Depressive symptoms in the second trimester relate to low oxytocin levels in African-American women: a pilot study

Protocol for a pilot study assessing a virtual mindfulness intervention for postpartum African American women

Elevated perinatal depressive symptoms are more common among disadvantaged African American women, and they are almost four times as likely to have postpartum posttraumatic stress compared to white women. For new mothers, depressive symptoms and posttraumatic stress can lead to negative parenting, poor mother-infant bonding, and delayed infant development. For African American women, a culturally adapted mindfulness-based intervention offers great potential as an acceptable approach to reduce psycho-behavioral symptoms and improve mother-infant interactions (i.e., bonding). Additionally, it is critical that mindfulness interventions consider time constraints of new mothers, provide accessible intervention delivery, address parenting, and consider the challenges of caring for an infant. Given these considerations, we describe a pilot research protocol in which we evaluate a culturally adapted mindfulness program: Mindfulness for African Americans Postpartum (MAAP). The intervention is based upon Kabat-Zinn's Mindfulness Based Stress Reduction program, but is adapted to include culturally relevant concepts of spirituality, inter-dependence, self-empowerment, and storytelling, which are salient to African American culture. To accommodate the needs of new mothers, a certified mindfulness interventionist delivers each session virtually using Zoom. The investigation uses a randomized controlled design in which African American women within 12 months of giving birth are randomized either to the MAAP intervention or to an Education Program. The primary aim is to determine the extent to which the MAAP intervention decreases maternal psycho-behavioral symptoms (perceived stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue) and improves mother-infant bonding. A secondary aim is to explore the effects of MAAP on proinflammatory cytokines and oxytocin. Culturally adapted mindfulness interventions delivered virtually will make mindfulness more accessible and meaningful to populations, like African American new mothers, who are at higher risk for postpartum mood disorders and poor infant outcomes.

Investigation of Hypothalamic Pituitary Adrenal Axis and Oxytocinergic System Changes in a Pragmatic Randomized Controlled Feasibility Trial of Acupuncture for Antenatal Depression

Background: Antenatal depression is common and associated with detrimental impacts on women and their families. Disrupted neuroendocrine functioning is reported in women experiencing perinatal mental health disturbances. Preliminary randomized controlled trial (RCT) evidence suggests acupuncture may provide a safe and effective adjunct treatment; however, underlying mechanisms of effect are unclear. We conducted an RCT examination of acupuncture for the management of antenatal depressive symptomologies, which included oxytocinergic and hypothalamic pituitary adrenal (HPA) axis system evaluations. This article reports postintervention changes to cortisol: dehydroepiandrosterone (DHEA) ratios, and oxytocin (OT) hormone concentrations. Methods: Fifty-seven women with Edinburgh Postnatal Depression Scale (EPDS) scores ≥13 were randomized to receive individually tailored depressed specific acupuncture, progressive muscle relaxation (PMR) attention comparator, or treatment as usual (TAU). Weekly 1-h sessions were conducted for 8 weeks (24-31 of pregnancy). Preintervention and postintervention saliva samples were collected. Results: Postintervention mean cortisol: DHEA ratio differences were not significantly predicted by group allocation (n = 46, p = 0.065). Two-group comparisons demonstrated cortisol: DHEA ratios were significantly increased and predicted by group allocation when acupuncture was compared to TAU (p = 0.039); however, not between acupuncture and PMR (p = 0.179), or PMR and TAU (p = 0.421). Postintervention OT concentrations were not significantly predicted by group allocation. Limitations: Small sample size and posthoc analysis Conclusion: Findings suggest positive regulation of the HPA axis may be an underlying mechanism by which acupuncture provided the significant improvements to antenatal depression, stress, and distress observed in this cohort. Trial Registration: Registered on March 19, 2015, with the Australian New Zealand Clinical Trials Registry (ACTRN12615000250538).

Oxytocin system polymorphisms rs237887 and rs2740210 variants increase the risk of depression in pregnant women with early abuse

