1.00, 1.11) and OR = 1.04 (95% CI = 1.00, 1.09), respectively] and each additional trimester of exposure to probable major depression across mid- to late pregnancy [OR = 1.66 (95% CI = 1.00, 2.74)] and SGA. Late pregnancy depression was not associated with SGA; depression during pregnancy was not associated with preterm birth. Conclusions for Practice In this population of predominantly Puerto Rican women, mid-pregnancy depression increased risk for SGA. Findings can inform culturally appropriate, targeted interventions to identify and treat pregnant women with depression.
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Barcelona de Mendoza V, Harville E, Theall K, Buekens P, Chasan-Taber L. Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population. Matern Child Health J 2017; 20:1151-60. [PMID: 26694041 DOI: 10.1007/s10995-015-1901-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = -0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = -0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.
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Affiliation(s)
- Veronica Barcelona de Mendoza
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA. .,Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Emily Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Katherine Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, 70112, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Lisa Chasan-Taber
- University of Massachusetts- Amherst, School of Public Health and Health Sciences, 405 Arnold House, 715 N. Pleasant Street, Amherst, MA, 01003, USA
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15
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Anderson C, Strickland S. The Influence of Acculturation on Traumatic Stress Following Childbirth Among Hispanic Adolescents. HISPANIC HEALTH CARE INTERNATIONAL 2017; 15:99-106. [PMID: 29164933 DOI: 10.1177/1540415317717410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Many studies have explored the role of acculturation on health outcomes; however, no studies to date have examined relationships between acculturation and the traumatic stress of childbirth among Hispanic adolescents. METHOD A convenience sample of 66 Hispanic adolescents 13 to 19 years of age completed the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II), a demographic sheet, birth appraisal scale, and the Impact of Event Scale within 72 hours of birth. RESULTS Significant associations were found between the ARSMA-II subscales and acculturation proxy variables, excluding language; however, only the Mexican Orientation Subscale and generation proxy variable influenced the birth experience. The study findings showed that Hispanic adolescents reporting a more traumatic childbirth identified closer with the Mexican culture and reported fewer family generations residing in the United States. CONCLUSION As an overlooked area of research, our findings support the need for additional research related to the traumatic stress of birth among Hispanic adolescents. Using multiple acculturation measurements, including the ARSMA-II, with larger, more diverse samples of adolescents, equally balanced between all categories of acculturation and placement within the five-tier generation matrix, can provide some insightful information and directed health care.
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Affiliation(s)
- Cheryl Anderson
- 1 College of Nursing and Health Innovation, Arlington, TX, USA
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16
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Santos H, Fried EI, Asafu-Adjei J, Ruiz RJ. Network Structure of Perinatal Depressive Symptoms in Latinas: Relationship to Stress and Reproductive Biomarkers. Res Nurs Health 2017; 40:218-228. [PMID: 28220506 PMCID: PMC5503306 DOI: 10.1002/nur.21784] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 01/16/2023]
Abstract
Based on emerging evidence, mood disorders can be plausibly conceptualized as networks of causally interacting symptoms, rather than as latent variables of which symptoms are passive indicators. In an innovative approach in nursing research, we used network analysis to estimate the network structure of 20 perinatal depressive (PND) symptoms. Then, two proof-of-principle analyses are presented: Incorporating stress and reproductive biomarkers into the network, and comparing the network structure of PND symptoms between non-depressed and depressed women. We analyzed data from a cross-sectional sample of 515 Latina women at the second trimester of pregnancy and estimated networks using regularized partial correlation network models. The main analysis yielded five strong symptom-to-symptom associations (e.g., cry-sadness), and five symptoms of potential clinical importance (i.e., high centrality) in the network. In exploring the relationship of PND symptoms to stress and reproductive biomarkers (proof-of-principle analysis 1), a few weak relationships were found. In a comparison of non-depressed and depressed women's networks (proof-of-principle analysis 2), depressed participants had a more connected network of symptoms overall, but the networks did not differ in types of relationships (the network structures). We hope this first report of PND symptoms as a network of interacting symptoms will encourage future network studies in the realm of PND research, including investigations of symptom-to-biomarker mechanisms and interactions related to PND. Future directions and challenges are discussed. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hudson Santos
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB# 7460 Chapel Hill, NC 27599
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17
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Preciado A, D'Anna-Hernandez K. Acculturative stress is associated with trajectory of anxiety symptoms during pregnancy in Mexican-American women. J Anxiety Disord 2017; 48:28-35. [PMID: 27780654 PMCID: PMC5737703 DOI: 10.1016/j.janxdis.2016.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 02/01/2023]
Abstract
Over half of pregnant women report anxiety symptoms and these symptoms may be precipitated by stressful experiences. Anxiety rates may be higher in Mexican-American women who experience sociocultural stressors, such as acculturation, acculturative stress and discrimination. However, the role of such stressors on the trajectory of anxiety symptoms across pregnancy is not yet known. Mexican-American women (n=151) completed surveys across pregnancy about acculturation, acculturative stress, perceived discrimination, and state anxiety. Multilevel modeling found that acculturation (Anglo orientation, b=0.050, SE=0.379, t (137.561)=0.134, p=0.894; Mexican orientation, b=0.775, SE=0.692, t (133.424)=1.121, p=0.264) and perceived discrimination (b=-1.259, SE=0.921, t (137.489)=-1.367, p=0.174) were not associated with the trajectory of anxiety symptoms. However, acculturative stress, even while controlling for perceived stress, was associated with high levels of anxiety symptoms that were elevated early in pregnancy (b=-0.045, SE=0.022, t (135.749)=-2, p=0.047). This work highlights the unique role of acculturative stress in risk for prenatal anxiety in early pregnancy.
