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Cui S, Xiong W, Zhao Z, Han Y, Cui T, Qu Z, Li Z, Zhang X. Negative impact of maternal depressive symptoms on infancy neurodevelopment: a moderated mediation effect of maternal inflammation. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02572-x. [PMID: 39190153 DOI: 10.1007/s00787-024-02572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024]
Abstract
Maternal depression promotes maternal inflammation and the risk of neurodevelopmental disorder in offspring, but the role of inflammation on the association between depression and neurodevelopment in offspring has not been extensively studied in humans. This study aims to examine the mediating role of maternal inflammation on the relationship between maternal depression and neurodevelopment in infants. 146 mother-child pairs were identified from Tianjin Maternal and Child Health Education and Service Cohort (Tianjin MCHESC). Maternal depression was investigated by the Center for Epidemiologic Studies Depression Scale and the Edinburgh Postnatal Depression Scale, and depressive trajectories were identified by latent class growth analysis. Inflammatory biomarkers in the three trimesters were assessed with enzyme-linked immunoassay. The Children Neuropsychological and Behavior Scale-Revision 2016 was used to measure neurodevelopment in infants. Principal component analysis was performed to identify inflammatory condition. Stepwise multiple linear regression analysis and mediation analysis were used to identify association among maternal depression, maternal inflammation and neurodevelopment in infants. Offspring in the low and moderate maternal depression groups exhibited higher adaptive behavior development quotient than those in the high maternal depression group. Higher maternal c-reactive protein level and higher inflammatory level in acute-phase of inflammation in the first trimester, and moderate maternal depression were associated with lower adaptive behavior quotients of infants. Inflammatory level in acute-phase of inflammation in the first trimester significantly mediated the association between maternal depression and adaptive behavior development of infants, with explaining 11.85% of the association. Maternal depression could impair adaptive behavior development in infants by inflammation.
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Affiliation(s)
- Shanshan Cui
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Wenjuan Xiong
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Ziyu Zhao
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Yu Han
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Tingkai Cui
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Zhiyi Qu
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Zhi Li
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xin Zhang
- Department of Maternal, Child & Adolescence Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Vaghef-Mehrabani E, Bell RC, Field CJ, Jarman M, Evanchuk JL, Letourneau N, Giesbrecht GF. Maternal pre-pregnancy diet and prenatal depression: the mediating role of pre-pregnancy weight status and prenatal inflammation. Br J Nutr 2024:1-15. [PMID: 38800987 DOI: 10.1017/s0007114524001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Depression is a common prenatal psychological complication. We aimed to investigate if maternal pre-pregnancy diet can impact prenatal depressive symptoms and the mediating role of pre-pregnancy BMI and inflammation. We used data (N 1141) from the Alberta Pregnancy Outcomes and Nutrition cohort study. We calculated Mediterranean diet adherence (MED) and dietary inflammatory index (DII) scores using data from pre-pregnancy FFQ. In the third-trimester, we assessed depressive symptoms using Edinburgh Postpartum Depression Scale (EPDS) and inflammation through serum C-reactive protein (CRP) levels. BMI was calculated from self-reported pre-pregnancy weight. Race-stratified analyses (white and people of colour) were run. We observed no association between MED or DII tertiles and depressive symptoms. However, white participants in the MED tertile-3 had lower risk of depression (EPDS < 10) compared with tertile-1 (OR = 0·56, 95 % CI, 0·33, 0·95). White individuals in MED tertile-3 had lower BMI (MD = -1·08; 95 % CI, -1·77, -0·39) and CRP (MD = -0·53; 95 % CI, -0·95, -0·11) than tertile-1, and those in DII tertile-2 (MD = 0·44; 95 % CI, 0·03, 0·84) and tertile-3 (MD = 0·42; 95 % CI, 0·01, 0·83) had higher CRP than tertile-1. Among people of colour, neither MED nor DII was associated with BMI or CRP, but BMI was negatively associated with depressive symptoms (β = -0·25, 95 % CI, -0·43, -0·06). We found no association between diet and depressive symptoms through BMI or CRP, in either race. Pre-pregnancy diet might affect the risk of prenatal depression in a race-specific way. Further research is required to explore the racial differences in the association between maternal diet and prenatal depressive symptoms/depression risk.
