1
|
Eriksson A, Kimmel MC, Furmark T, Wikman A, Grueschow M, Skalkidou A, Frick A, Fransson E. Investigating heart rate variability measures during pregnancy as predictors of postpartum depression and anxiety: an exploratory study. Transl Psychiatry 2024; 14:203. [PMID: 38744808 PMCID: PMC11094065 DOI: 10.1038/s41398-024-02909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.
Collapse
Affiliation(s)
- Allison Eriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Mary Claire Kimmel
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marcus Grueschow
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas Frick
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
2
|
Hurwitz E, Butzin-Dozier Z, Master H, O'Neil ST, Walden A, Holko M, Patel RC, Haendel MA. Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study. JMIR Mhealth Uhealth 2024; 12:e54622. [PMID: 38696234 PMCID: PMC11099816 DOI: 10.2196/54622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. OBJECTIVE The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. METHODS Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. RESULTS Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method's specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. CONCLUSIONS This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies.
Collapse
Affiliation(s)
- Eric Hurwitz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zachary Butzin-Dozier
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Shawn T O'Neil
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anita Walden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Holko
- International Computer Science Institute, Berkeley, CA, United States
| | - Rena C Patel
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melissa A Haendel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
3
|
Singh Solorzano C, Grano C. Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy. J Psychosom Res 2023; 174:111484. [PMID: 37690332 DOI: 10.1016/j.jpsychores.2023.111484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/11/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Altered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms. METHODS In this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire - Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire - 9. RESULTS Findings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (β = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates. CONCLUSIONS Evaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.
Collapse
Affiliation(s)
| | - Caterina Grano
- Department of Psychology, Sapienza University, Rome, Italy.
| |
Collapse
|
4
|
Bossung V, Singer A, Ratz T, Rothenbühler M, Leeners B, Kimmich N. Changes in Heart Rate, Heart Rate Variability, Breathing Rate, and Skin Temperature throughout Pregnancy and the Impact of Emotions-A Longitudinal Evaluation Using a Sensor Bracelet. SENSORS (BASEL, SWITZERLAND) 2023; 23:6620. [PMID: 37514915 PMCID: PMC10385491 DOI: 10.3390/s23146620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: Basic vital signs change during normal pregnancy as they reflect the adaptation of maternal physiology. Electronic wearables like fitness bracelets have the potential to provide vital signs continuously in the home environment of pregnant women. (2) Methods: We performed a prospective observational study from November 2019 to November 2020 including healthy pregnant women, who recorded their wrist skin temperature, heart rate, heart rate variability, and breathing rate using an electronic wearable. In addition, eight emotions were assessed weekly using five-point Likert scales. Descriptive statistics and a multivariate model were applied to correlate the physiological parameters with maternal emotions. (3) Results: We analyzed data from 23 women using the electronic wearable during pregnancy. We calculated standard curves for each physiological parameter, which partially differed from the literature. We showed a significant association of several emotions like feeling stressed, tired, or happy with the course of physiological parameters. (4) Conclusions: Our data indicate that electronic wearables are helpful for closely observing vital signs in pregnancy and to establish modern curves for the physiological course of these parameters. In addition to physiological adaptation mechanisms and pregnancy disorders, emotions have the potential to influence the course of physiological parameters in pregnancy.