Prepartum depression is associated with early adversity, pregnancy complications, preterm delivery, postpartum depression, and long-term effects on child neurodevelopment. The oxytocin (OXT) system is affected by early adverse experiences and has been associated with depression. In the current study, we investigated risk factors for prenatal depressive symptoms, mainly the effects of early childhood and adolescence trauma, in combination with the presence of certain variants of polymorphisms of OXT and OXT receptor (OXTR) genes. We hypothesized that early childhood and adolescence trauma has higher negative effects in carriers of genetic variants of the OXT/OXTR system, increasing their risk for depression. Early in pregnancy (8-14 weeks), 141 pregnant women from a Uruguayan population were asked to provide DNA samples and complete questionnaires that assessed their experience of child abuse, depression symptoms, and other variables that included demographic information. Our results showed that 23.5% of pregnant women had depressive symptoms. Several OXT and OXTR genetic variants were associated with higher risk of prepartum depression only in those pregnant women who suffered emotional abuse during infancy or adolescence. Logistic regression (Nagelkerke's R2  = .33) revealed that women who suffered early abuse and were carriers of the variants CC of rs2740210 (OXT) or AA of rs237887 (OXTR) had significantly higher risk of experiencing depressive symptoms. Antecedents of psychiatric disorders also contributed to the risk of depression. We conclude that emotional abuse contributes to the risk of depression in different ways in women carrying different OXT and OXTR genetic variants. Early detection and closer follow-up of women with child abuse and certain OXT genetic variants, among other risk factors, could reduce the long-term impact of prepartum depression.

Maternal stress and vulnerability to depression: coping and maternal care strategies and its consequences on adolescent offspring

Depressive mothers often find mother-child interaction to be challenging. Maternal stress may further impair mother-child attachment, which may increase the risk of negative developmental consequences. We used rats with different vulnerability to depressive-like behavior (Wistar and Kyoto) to investigate the impact of stress (maternal separation-MS) on maternal behavior and adolescent offspring cognition. MS in Kyoto dams increased pup-contact, resulting in higher oxytocin levels and lower anxiety-like behavior after weaning, while worsening their adolescent offspring cognitive behavior. Whereas MS in Wistar dams elicited higher quality of pup-directed behavior, increasing brain-derived neurotrophic factor (BDNF) in the offspring, which seems to have prevented a negative impact on cognition. Hypothalamic oxytocin seems to affect the salience of the social environment cues (negatively for Kyoto) leading to different coping strategies. Our findings highlight the importance of contextual and individual factors in the understanding of the oxytocin role in modulating maternal behavior and stress regulatory processes.

Immunological and other biological correlates of the impact of antenatal depression on the mother-infant relationship

Antenatal depression affects up to 20% of pregnancies, yet research has historically focused on postnatal depression and its effects on mothers and their offspring. Studies are now emerging highlighting the impact that depression in pregnancy can also carry on both members of the dyad, including difficulties with psychological, physical, and social functioning. More specifically, researchers have begun to examine whether antenatal depression may lead to difficulties in the developing mother-infant relationship and subsequent infant attachment. While much of the research on this has explored psychosocial mechanisms behind the pathway from antenatal depression to a disrupted relationship in the postpartum, few studies have looked at biological underpinnings of this process. Of the literature that exists, it has been found that mothers with depression in pregnancy have lower levels of oxytocin and increased levels of inflammatory markers, plausibly creating difficulties in the mother-infant bonding process, leading to impaired mother-infant interactions and non-secure infant attachment. Furthermore, infants with non-secure attachments are at risk of entering a proinflammatory state due to a dysregulated stress response system. Overall, the literature on the neurobiology of mother-infant interactions and infant attachment in the context of antenatal depression is sparse, thus warranting future research.

Are pregnancy and postpartum oxytocin level a predictive biomarker for postpartum depression?

AIM

This study aims to determine the relationship between the late pregnancy and postpartum oxytocin levels and postpartum depression (PPD) symptoms.

METHODS

This longitudinal study was conducted with 70 pregnant women. Data collection was performed through two interviews. While the first interview was conducted in the 30th to 38th gestational weeks, the second interview was conducted in the 4th to 12th weeks in the postpartum period. Oxytocin level measurement was performed with a saliva sample. Saliva samples were analyzed with enzyme-linked immunosorbent assay kits.

RESULTS

The prevalence of depressive symptoms in the postpartum period was found significantly higher than the prevalence in late pregnancy. Depression symptoms reached the highest level in the 12th week. The late pregnancy oxytocin level was significantly higher than the postpartum oxytocin level. A weak, negative correlation was found between PPD symptoms and the late pregnancy oxytocin level. However, when linear regression analysis was performed, it was concluded that there was a medium, negative relationship model between PPD symptoms and the late pregnancy oxytocin level. However, no relationships were found between PPD symptoms and oxytocin level.

CONCLUSION

In conclusion, this study found that the late pregnancy oxytocin level could be a predictive biomarker for postpartum depression. Predicting the risk of PPD in the pregnancy period could provide an opportunity for early diagnosis and treatment.