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Affiliation(s)
- Andrea Preciado
- Department of Psychology, California State University San Marcos, United States.
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18
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Fellmeth G, Fazel M, Plugge E. Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis. BJOG 2017; 124:742-752. [PMID: 27320110 DOI: 10.1111/1471-0528.14184] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration. OBJECTIVES This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC). SEARCH STRATEGY We systematically searched nine electronic databases and the grey literature using a predefined search strategy. SELECTION CRITERIA Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design. DATA COLLECTION AND ANALYSIS Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively. MAIN RESULTS Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population. CONCLUSIONS One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority. TWEETABLE ABSTRACT One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.
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Affiliation(s)
- G Fellmeth
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - E Plugge
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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19
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Accortt EE, Cheadle ACD, Dunkel Schetter C. Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J 2016; 19:1306-37. [PMID: 25452215 DOI: 10.1007/s10995-014-1637-2] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Complications related to preterm birth (PTB) and low birth weight (LBW) are leading causes of infant morbidity and mortality. Prenatal depression is a hypothesized psychosocial risk factor for both birth outcomes. The purpose of this systematic review was to examine evidence published between 1977 and 2013 on prenatal depression and risks of these primary adverse birth outcomes. A systematic search of the PUBMED and PsycINFO databases was conducted to identify studies testing the associations between prenatal depressive symptoms, or diagnoses of depression, and risk of PTB or LBW. We systematically selected 50 published reports on PTB and length of gestation, and 33 reports on LBW and BW. Results were reviewed by two independent reviewers and we evaluated the quality of the evidence with an established systematic review method, the Newcastle Ottawa Scale. We then undertook a narrative synthesis of the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Less than a quarter of 50 published reports found that prenatal depression was significantly associated with PTB or gestational age. In contrast, slightly more than half of the 33 reports found that prenatal depression was associated with LBW or BW. When weighing methodological features, we determined that the effects of prenatal depression on LBW are more consistent than effects on length of gestation or PTB. Although the evidence may not be strong enough to support routine depression screening for risk of adverse outcomes, screening to enable detection and timely treatment to reduce risk of postpartum depression is warranted. Further rigorous research on prenatal depression and adverse birth outcomes is needed.
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Affiliation(s)
- Eynav Elgavish Accortt
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA,
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20
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Anderson CA, Pierce L. Depressive Symptoms and Violence Exposure: Contributors to Repeat Pregnancies Among Adolescents. J Perinat Educ 2016; 24:225-38. [PMID: 26834444 DOI: 10.1891/1058-1243.24.4.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Depressive symptoms and violence exposure (VE) often cooccur and have been recognized to influence childbearing; contribution to repeat pregnancy is unclear and examined in this article. This cross-sectional, descriptive, study screened for depressive symptoms and VE among 193 adolescent mothers at a large county hospital in Southwestern United States. Repeat pregnancy and depressive symptoms characterized one-third and one-quarter of adolescents, respectively. Despite minimal disclosure of VE, repeat pregnancy was significantly influenced by child abuse and past traumatic life experiences. Assessments and interventions with adolescents should focus on frequency of repeat pregnancies and symptoms of depression and VE. Nurses and childbirth educators are poised to offer birth control information and education, support, and resources highlighting depression and VE to adolescents.