Collapse
Affiliation(s)
- Verena Bossung
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Adrian Singer
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Tiara Ratz
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | | | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Nina Kimmich
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| |
Collapse
|
5
|
Rådmark L, Osika W, Wallén MB, Nissen E, Lönnberg G, Bränström R, Henje E, Gardner R, Fransson E, Karlsson H, Niemi M. Autonomic function and inflammation in pregnant women participating in a randomized controlled study of Mindfulness Based Childbirth and Parenting. BMC Pregnancy Childbirth 2023; 23:237. [PMID: 37038176 PMCID: PMC10084615 DOI: 10.1186/s12884-023-05528-2] [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: 06/07/2022] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are significant events in many women's lives, and the prevalence of depressive symptoms increases during this vulnerable period. Apart from well documented cognitive, affective, and somatic symptoms, stress and depression are associated with physiological changes, such as reduced heart-rate variability (HRV) and activation of the inflammatory response system. Mindfulness Based Interventions may potentially have an effect on both HRV, inflammatory biomarkers, and self-assessed mental health. Therefore, the aim of this study was to assess the effects of a Mindfulness Childbirth and Parenting (MBCP) intervention on HRV, serum inflammatory marker levels, through an RCT study design with an active control group. METHODS This study is a sub-study of a larger RCT, where significant intervention effects were found on perinatal depression (PND) and perceived stress. Participants were recruited through eight maternity health clinics in Stockholm, Sweden. In this sub-study, we included altogether 80 women with increased risk for PND, and blood samples and HRV measures were available from 60 of the participants (26 in the intervention and 34 in the control group). RESULTS Participants who received MBCP reported a significantly larger reduction in perceived stress and a significantly larger increase in mindfulness, compared to participants who received the active control treatment. However, in this sub-study, the intervention had no significant effect on PND, inflammatory serum markers or measures of HRV. CONCLUSIONS No significant differences were found regarding changes in HRV measures and biomarkers of inflammation, larger studies may be needed in the future. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02441595 . Registered 12 May 2015 - Retrospectively registered.
Collapse
Affiliation(s)
- Lina Rådmark
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden
| | - Walter Osika
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden
- Northern Stockholm Psychiatry, Stockholm Health Care Services, Vårdvägen 1, 112 81, Stockholm, Sweden
| | | | - Eva Nissen
- Karolinska Institutet, Department Women's and Children's Health, Stockholm, Sweden
| | - Gunilla Lönnberg
- Karolinska Institutet, Department Women's and Children's Health, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37, Uppsala, Sweden
| | - Richard Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Eva Henje
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, 901 85, Umeå, Sweden
| | - Renee Gardner
- Department of Global Public Health, Karolinska Institutet, Solnavägen 1 E, 10431, Stockholm, Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solnavägen 9, 171 65, Stockholm, Sweden
- Department of Women´s and Children´s Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Niemi
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, CSS, Center for Social Sustainability, Karolinska Institutet, Alfred Nobels allé 23, 141 83, Huddinge, Sweden.
- Department of Global Public Health, Karolinska Institutet, Solnavägen 1 E, 10431, Stockholm, Sweden.
| |
Collapse
|
6
|
Dias RA, de Faria Cardoso C, Ghimouz R, Nono DA, Silva JA, Acuna J, Baltatu OC, Campos LA. Quantitative cardiac autonomic outcomes of hydrotherapy in women during the first stage of labor. Front Med (Lausanne) 2023; 9:987636. [PMID: 36660001 PMCID: PMC9844258 DOI: 10.3389/fmed.2022.987636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/05/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Most hydrotherapy studies during childbirth report findings related to pain using a widespread set of subjective measures. In this study, ECG biomarkers as quantitative cardiac autonomic outcomes were used to assess the effects of warm shower hydrotherapy on laboring women during the first stage of labor. Methods This was a prospective single-blind cohort study on stage I delivering women. Their cardiac autonomic function was assessed using heart rate variability (HRV) measures during a deep breathing test using point-of-care testing comprised of an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. Labor pain and anxiety were assessed using the Visual Analog Scale for Pain (VASP) and the Beck Anxiety Inventory (BAI). A total of 105 pregnant women in the first stage of labor who received warm shower hydrotherapy, intravenous analgesia (scopolamine + sodium dipyrone), or spinal anesthetic (bupivacaine + morphine) were enrolled. Results In women during the first stage of labor, parasympathetic modulation reflected through RMSSD (root mean square of successive RR interval differences) was significantly reduced by hydrotherapy and intravenous analgesia (before vs. after mean rank diff. 35.73 and 65.93, respectively, p < 0.05). Overall HRV (SDNN, standard deviation of RR intervals) was significantly decreased only by intravenous analgesia (before vs. after mean rank diff. 65.43, p < 0.001). Mean heart rate was significantly increased by intravenous analgesia, while spinal anesthesia reduced it, and hydrotherapy did not alter it (before vs. after mean rank diff. -49.35*, 70.38*, -24.20 NS , respectively, *p < 0.05, NS not significant). Conclusion This study demonstrates that warm shower therapy may impact the sympathovagal balance via parasympathetic withdrawal in women during the initial stage of labor. The findings of this study provide quantitative support for using warm shower hydrotherapy during labor via point-of-care testing. The dependability of hydrotherapy as a non-pharmacological treatment is linked to the completion of more clinical research demonstrating quantitative evidence via outcome biomarkers to support indications on stress and birth progress.