Oxytocin: at birth and beyond. A systematic review of the long-term effects of peripartum oxytocin

Oxytocin is one of the most commonly used medications during labour and delivery. Recent insights from basic neuroscience research suggest that the uterotonic effects of oxytocin may arguably be trivial when compared with its profound effects on higher-order human behaviour. The purpose of this review is to highlight the potential consequences of manipulating oxytocinergic signalling during the peripartum period and its long-term impact on the maternal-infant dyad. We identified four domains where modulation of oxytocinergic signalling might be consequential: postpartum depression; breastfeeding; neurodevelopment; and chronic pain, and performed a literature search to address the impact of peripartum oxytocin administration. We have shown modest, but inconsistent, evidence linking peripartum oxytocin administration with postpartum depression. Breastfeeding success appeared to be negatively correlated with peripartum oxytocin exposure, perhaps secondary to impaired primitive neonatal reflexes and maternal-infant bonding. The association between perinatal oxytocin exposure and subsequent development of neurodevelopmental disorders such as autism in the offspring was weak, but these studies were limited by the lack of information on the cumulative dose. Finally, we identified substantial evidence for analgesic and anti-hypersensitivity effects of oxytocin which might partly explain the low incidence of chronic pain after caesarean birth. Although most data presented here are observational, our review points to a compelling need for robust clinical studies to better dissect the impact of peripartum oxytocin administration, and as stewards of its use, increase the precision with which we administer oxytocin to prevent overuse of the drug.

Views on Exercise Among Black Women During Pregnancy

OBJECTIVE

To describe and understand exercise practices, beliefs about exercise, support for exercise, barriers to exercise, and preferences for a group exercise program in the context of individual and environmental factors among Black women during pregnancy.

DESIGN

Mixed-methods design.

SETTING

Large university-affiliated urban midwifery practice.

PARTICIPANTS

Fourteen Black women who were pregnant.

METHODS

We conducted semistructured interviews to determine participants' exercise practices, beliefs about exercise while pregnant, exercise support and barriers, and preferences for a group pregnancy exercise program. Participants also completed self-report measures for exercise, neighborhood environment, symptoms of depression, and sociodemographic characteristics. We used matrices to facilitate integrated analysis of the interview and self-report data to determine areas of concordance and discordance among the data sources and to note patterns in the data.

RESULTS

We identified and described themes that represented concepts in our data: Exercise Misinformation and Folklore, Supportfor Exercise While Pregnant, Barriers to Exercise While Pregnant, Perceived Health Benefits, and Exercise Program Preferences. Data diverged for some participants on neighborhood as a barrier to exercise. Except for the two participants with high levels of symptoms of depression, data converged regarding symptoms of depression as a barrier to exercise.

CONCLUSION

Health care providers can successfully promote exercise if they provide education about exercise during pregnancy, help pregnant women overcome barriers to exercise, prompt women to exercise with partners for tangible and social support while pregnant, and refer women to exercise programs for pregnant women if available.

The association of oxytocin with major depressive disorder: role of confounding effects of antidepressants

Major depressive disorder is a genetic susceptible disease, and a psychiatric syndrome with a high rate of incidence and recurrence. Because of its complexity concerning etiology and pathogenesis, the cure rate of first-line antidepressants is low. In recent years, accumulative evidences revealed that oxytocin act as a physiological or pathological participant in a variety of complex neuropsychological activities, including major depressive disorder. Six electronic databases (Web of Science, PubMed, Scopus, Google Scholar, CNKI, and Wanfang) were employed for researching relevant publications. At last, 226 articles were extracted. The current review addresses the correlation of the oxytocin system and major depressive disorder. Besides, we summarize the mechanisms by which the oxytocin system exerts potential antidepressant effects, including regulating neuronal activity, influencing neuroplasticity and regeneration, altering neurotransmitter release, down regulating hypothalamic-pituitary-adrenal axis, anti-inflammatory, antioxidation, and genetic effects. Increasing evidence shows that oxytocin and its receptor gene may play a potential role in major depressive disorder. Future research should focus on the predictive ability of the oxytocin system as a biomarker, as well as its role in targeted prevention and early intervention of major depressive disorder.

Is There an Association Between Oxytocin Levels in Plasma and Pregnant Women's Mental Health?

