On maternal Post-Partum/Natal depression. A global underrecognized problem and the need for better Treatment strategies

Wheel Running During Pregnancy Alleviates Anxiety-and Depression-Like Behaviors During the Postpartum Period in Mice: The Roles of NLRP3 Neuroinflammasome Activation, Prolactin, and the Prolactin Receptor in the Hippocampus

Despite the increase in the prevalence of postpartum depression among maternal disorder, its treatment outcomes remain suboptimal. Studies have shown that exercise can reduce postpartum depressive episodes in the mother, but the effects of exercise during pregnancy on maternal behavior and the potential mechanisms involved remain poorly understood. From the second day of pregnancy to the day of birth, dams exercised for 1 h a day by running on a controlled wheel. The maternal behaviors of the dams were assessed on postpartum day 2 to postpartum day 8. Chronic restraint stress was applied from postpartum day 2 to day 12. Blood was collected on postpartum days 3 and 8, then subjected to ELISA to determine the serum concentration of prolactin. The weight of each dam and the food intake were recorded. Anxiety- and depression-like behavioral tests were conducted, and hippocampal neuroinflammation and prolactin receptor levels were measured. The dams exhibited elevated levels of anxiety and depression, decreased serum prolactin levels, decreased prolactin receptor expression, and activation of NLRP3-mediated neuroinflammation in the hippocampus following the induction of postpartum chronic restraint stress, which were reversed with controlled wheel running during pregnancy. Overall, the findings of this study revealed that the preventive effects of exercise during pregnancy on postpartum anxiety-and depression-like behaviors were accompanied by increased serum prolactin levels, hippocampal prolactin receptor expression and hippocampal NLRP3-mediated neuroinflammation.

Unveiling the potential of estrogen: Exploring its role in neuropsychiatric disorders and exercise intervention

Neuropsychiatric disorders shorten human life spans through multiple ways and become major threats to human health. Exercise can regulate the estrogen signaling, which may be involved in depression, Alzheimer's disease (AD) and Parkinson's disease (PD), and other neuropsychiatric disorders as well in their sex differences. In nervous system, estrogen is an important regulator of cell development, synaptic development, and brain connectivity. Therefore, this review aimed to investigate the potential of estrogen system in the exercise intervention of neuropsychiatric disorders to better understand the exercise in neuropsychiatric disorders and its sex specific. Exercise can exert a protective effect in neuropsychiatric disorders through regulating the expression of estrogen and estrogen receptors, which are involved in neuroprotection, neurodevelopment, and neuronal glucose homeostasis. These processes are mediated by the downstream factors of estrogen signaling, including N-myc downstream regulatory gene 2 (Ndrg2), serotonin (5-HT), delta like canonical Notch ligand 1 (DLL1), NOD-like receptor thermal protein domain associated protein 3 (NLRP3), etc. In addition, exercise can act on the estrogen response element (ERE) fragment in the genes of estrogenic downstream factors like β-amyloid precursor protein cleavase 1 (BACE1). However, there are few studies on the relationship between exercise, the estrogen signaling pathway, and neuropsychiatric disorders. Hence, we review how the estrogen signaling mediates the mechanism of exercise intervention in neuropsychiatric disorders. We aim to provide a theoretical perspective for neuropsychiatric disorders affecting female health and provide theoretical support for the design of exercise prescriptions.

Graves' disease as a driver of depression: a mechanistic insight

Graves' disease (GD) is characterized by diffuse enlargement and overactivity of the thyroid gland, which may be accompanied by other physical symptoms. Among them, depression can dramatically damage patients' quality of life, yet its prevalence in GD has not received adequate attention. Some studies have established a strong correlation between GD and increased risk of depression, though the data from current study remains limited. The summary of mechanistic insights regarding GD and depression has underpinned possible pathways by which GD contributes to depression. In this review, we first summarized the clinical evidence that supported the increased prevalence of depression by GD. We then concentrated on the mechanistic findings related to the acceleration of depression in the context of GD, as mounting evidence has indicated that GD promotes the development of depression through various mechanisms, including triggering autoimmune responses, inducing hormonal disorders, and influencing the thyroid-gut-microbiome-brain axis. Finally, we briefly presented potential therapeutic approaches to decreasing the risk of depression among patients with GD.