Collapse
Affiliation(s)
- Raquel Aparecida Dias
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil
| | - Cláudia de Faria Cardoso
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil
| | - Rym Ghimouz
- Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Daniel Alessander Nono
- Center for Special Technologies, National Institute for Space Research (INPE), São José dos Campos, Brazil
| | | | - Juan Acuna
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates,*Correspondence: Ovidiu Constantin Baltatu,
| | - Luciana Aparecida Campos
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates,Luciana Aparecida Campos,
| |
Collapse
|
7
|
Singh Solorzano C, Violani C, Grano C. Pre-partum HRV as a predictor of postpartum depression: The potential use of a smartphone application for physiological recordings. J Affect Disord 2022; 319:172-180. [PMID: 36162652 DOI: 10.1016/j.jad.2022.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to investigate the role of a time-domain Heart Rate Variability index (the root mean square of successive difference between NN intervals, rMSSD) as a predictor of the onset of postpartum depression. HRV has been related to an increased risk of depression in the general population. However, its role in pregnant women is not clear, and the potential use of smartphone applications to evaluate HRV in this population has not been investigated. METHODS In study 1, simultaneous electrocardiogram and smartphone photoplethysmography were collected. The rMSSD was determined from each recording to evaluate the accuracy of a smartphone application in the measurement of HRV. In study 2, 135 pregnant women provided rMSSD values measured through a smartphone application in the prepartum (second or third trimester) and filled in the Edinburgh Postnatal Depression Scale in the postpartum (one month after the childbirth). RESULTS Study 1 showed the excellent accuracy of the smartphone application in the measurement of rMSSD. Study 2 indicated that lower prepartum rMSSD predicted higher depressive symptoms in the postpartum (β = -0.217, p = 0.010) after controlling for prepartum depressive symptoms and other potential covariates. LIMITATIONS Artefacts (e.g., hand movements) might have corrupted the physiological signal registered. CONCLUSION This study showed that a reduced vagal tone, indexed by lower rMSSD, during pregnancy was a predictor of depressive symptoms one month after childbirth. The prepartum period may offer an important timeframe to implement preventive intervention on vagal modulation in order to prevent depressive symptoms in the postpartum.
Collapse
Affiliation(s)
| | | | - Caterina Grano
- Department of Psychology, Sapienza University, Rome, Italy.
| |
Collapse
|
8
|
Sarhaddi F, Azimi I, Axelin A, Niela-Vilen H, Liljeberg P, Rahmani AM. Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context. JMIR Mhealth Uhealth 2022; 10:e33458. [PMID: 35657667 PMCID: PMC9206203 DOI: 10.2196/33458] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV. Objective The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period. Methods A total of 58 pregnant women were monitored using an Internet of Things–based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. Results HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004). Conclusions Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings.