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Affiliation(s)
- Elnaz Vaghef-Mehrabani
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Megan Jarman
- School of Psychology, College of Health and Life Sciences, Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Jenna L Evanchuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | | | - Gerald F Giesbrecht
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Wright MA, Giurgescu C, Misra DP, Slaughter-Acey JC, Engeland CG. Neighborhood racial composition and experiences of racial discrimination: Associations with cytokines during pregnancy among African American women. Brain Behav Immun Health 2024; 35:100715. [PMID: 38193096 PMCID: PMC10771980 DOI: 10.1016/j.bbih.2023.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
Background Preterm birth rates are consistently higher in African American (AA) pregnancies compared to White pregnancies in the United States. Neighborhood racial composition, experiences of racial discrimination, and systemic inflammation are factors that have been associated with preterm birth and other adverse pregnancy outcomes that may account for these disparities. Here, we investigated whether perceived neighborhood racial composition and experiences of discrimination were predictive of cytokine levels during pregnancy among AA individuals. Methods 545 AA individuals completed surveys and had blood samples collected at prenatal clinics in the Midwest at three timepoints (8-18,19-29, and 30-36 weeks gestation) throughout pregnancy. Pro-inflammatory [interferon (IFN)-γ, interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, macrophage migration inhibitory factor (MIF)] and anti-inflammatory cytokines (IL-10) were quantified. Multivariate and multilevel models were used to examine associations of perceived neighborhood racial composition and experiences of racial discrimination with cytokine levels, controlling for relevant covariates. Results Perceived neighborhood racial composition was significantly associated with MIF at 30-36 weeks gestation in multivariate regression (p < 0.001). Living in neighborhoods with more compared to fewer White people was predictive of higher levels of MIF (b = 0.599, SE = 0.12, p < 0.001). Experiences of discrimination were also associated with higher levels of MIF (β = 0.141, SE = 0.07, p = 0.036). Neither predictor was associated with other cytokines. Follow-up analyses revealed that neighborhood racial composition was also predictive of higher MIF levels at 8-18 weeks gestation (p = 0.02) and at 19-29 weeks gestation (p = 0.04). Conclusions Living in neighborhoods with more White individuals and having more lifetime experiences of racial discrimination were positively related to levels of the pro-inflammatory cytokine, MIF, among pregnant AA individuals. MIF's known positive relationships with chronic stress and preterm birth suggest that these elevations in MIF may have negative health consequences. Future studies should explore whether MIF serves as a pathway between neighborhood racial composition or experiences of racial discrimination and preterm birth risk among AA individuals.
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Affiliation(s)
- Molly A. Wright
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Jaime C. Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Christopher G. Engeland
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
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Woo J, Guffey T, Dailey R, Misra D, Giurgescu C. Vitamin D Status as an Important Predictor of Preterm Birth in a Cohort of Black Women. Nutrients 2023; 15:4637. [PMID: 37960290 PMCID: PMC10649077 DOI: 10.3390/nu15214637] [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: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Vitamin D deficiency (25 (OH)D < 20 ng/mL) is a modifiable risk factor that has been associated with an increased risk of preterm birth (PTB) (<37 weeks gestation). Black women are at a high risk for vitamin D deficiency due to higher melanin levels. Vitamin D sufficiency may be protective against PTB risk in Black women. Black participants between 8 and 25 weeks of gestation were included in this nested case-control study. The sample consisted of women who had either PTBs (n = 57) or term births, were selected based on maternal age compared to those who had PTBs (n = 118), and had blood samples available between 8 and 25 weeks of gestation. The women completed questionnaires about depressive symptoms and smoking behavior and had blood collected to determine their vitamin D levels. Gestational age at birth, hypertensive disorders, and body mass index (BMI) were collected from the medical records. The odds of PTB were increased by 3.34 times for participants with vitamin D deficiency after adjusting for hypertensive disorders of pregnancy and depressive symptoms. Vitamin D assessment and supplementation may be an important intervention for preventing PTB in pregnant Black women.
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Affiliation(s)
- Jennifer Woo
- College of Nursing, Texas Woman’s University, Dallas, TX 75235, USA
- Greene Center for Reproductive Biology, UT Southwestern, Dallas, TX 75390, USA
| | - Thomas Guffey
- Center for Research Design and Analysis, Texas Woman’s University, Denton, TX 76204, USA;
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48202, USA;
| | - Dawn Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48823, USA;
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL 32816, USA;