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21
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Rubin LP. Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics. Pediatr Res 2016; 79:127-35. [PMID: 26484619 DOI: 10.1038/pr.2015.203] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/13/2015] [Indexed: 11/09/2022]
Abstract
The concepts of allostasis (stability through adaptation) and accumulated life stress (McEwen's allostatic load) aim to understand childhood and adult outcomes. Chronic malnutrition, changes in social condition, and adverse early-life experiences may program phenotypes and contribute to long-lasting disease risk. However, integration of life course approaches, social and economic contexts, and comparison among different biopsychosocial models has not generally been explored. This review critically examines the literature and evaluates recent insights into how environmental stress can alter lifelong hypothalamic-pituitary-adrenal axis and immune system responsiveness and induce metabolic and neurodevelopmental maladaptation. Models of biopsychosocial stress overlap but may consider different conditions. Concepts include allostasis, which incorporates hormonal responses to predictable environmental changes, and Geronimus's "weathering," which aims to explain how socially structured, repeated stress can accumulate and increase disease vulnerability. Weathering emphasizes roles of internalized/interpersonal racism in outcomes disparities. For Mexican immigrants and Mexican Americans, the "acculturation" framework has proven especially useful to explore disparities, including preterm birth and neuropsychiatric risks in childhood. Complexities of stress assessments and recent research into epigenetic mechanisms mediating effects of physical, nutritional, psychological, and social stress are reviewed.
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Affiliation(s)
- Lewis P Rubin
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas
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22
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Ruiz RJ, Dwivedi AK, Mallawaarachichi I, Balcazar HG, Stowe RP, Ayers KS, Pickler R. Psychological, cultural and neuroendocrine profiles of risk for preterm birth. BMC Pregnancy Childbirth 2015; 15:204. [PMID: 26334745 PMCID: PMC4558793 DOI: 10.1186/s12884-015-0640-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/28/2015] [Indexed: 12/04/2022] Open
Abstract
Background Preterm birth remains a major obstetrical problem and identification of risk factors for preterm birth continues to be a priority in providing adequate care. Therefore, the purpose of this study was to elucidate risk profiles for preterm birth using psychological, cultural and neuroendocrine measures. Methods From a cross sectional study of 515 Mexican American pregnant women at 22–24 weeks gestation, a latent profile analysis of risk for preterm birth using structural equation modeling (SEM) was conducted. We determined accurate gestational age at delivery from the prenatal record and early ultrasounds. We also obtained demographic and prenatal data off of the chart, particularly for infections, obstetrical history, and medications. We measured depression (Beck Depression Inventory), mastery (Mastery scale), coping (The Brief Cope), and acculturation (Multidimensional Acculturation Scale) with reliable and valid instruments. We obtained maternal whole blood and separated it into plasma for radioimmunoassay of Corticotrophin Releasing Hormone (CRH). Delivery data was obtained from hospital medical records. Results Using a latent profile analysis, three psychological risk profiles were identified. The “low risk” profile had a 7.7 % preterm birth rate. The “moderate risk” profile had a 12 % preterm birth rate. The “highest risk” profile had a 15.85 % preterm birth rate. The highest risk profile had double the percentage of total infections compared to the low risk profile. High CRH levels were present in the moderate and highest risk profiles. Conclusion These risk profiles may provide a basis for screening for Mexican American women to predict risk of preterm birth, particularly after they are further validated in a prospective cohort study. Future research might include use of such an identified risk profile with targeted interventions tailored to the Hispanic culture.
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Affiliation(s)
- R Jeanne Ruiz
- Texas A&M University Health Science Center College of Nursing, 8447 State Highway 47, Bryan, TX, 77807-3260, USA.
| | - Alok Kumar Dwivedi
- Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Indika Mallawaarachichi
- Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Hector G Balcazar
- The University of Texas School of Public Health, El Paso Regional Campus, 1100 North Stanton Suite 110, El Paso, TX, 79902, USA.
| | - Raymond P Stowe
- Microgen Laboratories, 903 Texas Avenue, La Marque, TX, 77568, USA.
| | - Kimberly S Ayers
- Texas A&M University Health Science Center College of Nursing, 3950 N A.W. Grimes Blvd, Round Rock, TX, 78665, USA.
| | - Rita Pickler
- The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.
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23
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Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review. Women Birth 2015; 28:179-93. [DOI: 10.1016/j.wombi.2015.02.003] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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24
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Abstract
Frequently undiagnosed and untreated, prenatal depression affects approximately one in four childbearing women. Screening and appropriate management is essential to prevent adverse consequences to both the woman and her unborn infant. Early conversations between the woman and her nurse practitioner are essential to making medical management decisions.