Collapse
Affiliation(s)
| | - Iman Azimi
- Department of Computing, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | | | - Pasi Liljeberg
- Department of Computing, University of Turku, Turku, Finland
| | - Amir M Rahmani
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
- School of Nursing, University of California, Irvine, Irvine, CA, United States
- Institute for Future Health, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
9
|
Tung I, Krafty RT, Delcourt ML, Melhem NM, Jennings JR, Keenan K, Hipwell AE. Cardiac vagal control in response to acute stress during pregnancy: Associations with life stress and emotional support. Psychophysiology 2021; 58:e13808. [PMID: 33713448 PMCID: PMC8169537 DOI: 10.1111/psyp.13808] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 01/21/2023]
Abstract
Life stressors during pregnancy can disrupt maternal stress regulation and negatively impact offspring health. Despite the important role of cardiac vagal control (e.g., heart rate variability; HRV) in stress regulation, few studies have investigated how life stressors and emotional support influence vagal control during pregnancy. This study aimed to (a) characterize patterns of cardiac vagal control in response to a stressor administered in pregnancy, and (b) examine the effects of life stress and emotional support on vagal control during rest, reactivity, and recovery. Participants included 191 pregnant women (79% Black; 21% White) living in an urban U.S. city (73% receiving public assistance). Heart rate (HR) and HRV (indexed by RMSSD) were recorded continually during the preparation, task, and recovery periods of the Trier Social Stress Test (TSST). Participants reported recent life stressors (e.g., relationship problems, financial hardship) and emotional support. Piecewise growth curve modeling was used to model rates of reactivity and recovery, adjusting for gestational age at time of assessment and recent health problems. Life stress predicted greater HR and HRV reactivity to the TSST as well as greater HRV recovery (vagal rebound). However, associations were only evident for women reporting high emotional support. Results suggest that pregnant women living with frequent life stressors may exhibit more rapid autonomic responses to acute stress, including more rapid vagal rebound after stressors, potentially reflecting physiological adaptation to anticipated high-stress environments; emotional support may enhance these responses. Studies are needed to investigate long-term health outcomes related to this stress response pattern.
Collapse
Affiliation(s)
- Irene Tung
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert T. Krafty
- Department of Biostatistics and Bioinformatics, Emory University, GA
| | - Meaghan L. Delcourt
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nadine M. Melhem
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - J. Richard Jennings
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Alison E. Hipwell
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
10
|
Shah Z, Pal P, Pal GK, Papa D, Bharadwaj B. Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy. J Affect Disord 2020; 277:503-509. [PMID: 32882507 DOI: 10.1016/j.jad.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy is a unique physiological state with systemic changes including cardiovascular, autonomic, hemodynamic and psychological. Increase in incidence of stress and depression in antenatal period has been reported. Autonomic changes in pregnancy and its dysfunction in depression are well documented. However, there is lack of evidence associating cardiovascular autonomic dysfunction to stress and depressed mood in pregnant women. METHODS In this correlation study, we assessed cardiovascular autonomic functions of 172 pregnant women using heart rate variability (HRV) and baroreflex sensitivity (BRS). The Edinburg postnatal depression scale (EPDS) was used to evaluate depressive symptoms and perceived stress scale (PSS) was used to assess stress. The HRV and BRS parameters were correlated with EPDS and PSS. Multiple regression analysis was performed for EPDS and PSS individually to study their association with cardiac autonomic functions(CAF). RESULTS HRV and BRS were well correlated to EPDS and PSS scores. The depression and stress were found to be significantly associated to autonomic dysfunctions as increased sympathetic and decreased parasympathetic activity. Among various CAF parameters, LF:HF ratio and BRS were found to be significantly associated with depression and stress among these women. CONCLUSION LF:HF ratio and BRS may be associated with depression during antenatal period. The depression in antenatal period may add on to cardiovascular risk in expecting mothers.
Collapse
Affiliation(s)
- Zinkal Shah
- Department of Physiology, JIPMER, Puducherry 605006, India
| | - Pravati Pal
- Department of Physiology, JIPMER, Puducherry 605006, India.