Analysis of the incidence and influencing factors of postpartum depression and anxiety: A cross-sectional study in Xinjiang from 2018 to 2021

BACKGROUND

Postpartum depression(PPD) and anxiety(PPA) have become the one of major public health threats. However, the research evidence on PPD and PPA in Xinjiang is insufficient. This research reports the incidence of PPD and PPA in the past 4 years, and analyzes the impact of sociodemographic and obstetric factors on postpartum mental health.

METHODS

The selected research objects are parturients who have undergone postpartum health check-ups in a tertiary hospital in Urumqi from January 2018 to September 2021. The study obtained the socio-demographic and obstetric information of the puerpera through general survey questionnaires, and used the PHQ-9 and GAD-7 scales to screen for PPD and PPA. Furthermore, after univariate analysis of related influencing factors of PPD and PPA, multiple binary logistic regression analysis was used to further explore the relationship between PPD and PPA and various influencing factors.

RESULTS

A total of 7,703 parturients were included in this study. The incidence of PPD (PHQ-9 ≥ 10) was 9.7% in 2018, 11.1% in 2019, 13.3% in 2020, and 14.2% in 2021 (χ² = 18.386, P < 0001). The incidence of PPA(GAD-7 ≥ 10) was 8.1% in 2018,8.6% in 2019, 11.4% in 2020, and 9.8% in 2021 (χ² = 16.895, P = 0.001). The six factors that were statistically different after univariate analysis were included in the multivariate binary logistic regression analysis. The final results suggested that women who delivery in 2020 were 1.405 times (95%CI:1.145-1.723) more likely to suffer from depression than those who delivery in 2018 and 1.688 times (95%CI:1.237-2.303) than that in 2021. Compared with puerpera with formal jobs, the incidence of PPD among puerpera who were self-employed (AOR = 1.372,95%CI:1.085-1.735) or unemployed(AOR = 1.348,95%CI:1.137-1.599) was on the rise. Moreover, studies have shown that mixed feeding (AOR = 1.515,95%CI: 1.296-1.772) or artificial feeding (AOR = 1.736,95%CI: 1.299-2.321) 6 weeks postpartum was associated with a higher risk of depression, and puerpera who delivered female infants (AOR = 0.780, 95%CI: 0.626-0.971) were less likely to report depressive symptoms. Simultaneously, for PPA, women who delivered in 2020 were 1.418 times (95%CI: 1.065-1.887) more likely to suffer from anxiety than those who delivered in 2018. Women aged 18-29 years (AOR = 2.070,95%CI:1.229-3.487) were more likely to report PPA than those over the age of 29. Similarly, women who selected cesarean section delivery (AOR = 1.332,95%CI:1.087-1.632) were more likely to have PPA. Mixed feeding (AOR = 1.436,95%CI: (1.193-1.729) ) or artificial feeding (AOR = 1.742,95%CI: 1.243-2.441) at 6 weeks postpartum was associated with a higher risk of anxiety. While puerpera who delivered female infants (AOR = 0.746,95%CI: 0.567-0.982) were less likely to report anxiety symptoms.

CONCLUSION

This study shows that in Xinjiang, the incidence of postpartum depression and anxiety was on the rise from 2018 to 2020, and although there was a slight decline in 2021, it was still higher than in 2019. Simultaneously, the proportion of overweight or obese, cesarean section, and non-breastfeeding women had increased year by year. Factors such as maternal age, occupation, mode of delivery, feeding pattern and neonatal gender may help to identify high-risk patients. Therefore, primary, secondary, and tertiary prevention should be given priority to reduce the incidence of postpartum depression and anxiety in high-risk groups.