BACKGROUND: Mood and anxiety disorders are prevalent in women during peripartum. AIMS: Purpose of the present article was to study the relationship between oxytocin (OT) plasma levels and affective symptoms in women during the third trimester of pregnancy. METHODS: Thirty-four pregnant women (13 with an affective disorder, 9 with preeclampsia, and 12 controls) were evaluated through the Edinburgh Postnatal Depression Scale (EPDS), the State/Trait Anxiety Inventory Form Y (STAI-Y), and the Prenatal Attachment Inventory (PAI). A blood sample was collected from all participants, and OT plasma levels have been compared between diagnostic groups. The total sample has been divided into two groups, according to OT median plasma levels, and compared using (a) χ² tests for qualitative variables and (b) a multivariate analysis of covariance for quantitative ones. RESULTS: No statistically significant difference was found among the diagnostic groups in terms of OT plasma levels (F = 0.49, p = .62). Women with lower OT plasma levels, independent from the presence of preeclampsia or an affective disorder, showed worse EPDS and STAI-S total scores than individuals with higher hormone levels (F = 5.93, p = .02 and F = 7.57, p = .01, respectively). CONCLUSIONS: OT may play a role in the etiology of anxious/depressive symptoms during perinatal period independent from a medical or psychiatric diagnosis. This result has a clear effect on the quality of the relationship of patients with mental health professionals, including nurses, and higher levels of this hormone, in the light of its anxiolytic and antidepressive effect, may make easier medical and nursing procedures.

A cohort study of dysmenorrhea and risk of low birth weight

OBJECTIVE

Little is known about the association between maternal history of dysmenorrhea and perinatal outcomes. The aim of this study was to investigate the association between maternal history of dysmenorrhea and low birth weight (LBW).

METHODS

A total of 6754 pregnant women were recruited from the ongoing prospective cohort study in Guangxi, China, in 2015-2018. Information on the maternal history of dysmenorrhea was obtained by questionnaires including visual analog scale (VAS) questions during the first antenatal care visit. The association of maternal history of dysmenorrhea and LBW was evaluated using logistic regression analyses adjusted for confounding factors (infant sex, maternal age, parity, pre-pregnancy body mass index (BMI) (kg/m²), gestational age, alcohol use during pregnancy, passive smoking, and occupational status).

RESULTS

Mothers with a history of dysmenorrhea were more likely to give birth to LBW infants (adjusted odds ratio (OR)=1.44; 95% confidence interval (CI): 1.12, 1.83). Among women with a history of dysmenorrhea, women ≥29 years old (adjusted OR 1.46; 95% CI 1.02, 2.10), multiparous (adjusted OR 1.59, 95% CI 1.12, 2.25), and women gave birth to female infant (adjusted OR = 1.53, 95% CI = 1.11, 2.11) had a higher risk of LBW.

CONCLUSIONS

As the first cohort study to investigate the association between maternal history of dysmenorrhea and LBW, our study shows that dysmenorrhea may increase the risk of LBW.

Is Oxytocin "Nature's Medicine"?

Oxytocin is a pleiotropic, peptide hormone with broad implications for general health, adaptation, development, reproduction, and social behavior. Endogenous oxytocin and stimulation of the oxytocin receptor support patterns of growth, resilience, and healing. Oxytocin can function as a stress-coping molecule, an anti-inflammatory, and an antioxidant, with protective effects especially in the face of adversity or trauma. Oxytocin influences the autonomic nervous system and the immune system. These properties of oxytocin may help explain the benefits of positive social experiences and have drawn attention to this molecule as a possible therapeutic in a host of disorders. However, as detailed here, the unique chemical properties of oxytocin, including active disulfide bonds, and its capacity to shift chemical forms and bind to other molecules make this molecule difficult to work with and to measure. The effects of oxytocin also are context-dependent, sexually dimorphic, and altered by experience. In part, this is because many of the actions of oxytocin rely on its capacity to interact with the more ancient peptide molecule, vasopressin, and the vasopressin receptors. In addition, oxytocin receptor(s) are epigenetically tuned by experience, especially in early life. Stimulation of G-protein–coupled receptors triggers subcellular cascades allowing these neuropeptides to have multiple functions. The adaptive properties of oxytocin make this ancient molecule of special importance to human evolution as well as modern medicine and health; these same characteristics also present challenges to the use of oxytocin-like molecules as drugs that are only now being recognized.

Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease

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.

The role of serum oxytocin levels in the second trimester in regulating prenatal anxiety and depression: A sample from Shanghai Maternal-Child Pairs Cohort study

BACKGROUND

Recent research suggested that oxytocin might be associated with prenatal anxiety or depression. Also, our previous study indicated that resilience could buffer the effect of stress on prenatal anxiety and depression, which is a kind of psychological adjustment ability to stress in life. The effects of oxytocin and resilience are supposed to be similar but no study was carried out to find the association between them. Current evidence on the effect of oxytocin on prenatal mental health were with small sample size and equivocal results, especially with a lack of studies in Chinese pregnant women.