| | | | - Dasari Papa
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
| | | |
Collapse
|
11
|
Mhajna M, Schwartz N, Levit-Rosen L, Warsof S, Lipschuetz M, Jakobs M, Rychik J, Sohn C, Yagel S. Wireless, remote solution for home fetal and maternal heart rate monitoring. Am J Obstet Gynecol MFM 2020; 2:100101. [DOI: 10.1016/j.ajogmf.2020.100101] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 12/11/2022]
|
12
|
Hypertensive Disorders of Pregnancy and Symptoms of Depression and Anxiety as Related to Gestational Age at Birth: Findings From the All Our Families Study. Psychosom Med 2019; 81:458-463. [PMID: 30985405 DOI: 10.1097/psy.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether symptoms of depression or state anxiety changed the strength or nature of the association between hypertensive disorders of pregnancy (HDP) and gestational age at birth. METHODS We conducted a secondary analysis of data from the All Our Families Cohort, a prospective pregnancy cohort study based in Calgary, Alberta, Canada. Self-reported depressive symptoms and state anxiety were assessed between 3 and 5 months of gestation, and obstetrical information, including diagnosis of HDP, parity, type of delivery, and gestational age at birth, was retrieved from the maternal discharge abstract. All models were adjusted for sociodemographic and obstetric confounders. RESULTS Of 2763 women who had a singleton pregnancy and live birth, 247 (9%) were diagnosed with HDP. Women with HDP had significantly shorter gestational length relative to those without the diagnosis (M = 37.87 versus M = 38.99 weeks of gestation), t(2761) = 9.43, p < .001. Moderation analyses showed significant HDP by depressive symptoms and HDP by state anxiety interactions, such that the strength of the association between HDP and gestational age at birth increased alongside greater depressive symptom and state anxiety severity. CONCLUSIONS Results suggest that depressive symptoms and state anxiety may add to the increased risk for shortened gestation associated with HDP. Women at high risk of cardiovascular complications during pregnancy may benefit from additional resources to manage symptoms of depression or anxiety.
Collapse
|
13
|
Herbell K. Identifying psychophysiological stress targets for the promotion of mental health in pregnant women. Arch Psychiatr Nurs 2019; 33:46-50. [PMID: 30663624 DOI: 10.1016/j.apnu.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Kayla Herbell
- Postdoctoral Fellow at the University of Missouri Sinclair School of Nursing S235 School of Nursing, University of Missouri, Columbia, MO 65211, United States of America.
| |
Collapse
|
14
|
Mindfulness skills during pregnancy: Prospective associations with mother's mood and neonatal birth weight. J Psychosom Res 2018; 107:14-19. [PMID: 29502758 DOI: 10.1016/j.jpsychores.2018.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Mindfulness skills have been associated with better mood and several health related outcomes. Because depressed mood during pregnancy has been related to worse child outcomes, the aim was to examine the association of mindfulness skills during pregnancy with the mother's depressive symptoms, gestational age, and neonatal birth weight. METHODS A subsample of 905 pregnant women who participated in the longitudinal cohort HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year) completed the 12-item Three Facet Mindfulness-Questionnaire-Short Form at 22weeks of gestation. The Edinburgh Depression Scale was completed to assess depressive symptoms at 12, 22 and 32weeks. The obstetric medical records were examined for gestational age and birth weight. RESULTS Mindfulness skills Acting with Awareness and Nonjudging at 22weeks were associated with less depressive symptoms at 22weeks and at 32weeks. When controlled for depressive symptoms at 22weeks, the association was still significant for Nonjudging predicting depressive symptoms at 32weeks (Beta=-0.12, p<0.01). Regarding the obstetric medical records, only Nonreacting was (positively) associated with birth weight (Beta=0.09, p<0.01). Controlling for gestational age, sex, parity, depressive symptoms, and health behavior, Nonreacting predicted a normal birth weight (OR=1.12, 95% CI=1.06-1.19), in contrast to low birth weight. CONCLUSION It seems that different mindfulness skills during pregnancy are important in predicting mother's depressive symptoms compared to the prediction of child's birth weight. Potential mechanisms are discussed.