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Affiliation(s)
- Cheryl A Anderson
- Cheryl A. Anderson is an associate professor and Carol Lieser is an associate professor of the Psych Nurse Practitioner Program at the University of Texas at Arlington, Arlington, Tex
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25
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Fox M, Entringer S, Buss C, DeHaene J, Wadhwa PD. Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective. Am J Public Health 2015; 105 Suppl 3:S409-23. [PMID: 25905831 PMCID: PMC4455494 DOI: 10.2105/ajph.2015.302571] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/04/2022]
Abstract
We propose a transdisciplinary, life span framework for examining the underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation-related processes in first-generation Hispanic immigrant mothers may affect the intrauterine development of an unborn child, via the process of fetal programming, to produce phenotypic effects that may alter the susceptibility for noncommunicable chronic diseases. In this manner, an intergenerational cascade of perpetuation may become established. Our framework may shed light on the biological, behavioral, and social causes of intergenerational cycles of vulnerability among immigrant minority groups, with public health and policy implications for primary prevention and intervention.
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Affiliation(s)
- Molly Fox
- Molly Fox is with the Early Human and Lifespan Development Program and the Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine. Sonja Entringer and Claudia Buss are with the UCI Development, Health, and Disease Research Program, School of Medicine, University of California, Irvine, and the Department of Medical Psychology, Charité Universitätsmedizin, Berlin, Germany. Jessica DeHaene and Pathik D. Wadhwa are with the UCI Development, Health, and Disease Research Program, School of Medicine, University of California, Irvine
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26
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Koniak-Griffin D, Brecht ML, Takayanagi S, Villegas J, Melendrez M. Physical activity and cardiometabolic characteristics in overweight Latina women. J Immigr Minor Health 2014; 16:856-64. [PMID: 23355122 PMCID: PMC3758377 DOI: 10.1007/s10903-013-9782-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This community-based study examined physical activity (PA) in relation to cardiometabolic risk factors among 223 adult, immigrant Latina women who were overweight or obese. Participants were predominantly of Mexican descent, married and low-income. Data were obtained through accelerometer readings and clinical measures (e.g., BMI, waist circumference, blood pressure, lipid profile, fasting blood sugar). Findings showed that many women were active (mean step count = 8,575 ± 3,191); 27.6 % achieved 10,000 steps per day, and only 11 % were sedentary. They engaged in short bouts of moderate PA rather than long-sustained moderate-to-vigorous activity. Three or more MetS traits were present in 45.3 % of the women, raising concerns about risk for diabetes and cardiovascular disease. More active women had lower BMI, weight, waist circumference, and triglycerides levels. Results point to the importance of targeting maintenance of PA in active women and intervening with culturally tailored programs to promote healthier behavior in those who are sedentary or somewhat active.
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Affiliation(s)
- Deborah Koniak-Griffin
- School of Nursing, University of California, Los Angeles (UCLA), 700 Tiverton Avenue, Factor Building 5-232, Los Angeles, CA, 90095-6919, USA,
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27
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Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstet Gynecol 2014; 123:857-67. [PMID: 24785615 DOI: 10.1097/aog.0000000000000170] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence and risk of antenatal and postpartum mental disorders among obese and overweight women. DATA SOURCES Seven databases (including MEDLINE and ClinicalTrials.gov) were searched from inception to January 7, 2013, in addition to citation tracking, hand searches, and expert recommendations. METHODS OF STUDY SELECTION Studies were eligible if antenatal or postpartum mental disorders were assessed with diagnostic or screening tools among women who were obese or overweight at the start of pregnancy. Of the 4,687 screened articles, 62 met the inclusion criteria for the review. The selected studies included a total of 540,373 women. TABULATION, INTEGRATION, AND RESULTS Unadjusted odds ratios were pooled using random-effects meta-analysis for antenatal depression (n=29), postpartum depression (n=16), and antenatal anxiety (n=10). Obese and overweight women had significantly higher odds of elevated depression symptoms than normal-weight women and higher median prevalence estimates. This was found both during pregnancy (obese odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27-1.61, overweight OR 1.19, 95% CI 1.09-1.31, median prevalence: obese 33.0%, overweight 28.6%, normal-weight 22.6%) and postpartum (obese OR 1.30, 95% CI 1.20-1.42, overweight OR 1.09, 95% CI 1.05-1.13, median prevalence: obese 13.0%, overweight 11.8%, normal-weight 9.9%). Obese women also had higher odds of antenatal anxiety (OR 1.41, 95% CI 1.10-1.80). The few studies identified for postpartum anxiety (n=3), eating disorders (n=2), or serious mental illness (n=2) also suggested increased risk among obese women. CONCLUSION Health care providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal-weight women, with intermediate risks for overweight women.