AIMS

To investigate the relationship between oxytocin and resilience, and its role in regulating prenatal anxiety and depression among Chinese women.

METHODS

The study was based on a sub-sample of the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) by stratified random sampling. A total of 632 participants completed blood collection for serum oxytocin measurement and questionnaires pertaining to early pregnancy stress and resilience in the second trimester, which were assessed by the Life Event Scale for Pregnancy Women (LESPW) and the revised Resilience Scale for Adults (RSA), respectively. Prenatal anxiety and depression were assessed by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively, at the third trimester. Correlation analysis and stratified linear regression analyses were conducted to understand the role of oxytocin in regulating prenatal anxiety and depression.

RESULTS

The concentration of serum oxytocin in the second trimester ranged from 98.14 pg⋅ml^-1 to 197.28 pg⋅ml^-1, and there was no significant difference between different gestational age (r = 0.024, P = 0.579). The association between stress and prenatal anxiety was stronger in high oxytocin group than that in low oxytocin group, with B value of 3.338 and 2.638, respectively, after adjusting for residence, educational level, family income and parity. The same effect was found in the association between stress and prenatal depression, with B value of 2.360 and 2.060, respectively. However, it was not significantly associated with early pregnancy stress (Z = 1.933, P = 0.630), prenatal anxiety (Z = 1.387, P = 0.165), prenatal depression (Z = -0.027, P = 0.978), nor resilience (F = 1.282, P = 0.280).

LIMITATIONS

The existence of recall bias and restricted residential areas of the participants may limit the extrapolation of the study. Also, unsynchronized sampling timing of the oxytocin and psychological resilience measures is another limitation.

CONCLUSIONS

Serum oxytocin levels in the second trimester had an effect of modification between early pregnancy stress and prenatal anxiety and depression. Pregnant women with high oxytocin in the second trimester should receive more attention and further study is needed on the mechanism of oxytocin for the mental health of pregnant women.

Anxiety or Nervousness Disturbs the Progress of Birth Based on Human Behavioral Evolutionary Biology

In general, anxiety or nervousness in pregnant women increases the risk of dystocia. Pregnant women are easily susceptible to anxiousness or nervousness. To support a safe and healthy birthing process, childbirth educators, other health-care professionals, and pregnant women require an in-depth understanding about the disruptive effects of anxiety or nervousness on birth progress. Anxiety and nervousness are difficult to quantify and may be influenced by culture. Therefore, reports comparing anxiety or nervousness with dystocia must include various biases. It is difficult to find this issue by medical research. Here, we discuss links between anxiety or nervousness and disturbance in the progress of birth based on the adaptive standpoint of human behavioral evolutionary biology.

A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant: Is Oxytocin Related to Posttraumatic Stress?

BACKGROUND

Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior.

PURPOSE

To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU).

METHODS

This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values.

RESULTS

Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r(8) = 0.8, P = .006) and lower levels of oxytocin (r(8) = 0.77, P = .026).

IMPLICATIONS FOR PRACTICE

These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms.

IMPLICATIONS FOR RESEARCH

Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.

Exploring associations between perinatal depression, anxiety, and urinary oxytocin levels in Latinas

Perinatal depression has been associated with lower oxytocin (OT) levels. However, few studies have explored this topic in relation to Latinas who are at high risk of perinatal depression. The objective of this study was to explore these associations in Latinas. A total of 108 Latinas in the third trimester of pregnancy participated in the study. Depression and urinary OT levels were assessed in pregnancy and 6 weeks postpartum. Nonparametric tests were implemented to test the proposed associations. Results revealed that 28% of the participants had probable depression in pregnancy, and 23% at 6 weeks postpartum. OT levels significantly decreased from prenatal to postpartum in the whole sample; however, participants with probable prenatal depression did not exhibit a significant change in OT levels. Participants who were depressed or anxious at 6 weeks postpartum exhibited persistently higher mean OT levels over time. A distinct pattern of higher levels of OT in depressed Latinas suggests that OT levels may be an important neuroendocrine factor contributing to depressive and anxious symptoms.

The maternal reward system in postpartum depression

The experience of motherhood is most often emotionally positive and rewarding, but for many new mothers suffering from postpartum depression (PPD), this is not the case. Preclinical and clinical research has sought to uncover brain changes underlying PPD in order to gain a better understanding of how this disorder develops. This review focuses on the mesolimbic dopamine system, particularly the ventral tegmental area-nucleus accumbens pathway which has been implicated in the regulation of critical functions disrupted in PPD including mood, motivation, and mothering. Specifically, we discuss normative changes in the mesolimbic system during motherhood in both rodents and humans and how these are impacted in PPD. We also consider modulation of mesolimbic dopamine by the hypothalamic neuropeptide oxytocin and how oxytocin-dopamine interactions regulate mood and mothering during the postpartum period. In addition to providing an overview of reward mechanisms in PPD, our goal is to highlight open questions which warrant further research.