Collapse
|
15
|
Glynn LM, Howland MA, Sandman CA, Davis EP, Phelan M, Baram TZ, Stern HS. Prenatal maternal mood patterns predict child temperament and adolescent mental health. J Affect Disord 2018; 228:83-90. [PMID: 29241049 PMCID: PMC10387303 DOI: 10.1016/j.jad.2017.11.065] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/08/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study quantifies the dynamics of maternal mood focusing on unpredictability, and to assess if greater unpredictability of prenatal maternal mood predicts child temperament and internalizing symptoms through early adolescence. METHODS The association between prenatal mood predictability and child internalizing symptoms were assessed in two longitudinal cohorts (N's = 227 and 180). Maternal mood was assessed repeatedly during pregnancy as early as 15 weeks' gestation. Predictability of maternal mood was calculated by applying Shannon's entropy to the distribution of responses on mood questionnaires. Maternal reports of child negative affectivity (a predictor of later internalizing) were collected at 6, 12, 24 months and 7 years of age. Child self-reports of anxiety symptoms were collected at 10 years and reports of depression symptoms at 13 years. RESULTS Fetal exposure to more elevated maternal mood entropy predicted higher levels of child negative affectivity at 12 months (r = .36; p < 01), 24 months (r = .31; p < 01) and 7 years (r = .32; p < 01) of age. In addition, children exposed to higher prenatal maternal mood entropy, reported higher levels of anxiety symptoms at 10 years (r = .24; p < 01) and elevated depressive symptoms at 13 years (r = .29; p < .01). These associations persisted after adjusting for maternal pre and postnatal mood valence (e.g. depression levels) and for other relevant demographic characteristics. CONCLUSIONS Our findings provide strong support for the notion that patterns of maternal mood influence the developing brain. More specifically, they suggest that prenatal maternal mood predictability may be a critical predictor of developmental mental health trajectories and should be considered when assessing early life influences on lifespan mental health.
Collapse
Affiliation(s)
- Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.
| | - Mariann A Howland
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Elysia P Davis
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA; Department of Psychology, University of Denver, Denver, CO, USA
| | - Michael Phelan
- Department of Statistics, University of California, Irvine, CA, USA
| | - Tallie Z Baram
- Department of Anatomy/Neurobiology, University of California, Irvine, CA, USA; Department of Pediatrics, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA
| | - Hal S Stern
- Department of Statistics, University of California, Irvine, CA, USA
| |
Collapse
|
16
|
Ecklund-Flores L, Myers MM, Monk C, Perez A, Odendaal HJ, Fifer WP. Maternal depression during pregnancy is associated with increased birth weight in term infants. Dev Psychobiol 2017; 59:314-323. [PMID: 28323349 DOI: 10.1002/dev.21496] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
Previous research of maternal depression during pregnancy suggests an association with low birth weight in newborns. Review of these studies reveals predominant comorbidity with premature birth. This current study examines antenatal depression and birth weight in term, medically low-risk pregnancies. Maternal physiological and demographic measures were collected as well. In total, 227 pregnant women were recruited to participate in four experimental protocols at Columbia University Medical Center. Results indicate that depressed pregnant women who carry to term had significantly higher heart rates, lower heart rate variability, and gave birth to heavier babies than those of pregnant women who were not depressed. Low income participants had significantly higher levels of depression, as well as significantly higher heart rates and lower heart rate variability, than those in higher income groups. In full-term infants, maternal prenatal depression appears to promote higher birth weight, with elevated maternal heart rate as a likely mediating mechanism.