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28
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Chittoor G, Farook VS, Puppala S, Fowler SP, Schneider J, Dyer TD, Cole SA, Lynch JL, Curran JE, Almasy L, Maccluer JW, Comuzzie AG, Hale DE, Ramamurthy RS, Dudley DJ, Moses EK, Arya R, Lehman DM, Jenkinson CP, Bradshaw BS, Defronzo RA, Blangero J, Duggirala R. Localization of a major susceptibility locus influencing preterm birth. Mol Hum Reprod 2013; 19:687-96. [PMID: 23689979 DOI: 10.1093/molehr/gat036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Preterm birth (PTB) is a complex trait, but little is known regarding its major genetic determinants. The objective of this study is to localize genes that influence susceptibility to PTB in Mexican Americans (MAs), a minority population in the USA, using predominantly microfilmed birth certificate-based data obtained from the San Antonio Family Birth Weight Study. Only 1302 singleton births from 288 families with information on PTB and significant covariates were considered for genetic analysis. PTB is defined as a childbirth that occurs at <37 completed weeks of gestation, and the prevalence of PTB in this sample was 6.4%. An ∼10 cM genetic map was used to conduct a genome-wide linkage analysis using the program SOLAR. The heritability of PTB was high (h(2) ± SE: 0.75 ± 0.20) and significant (P = 4.5 × 10(-5)), after adjusting for the significant effects of birthweight and birth order. We found significant evidence for linkage of PTB (LOD = 3.6; nominal P = 2.3 × 10(-5); empirical P = 1.0 × 10(-5)) on chromosome 18q between markers D18S1364 and D18S541. Several other chromosomal regions (2q, 9p, 16q and 20q) were also potentially linked with PTB. A strong positional candidate gene in the 18q linked region is SERPINB2 or PAI-2, a member of the plasminogen activator system that is associated with various reproductive processes. In conclusion, to our knowledge, perhaps for the first time in MAs or US populations, we have localized a major susceptibility locus for PTB on chromosome 18q21.33-q23.
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Affiliation(s)
- G Chittoor
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78245-0549, USA
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29
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Ruiz RJ, Stowe RP, Brown A, Wommack J. Acculturation and biobehavioral profiles in pregnant women of Hispanic origin: generational differences. ANS Adv Nurs Sci 2012; 35:E1-E10. [PMID: 22869214 DOI: 10.1097/ans.0b013e3182626199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Hispanics, acculturation may lead to negative health outcomes. This study used a cross-sectional design to investigate the psychosocial and biological risks in acculturating pregnant women of Hispanic origin (n = 470). Psychosocial risks-depressive symptoms, anxiety, and stress-were assessed by self-report, whereas biological measures included stress-related and reproductive hormones. Mental health deteriorated across generations, with worsening depression, anxiety, and stress with successive generations. Stress and reproductive hormone levels decreased across generations, whereas body mass index and number of sexual partners increased. These data provide potential biobehavioral explanations of the relationship between acculturation and declining health among Hispanic women in the United States.
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30
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Walker JL, Ruiz RJ, Chinn JJ, Marti N, Ricks TN. Discrimination, acculturation and other predictors of depression among pregnant Hispanic women. Ethn Dis 2012; 22:497-503. [PMID: 23140083 PMCID: PMC3503150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The purpose of our study was to examine the effects of socioeconomic status, acculturative stress, discrimination, and marginalization as predictors of depression in pregnant Hispanic women. DESIGN A prospective observational design was used. SETTING Central and Gulf coast areas of Texas in obstetrical offices. PARTICIPANTS A convenience sample of 515 pregnant, low income, low medical risk, and self-identified Hispanic women who were between 22-24 weeks gestation was used to collect data. MEASURES The predictor variables were socioeconomic status, discrimination, acculturative stress, and marginalization. The outcome variable was depression. RESULTS Education, frequency of discrimination, age, and Anglo marginality were significant predictors of depressive symptoms in a linear regression model, F (6, 458) = 8.36, P<.0001. Greater frequency of discrimination was the strongest positive predictor of increased depressive symptoms. CONCLUSIONS It is important that health care providers further understand the impact that age and experiences of discrimination throughout the life course have on depressive symptoms during pregnancy.
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Affiliation(s)
- Janiece L Walker
- University of Texas at Austin, School of Nursing, Austin, TX, USA.
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