The effects of intrapartum synthetic oxytocin on maternal postpartum mood: findings from a prospective observational study

Postpartum depression (PPD) affects up to 19% of all mothers, with detrimental effects on both mother and child. The antidepressant and anxiolytic effects of plasma oxytocin are well-documented, but it is still disputable whether synthetic oxytocin (synOT) may protect women against postpartum mood alterations. The current study examined the association between synOT intrapartum and maternal mood postpartum using a prospective design. Two hundred sixty women were screened for depressive symptoms in the last trimester of pregnancy and then again 6 weeks and 9 months postpartum using the Edinburgh Postnatal Depression Scale. They also completed Maternity Blues Questionnaire in the first postpartum week. The data concerning the intrapartum interventions and health status of the newborn were extracted from the medical records. Cox proportional hazards regression adjusted for a history of depression, mode of delivery, and childbirth experience showed that synOT predicted a significantly lower risk of PPD (HR = 0.65, 95% CI 0.45-0.95, p = 0.025). The risk factors for PPD included a history of depression (HR = 3.20, 95% CI 2.33-4.40, p < 0.001) and negative childbirth experience (HR = 1.39, 95% CI 1.01-1.90, p = 0.040). Logistic regression adjusted for the same covariates found no significant effect of synOT on maternity blues (OR = 0.64, 95% CI 0.31-1.32, p = 0.23). While synOT administered intrapartum does not affect maternal mood immediately, it may come to effect some weeks after childbirth to protect mothers from developing PPD symptoms.

Role of oxytocin in parental behaviour

Both animal and human studies have provided conclusive evidence that oxytocin (OXT) acts in the brain (eg, medial preoptic area, ventral tegmental area, nucleus accumbens) to promote parental behaviour under different reproductive and physiological conditions. OXT appears to accelerate and strengthen the neural process that makes newborns attractive or rewarding. Furthermore, OXT reduces stress/anxiety and might improve mood and well being, resulting in indirect benefits for parents. However, OXT also plays a role in the development of species reproductive and social strategies, making some species or individuals more prone to display caring activities in nonreproductive contexts. There are important differences in the development of the OXT system and its regulation by gonadal hormones that can make individuals or species very different. Those intra- and interspecific differences in the OXT system have been associated with differences in parental behaviour. For example, differences in OXT levels in body fluids and genetic variants for the OXT and OXT receptor genes have been associated with variability in parental mood and behaviour in humans. Thus, OXT has received much attention as a potential therapeutic agent for affective, emotional and behavioural problems. Despite many preliminary studies indicating promising findings, several unknown aspects of the OXT system remain to be addressed before we can achieve a complete understanding of its function in the brain. The enormous interest that this area of study has attracted in the last decade will likely continually contribute to advancing our understanding of the role of OXT in parental behaviour and other behavioural and physiological functions.

Perinatal depression and DNA methylation of oxytocin-related genes: a study of mothers and their children

The present study investigated the association of perinatal depression (PD) with differential methylation of 3 genomic regions among mother and child dyads: exon 3 within the oxytocin receptor (OXTR) gene and 2 intergenic regions (IGR) between the oxytocin (OXT) and vasopressin (AVP) genes. Maternal PD was assessed at 5 time-points during pregnancy and postpartum. Four groups were established based on Edinburgh Postnatal Depression Scale (EPDS) cut-off scores: no PD, prenatal or postpartum depressive symptoms only and persistent PD (depressive symptoms both prenatally and postpartum). Salivary DNA was collected from mothers and children at the final time-point, 2.9years postpartum. Mothers with persistent PD had significantly higher overall OXTR methylation than the other groups and this pattern extended to 16/22 individual CpG sites. For the IGR, only the region closer to the AVP gene (AVP IGR) showed significant differential methylation, with the persistent PD group displaying the lowest levels of methylation overall, but not for individual CpG sites. These results suggest that transient episodes of depression may not be associated with OXTR hypermethylation. Validation studies need to confirm the downstream biological effects of AVP IGR hypomethylation as it relates to persistent PD. Differential methylation of the OXTR and IGR regions was not observed among children exposed to maternal PD. The consequences of OXTR hypermethylation and AVP IGR hypomethylation found in mothers with persistent PDS may not only impact the OXT system, but may also compromise maternal behavior, potentially resulting in negative outcomes for the developing child.