Collapse
Affiliation(s)
- Lisa Ecklund-Flores
- Department of Psychology, Mercy College, Dobbs Ferry, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Michael M Myers
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
- Department of Pediatrics, Columbia University Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Stellenbosh University, Cape Town, South Africa
| | - Catherine Monk
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
- Department of Obstetrics, Columbia University Medical Center, New York, New York
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, New York
| | - Albany Perez
- Department of Psychology, Mercy College, Dobbs Ferry, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Hein J Odendaal
- Department of Obstetrics and Gynecology, Stellenbosh University, Cape Town, South Africa
| | - William P Fifer
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
- Department of Pediatrics, Columbia University Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Stellenbosh University, Cape Town, South Africa
| |
Collapse
|
17
|
Mizuno T, Tamakoshi K, Tanabe K. Anxiety during pregnancy and autonomic nervous system activity: A longitudinal observational and cross-sectional study. J Psychosom Res 2017; 99:105-111. [PMID: 28712414 DOI: 10.1016/j.jpsychores.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the longitudinal change in autonomic nervous system (ANS) activity during pregnancy and the association between anxiety during pregnancy and ANS activity. METHODS Pregnant Japanese women with a singleton fetus and normal pregnancy were recruited (n=65). ANS activity and anxiety were measured using a self-rating questionnaire at approximately 20, 30, and 36weeks of gestation. Very low (VLF) and high (HF) frequency bands of heart rate variability spectrums were used. Anxiety was assessed using the Japanese version of the State-Trait Anxiety Inventory. A score of 45 or more on trait-anxiety and the other represent the trait-anxiety group and the non- trait-anxiety group, respectively. The state-anxiety group and the non-state-anxiety group were defined in the same manner. RESULTS Longitudinal observation of individual pregnant women indicated the significant increasing trend (p=0.002) of VLF power and the significant decreasing trend (p<0.001) of HF power during 20 to 36 gestation weeks. Compared with the non-trait-anxiety group, the trait-anxiety group had significantly lower VLF values at 20 gestational weeks (p=0.033) and had significantly lower HF values at 30 and 36 gestational weeks (p=0.015 and p=0.044, respectively). The increasing rate of VLF from 20 to 36 gestational weeks was higher among the trait-anxiety group. The same associations were observed between the state-anxiety and non-state-anxiety groups at 20 gestational weeks. CONCLUSIONS Anxiety during pregnancy decreased heart rate variability. Anxiety in second trimester pregnancy promoted a subsequent increase in sympathetic activity.
Collapse
Affiliation(s)
- Taeko Mizuno
- Department of Nursing, Nagoya University Graduate, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture, Japan.
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture, Japan.
| | - Keiko Tanabe
- School of Medicine, Graduate School of Nursing, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi Prefecture, Japan.
| |
Collapse
|
18
|
Park SE, Park D, Song KI, Seong JK, Chung S, Youn I. Differential heart rate variability and physiological responses associated with accumulated short- and long-term stress in rodents. Physiol Behav 2017; 171:21-31. [DOI: 10.1016/j.physbeh.2016.12.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
|
19
|
Braeken MA, Jones A, Otte RA, Nyklíček I, Van den Bergh BR. Potential benefits of mindfulness during pregnancy on maternal autonomic nervous system function and infant development. Psychophysiology 2016; 54:279-288. [DOI: 10.1111/psyp.12782] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/12/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Marijke A.K.A. Braeken
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University; Hasselt Belgium
- Department of Psychology; KU Leuven Leuven Belgium
| | - Alexander Jones
- Institute of Cardiovascular Science, University College London; London UK
| | - Renée A. Otte
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
| | - Ivan Nyklíček
- Center for Research in Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University; Tilburg The Netherlands
| | - Bea R.H. Van den Bergh
- Faculty of Social and Behavioural Sciences; Tilburg University; Tilburg The Netherlands
- Department of Psychology; KU Leuven Leuven Belgium
- Department of Welfare, Public Health and Family; Flemish Government; Brussels Belgium
| |
Collapse
|
20
|
Rouleau CR, Tomfohr-Madsen LM, Campbell TS, Letourneau N, O'Beirne M, Giesbrecht GF. The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension. Biol Psychol 2016; 117:32-42. [PMID: 26868182 DOI: 10.1016/j.biopsycho.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 01/20/2023]
Abstract
Reduced cardiac vagal control, indexed by relatively lower high-frequency heart rate variability (HF-HRV), is implicated in depressed mood and hypertensive disorders among non-pregnant adults whereas research in pregnancy is limited. This study examined whether maternal HF-HRV during pregnancy mediates the association between depressed mood and gestational hypertension. Depressive symptoms (Edinburgh Depression Scale) and HF-HRV were measured during early (M=14.9 weeks) and late (M=32.4 weeks) pregnancy in 287 women. Gestational hypertension was determined by chart review. Depressive symptoms were associated with less HF-HRV (b=-0.02, p=.001). There was an indirect effect of depressed mood on gestational hypertension through late pregnancy HF-HRV (b=0.04, 95% CI 0.0038, 0.1028) after accounting for heart rate. These findings suggest cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension, though causal ordering remains uncertain.