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Jha A, Baumann N, Shadid I, Shah J, Chen YCS, Lee-Sarwar KA, Zeiger RS, O'Connor GT, Bacharier LB, Carey VJ, Laranjo N, Fichorova RN, Litonjua AA, Weiss ST, Mirzakhani H. The relationship of fetal sex and maternal race and ethnicity with early and late pregnancy C-reactive protein and interleukin-8. Am J Reprod Immunol 2023; 90:e13746. [PMID: 37491932 DOI: 10.1111/aji.13746] [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: 09/05/2022] [Revised: 03/11/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Promotion of a healthy pregnancy is dependent on a coordinated immune response that minimizes inflammation at the maternal-fetal interface. Few studies investigated the effect of fetal sex on proinflammatory biomarkers during pregnancy and whether maternal race could impact this association. We aimed to examine whether fetal sex could, independently of maternal race/ethnicity and the condition of pregnancy (normal vs. complicated), impact inflammatory markers (C-reactive protein [CRP] and interleukin-8 [IL-8] levels) in early and late pregnancy. METHODS OF STUDY This study was a cohort analysis using prospectively collected data from pregnant women who participated in the Vitamin Antenatal Asthma Reduction Trial (VDAART, N = 816). Maternal serum CRP and IL-8 levels were measured in early and late pregnancy (10-18 and 32-38 weeks of gestation, respectively). Five hundred and twenty-eight out of 816 pregnant women who participated in the trial had available CRP and IL-8 measurements at both study time points. We examined the association of fetal sex with early and late CRP and IL-8 levels and their paired sample difference. We further investigated whether maternal race/ethnicity, pregnancy complications (i.e., preeclampsia and gestational diabetes), and early pregnancy body mass index (BMI) could affect the association between these two biomarkers and fetal sex adjusting for potential confounders. For this purpose, we used generalized linear and logistic regression models on log-normalized early and late CRP and IL-8 levels as well as their split at median to form high and low groups. RESULTS Women pregnant with male fetuses (266/528 = 56.5%) had higher CRP levels in early to mid-pregnancy (β = .18: 95% confidence interval [CI]: CI = 0.03-0.32; p = .02). Twenty-seven percent (143/528) of the study subjects were Hispanic. Hispanic African American [AA] women and women of races other than White and AA had higher levels of CRP at early to mid-pregnancy compared with White women (β = .57; 95% CI: 0.17-0.97; p < .01 and β = .27; 95% CI: 0.05-0.48; p = .02, respectively). IL-8 levels were not associated with fetal sex in early and late pregnancy (p's > .05). Other factors such as gestational diabetes and early pregnancy BMI were associated with higher CRP levels and higher CRP and IL-8 levels, respectively. Dichotomizing log-normalized cytokine levels at the median in a sensitivity analysis, women with male fetuses had lower odds of high (above-median) IL-8 levels at early pregnancy. Also, women with races other than AA and White carrying male fetuses had higher odds of having high (above-median) late-pregnancy CRP and early-pregnancy IL-8 levels (adjusted odds ratio [aOR] = 3.80, 95% CI: 0.24-1.23; p = .02 and aOR = 3.57; 95% CI: 0.23-1.03; p = .02, respectively). Of the pregnancy complications, women with gestational diabetes mellitus had a higher paired difference of early and late pregnancy CRP levels (β = .38; 95% CI: 0.09-0.68; p = .01), but no difference in IL-8 levels (p's > .05). No associations between the inflammatory markers and preeclampsia were found. CONCLUSION Fetal sex is associated with CRP in early pregnancy and an association with IL-8 in early pregnancy is implied. Our study further indicates that maternal race/ethnicity could be a contributing factor in the relationship between fetal sex and inflammatory responses during pregnancy. However, the specificity and level of the contribution might vary by type of cytokine, pregnancy stage, and other confounding factors such as BMI that may impact these associations.
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Affiliation(s)
- Anjali Jha
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Baumann
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Iskander Shadid
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jhill Shah
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yih-Chieh S Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen A Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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McCormack C, Abuaish S, Monk C. Is There an Inflammatory Profile of Perinatal Depression? Curr Psychiatry Rep 2023; 25:149-164. [PMID: 36947355 DOI: 10.1007/s11920-023-01414-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW To synthesize and critically examine recent evidence regarding associations between immune system activity and perinatal depression. RECENT FINDINGS Despite a significant number of studies assessing potential immunological markers of perinatal depression, it does not appear that levels of any individual pro- or anti-inflammatory marker is a useful predictor of perinatal depression. Some recent studies have observed differences in overall immune system functioning and adaptation across this period, taking into account multiple pro- and anti- inflammatory markers. Furthermore, there is evidence for interactions between depression and maternal psychosocial factors. Immune system functioning may be a mechanism through which social determinants of health contribute to risk for perinatal depression. There is substantial evidence implicating dysregulated immune activity in perinatal depression, yet little clarity regarding a consistent immune profile, especially based on analysis of circulating peripheral cytokines.
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Affiliation(s)
- Clare McCormack
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY, USA.
| | - Sameera Abuaish
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Catherine Monk
- Departments of Obstetrics and Gynecology and Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Emeny RT, Zhang K, Goodman D, Dev A, Lewinson T, Wolff K, Kerrigan CL, Kraft S. Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease. Curr Protoc 2022; 2:e556. [PMID: 36200800 DOI: 10.1002/cpz1.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.
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Affiliation(s)
- Rebecca T Emeny
- Department of Internal Medicine, Division of Molecular Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Daisy Goodman
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alka Dev
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Terri Lewinson
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kristina Wolff
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Carolyn L Kerrigan
- Medical Director, Patient Reported Outcomes, Dartmouth-Hitchcock, Professor of Surgery, Active Emerita, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Sally Kraft
- Vice President of Population Health, Dartmouth Health, Lebanon, New Hampshire
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