Association of peripartum synthetic oxytocin administration and depressive and anxiety disorders within the first postpartum year

BACKGROUND

Due to its potent effects on social behavior, including maternal behavior, oxytocin has been identified as a potential mediator of postpartum depression and anxiety. The objective of this study was to examine the relationship between peripartum synthetic oxytocin administration and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to peripartum synthetic oxytocin would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure.

METHODS

Population-based data available through the Massachusetts Integrated Clinical Academic Research Database (MiCARD) were used to retrospectively (2005-2014) examine this relationship and calculate the relative risk of peripartum synthetic oxytocin for the development of postpartum depressive and anxiety disorders in exposed (n = 9,684) compared to unexposed (n = 37,048) deliveries.

RESULTS

Among deliveries to women with a history of prepregnancy depressive or anxiety disorder, exposure to peripartum oxytocin increased the risk of postpartum depressive or anxiety disorder by 36% (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.20-1.55). In deliveries to women with no history of prepregnancy depressive or anxiety disorder, exposure to peripartum oxytocin increased the risk of postpartum depressive or anxiety disorder by 32% compared to those not exposed (RR: 1.32; 95% CI: 1.23-1.42).

CONCLUSIONS

Contrary to our hypothesis, results indicate that women with peripartum exposure to synthetic oxytocin had a higher relative risk of receiving a documented depressive or anxiety disorder diagnosis or antidepressant/anxiolytic prescription within the first year postpartum than women without synthetic oxytocin exposure.

Oxytocin and depression in the perinatal period-a systematic review

Postpartum depression (PPD) is the most common postnatal psychiatric disorder, and it represents a considerable problem to the health and well-being of women and their families. Several pathogenic mechanisms have been identified in PPD, and recently, oxytocin (OT), known to be involved in childbirth and lactation, has drawn attention as a possible diagnostic and therapeutic tool in this disorder. The aim of this review was to assess and summarize the current literature on the relationship between OT as a potential depressive biomarker and depression in the perinatal period. We conducted a literature search on four electronic databases (Pubmed, PsycINFO, Web of Science, and Science Direct) by applying the following search terms: oxytocin AND (postpartum OR postnatal OR perinatal OR peripartum) AND (depression OR depressive). Six studies were included and a total of 620 pregnant women were recruited and completed the follow-up. Depressive symptoms were evaluated using self-report scales, and in three studies, the diagnosis of major depression was additionally confirmed using semi-structured interviews. Peripheral OT levels and depression were assessed during pregnancy and/or after delivery. Higher OT levels were associated with lower depressive symptoms, even if this association lacked statistical significance in two studies. Although some studies are beginning to shed light upon the complex nature of OT's effect in depression, its role as a diagnostic and therapeutic tool in PPD is still unclear. Future research is needed to clarify the neuroendocrinological and psychosocial particularities of mothers with PPD and to define a specific profile associated with OT dysfunction.

Racial discrimination predicts greater systemic inflammation in pregnant African American women

PURPOSE

Chronic exposure to racial discrimination by pregnant African American women may lead to allostatic overload; thereby, predisposing women to systemic inflammation. Thus, the goal of this study was to examine if experiences of racial discrimination are related to systemic inflammation in pregnant African Americans.

METHODS

A sample of 96 African American women from Chicago completed questionnaires and had blood drawn during the second trimester of pregnancy (19.7±2.5 weeks).

RESULTS

Experiences of racial discrimination were associated with higher cytokine levels of interleukin (IL)-4 (B=2.161, 95% CI = 1.02-3.30, p<.001) and IL-6 (B=1.859, 95% CI=.61-3.11, p=.004) when controlling for covariates.

CONCLUSION

These findings suggest that experiences of racial discrimination may cause physiological wear and tear on the body leading to alteration of immune functions. Nurses should inquire about women's experiences of racial discrimination and make referrals for community or church support groups for women who report racial discrimination.

Father Involvement and Psychological Well-Being of Pregnant Women

PURPOSE

This study examined the relationships among father of the baby involvement during pregnancy, depressive symptoms, and psychological well-being in African American women.

STUDY DESIGN AND METHODS

Using a prospective study design, a sample of 95 pregnant African American women receiving prenatal care at a medical center in Chicago completed the self-report instruments about father of the baby involvement, depressive symptoms, and psychological well-being twice during pregnancy, once at between 15 and 25 weeks and once between 25 and 37 weeks.