Collapse
Affiliation(s)
- Codie R Rouleau
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada.
| | | |
Collapse
|
21
|
Kondo T, Kawamoto M. Acupuncture and moxibustion for stress-related disorders. Biopsychosoc Med 2014; 8:7. [PMID: 24456818 PMCID: PMC3903561 DOI: 10.1186/1751-0759-8-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/20/2014] [Indexed: 12/29/2022] Open
Abstract
Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally. This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders. The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy. Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.
Collapse
Affiliation(s)
- Tetsuya Kondo
- Kansai University of Health Sciences, 2-11-1, Wakaba, Kumatori-cho, Sennan-gun 590-0482, Japan.
| | | |
Collapse
|
22
|
Siepmann M, Hennig UD, Siepmann T, Nitzsche K, Mück-Weymann M, Petrowski K, Weidner K. The Effects of Heart Rate Variability Biofeedback in Patients with Preterm Labour. Appl Psychophysiol Biofeedback 2013; 39:27-35. [DOI: 10.1007/s10484-013-9238-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Stuebe AM, Grewen K, Pedersen CA, Propper C, Meltzer-Brody S. Failed lactation and perinatal depression: common problems with shared neuroendocrine mechanisms? J Womens Health (Larchmt) 2012; 21:264-72. [PMID: 22204416 PMCID: PMC3298672 DOI: 10.1089/jwh.2011.3083] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In the early postpartum period, mother and infant navigate a critical neuroendocrine transition from pregnancy to lactation. Two major clinical problems that occur during this transition are failed lactation and perinatal mood disorders. These disorders often overlap in clinical settings. Failed lactation is common. Although all major medical organizations recommend 6 months of exclusive breastfeeding, only 13% of women in the United States achieve this recommendation. Perinatal mood disorders affect 10% of mothers, with substantial morbidity for mother and child. We hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders. In this hypothesis article, we discuss data from both animal models and clinical studies that suggest neuroendocrine mechanisms that may underlie these two disorders. Research to elucidate the role of these underlying mechanisms may identify treatment strategies both to relieve perinatal depression and to enable women to achieve their infant feeding goals.
Collapse
Affiliation(s)
- Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA.
| | | | | | | | | |
Collapse
|
24
|
Lazinski MJ, Shea AK, Steiner M. Effects of maternal prenatal stress on offspring development: a commentary. Arch Womens Ment Health 2008; 11:363-75. [PMID: 18975045 DOI: 10.1007/s00737-008-0035-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 10/01/2008] [Indexed: 01/21/2023]
Abstract
Pregnancy is associated with major physiological changes and adaptation to these changes is crucial for normal fetal development. Heightened emotional stress during pregnancy may interfere with the necessary adaptation and lead to dysregulation of the two major stress response systems: the Hypothalamic-Pituitary-Adrenal (HPA) Axis and the Autonomic Nervous System (ANS). Negative effects on the fetus of such maladaptation have been documented in both animals and humans and range from poor birth outcomes to negative impacts on neurodevelopment, as well as long term emotional and behavioural disturbances. Conversely, it has been hypothesized that low levels of maternal prenatal stress may actually have an adaptive value for the offspring. Investigation of these associations employing physiological markers and repeated measures throughout pregnancy and postpartum of both the mother and the offspring, is required in order to understand the various effects of prenatal stress on the development of the offspring. It is also crucial to explore the possibility of variable periods of vulnerability throughout gestation. The aim of this commentary is to reexamine the current literature on the ill-effects of maternal stress during pregnancy on the offspring and to explore avenues for future treatment and prevention.
Collapse
Affiliation(s)
- Marysia J Lazinski
- Women's Health Concerns Clinic, St Joseph's Healthcare, Hamilton, ON, Canada
| | | | | |
Collapse
|