RESULTS

Eighty percent of women reported that the father of the baby was involved during their pregnancy. Twenty-eight percent of women had clinically relevant depressive symptoms (CES-D scores ≥16) at the first data collection and 25% of women had clinically relevant depressive symptoms at the second data collection. Compared with women who reported no father involvement during pregnancy, women who reported father involvement during pregnancy had lower levels of depressive symptoms and higher levels of psychological well-being.

CLINICAL IMPLICATIONS

Fathers' involvement is important during pregnancy; nurses should encourage fathers to participate at prenatal visits and ask questions, and educate fathers on pregnancy process and procedures during prenatal care.

Church Member Support Benefits Psychological Well-Being of Pregnant African American Women

Depression during pregnancy is common, and pregnant African American (AA) women are more likely to experience depressive symptoms compared with pregnant non-Hispanic white women. This study explored AA women's experience of church attendance, church member support, depressive symptoms, and psychological well-being at 15-25 weeks' gestation. Nurses need to be aware of the importance of church support and encourage clergy and church members to be supportive of pregnant women.

Inflammatory and Epigenetic Pathways for Perinatal Depression

Depression during the perinatal period is common and can have adverse consequences for women and their children. Yet, the biobehavioral mechanisms underlying perinatal depression are not known. Adverse early life experiences increase the risk for adult depression. One potential mechanism by which this increased risk occurs is epigenetic embedding of inflammatory pathways. The purpose of this article is to propose a conceptual model that explicates the linkage between early life adversity and the risk for maternal depression. The model posits that early life adversity embeds a proinflammatory epigenetic signature (altered DNA methylation) that predisposes vulnerable women to depression during pregnancy and the postpartum period. As proposed, women with a history of early life adversity are more likely to exhibit higher levels of proinflammatory cytokines and lower levels of oxytocin in response to the demands of pregnancy and new motherhood, both of which are associated with the risk for perinatal depression. The model is designed to guide investigations into the biobehavioral basis for perinatal depression, with emphasis upon the impact of early life adversity. Testing this model will provide a better understanding of maternal depressive risk and improve identification of vulnerable women who would benefit from targeted interventions that can reduce the impact of perinatal depression on maternal–infant health.

MATERNAL DEPRESSION AND CHILD OXYTOCIN RESPONSE; MODERATION BY MATERNAL OXYTOCIN AND RELATIONAL BEHAVIOR

BACKGROUND

Maternal postpartum depression (PPD) carries long-term detrimental effects on children's well-being, yet the mechanisms of transmission remain unclear. One possible pathway of vulnerability involves the oxytocinergic (OT) system, which is transferred from mother to child via sensitive caregiving and is disrupted in PPD.

METHOD

A large birth cohort (N = 1983) of women were repeatedly assessed for depression from birth to 6 years. Utilizing an extreme case design, two matched cohorts were formed; mothers chronically depressed from birth to 6 years and nondepressed controls (N = 97, depressed = 41, nondepressed; N = 56). At 6 years, mothers and children underwent psychiatric diagnosis, urinary OT was assayed from mother and child before and after social contact, and mother-child interactions were coded.

RESULTS

Baseline OT and OT response of mother and child were interrelated and children of depressed mothers showed low baseline OT and attenuated OT response. Child OT response was negatively predicted by maternal depression, child Axis-I psychopathology, maternal expressed negative affect, and child social withdrawal. Interaction effect of maternal baseline OT and depression emerged. Slope analysis indicated that when maternal OT was medium or low, child OT response was negatively impacted by maternal depression. However, when maternal OT was high, child OT was unaffected, suggesting that maternal OT functionality buffers the effects of depression on the child.

CONCLUSION

Results suggest involvement of the OT system in the cross-generational transfer of vulnerability, as well as resilience, from depressed mothers to their children. Because the OT system is open to interventions that enhance maternal touch and contact, findings have important implications for targeted early dyadic inventions.

Prevalence and Predictors of Depressive Symptoms in Pregnant African American Women

African American women may be especially vulnerable to antepartum depression, a major health concern during pregnancy. This study investigated the prevalence and predictors of depressive symptoms in a sample of African American women who were between 14-17 weeks pregnant, a timeframe that is typically thought to be a time of general well-being. Two-thirds reported a CES-D score ≥ 16 indicative of depressive symptomatology. Age, perceived stress (as measured by the Perceived Stress Scale [PSS]), and anxiety (as measured by the State Trait Anxiety Inventory [STAI]) predicted depressive symptoms; the interaction between PSS and STAI scores was also a significant predictor. Our study findings suggest that early identification of stress and anxiety, in addition to depressive symptoms, is vital for intervention with this group.