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Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [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: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
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Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
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Bradley H, Fine D, Minai Y, Gilabert L, Gregory K, Smith L, Gao W, Giase G, Krogh-Jespersen S, Zhang Y, Wakschlag L, Brito NH, Feliciano I, Thomason M, Cabral L, Panigrahy A, Potter A, Cioffredi LA, Smith BA. Maternal perceived stress and infant behavior during the COVID-19 pandemic. Pediatr Res 2023; 94:2098-2104. [PMID: 37500757 PMCID: PMC10665182 DOI: 10.1038/s41390-023-02748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/07/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Maternal stress has negative consequences on infant behavioral development, and COVID-19 presented uniquely stressful situations to mothers of infants born during the pandemic. We hypothesized that mothers with higher levels of perceived stress during the pandemic would report higher levels of infant regulatory problems including crying and interrupted sleep patterns. METHODS As part 6 sites of a longitudinal study, mothers of infants born during the pandemic completed the Perceived Stress Scale, the Brief Infant Sleep Questionnaire, and an Infant Crying survey at 6 (n = 433) and 12 (n = 344) months of infant age. RESULTS Maternal perceived stress, which remained consistent at 6 and 12 months of infant age, was significantly positively correlated with time taken to settle infants. Although maternal perceived stress was not correlated with uninterrupted sleep length, time taken to put the infant to sleep was correlated. Perceived stress was also correlated with the amount of infant crying and fussiness reported at 6 months. CONCLUSIONS Mothers who reported higher levels of perceived stress during the pandemic reported higher levels of regulatory problems, specifically at 6 months. Examining how varying levels of maternal stress and infant behaviors relate to overall infant developmental status over time is an important next step. IMPACT Women giving birth during the COVID-19 pandemic who reported higher levels of stress on the Perceived Stress Scale also reported higher levels of infant fussiness and crying at 6 months old, and more disruptive sleep patterns in their infants at 6 months and 12 months old. Sleeping problems and excessive crying in infancy are two regulatory problems that are known risk factors for emotional and behavioral issues in later childhood. This paper is one of the first studies highlighting the associations between maternal stress and infant behaviors during the COVID-19 pandemic.
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Affiliation(s)
- Holly Bradley
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Dana Fine
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Yasmin Minai
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Laurel Gilabert
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Kimberly Gregory
- Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, Los Angeles, CA, USA
| | - Lynne Smith
- Harbor-UCLA Medical Center Department of Pediatrics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Wei Gao
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Gina Giase
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | | | - Yudong Zhang
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Lauren Wakschlag
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Integra Feliciano
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Moriah Thomason
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Laura Cabral
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandra Potter
- University of Vermont Medical Center, Psychiatry, Burlington, VT, USA
| | - Leigh-Anne Cioffredi
- Department of Pediatrics, University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Beth A Smith
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.
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Mlili NE, Ahabrach H, Cauli O. Hair Cortisol Concentration as a Biomarker of Symptoms of Depression in the Perinatal Period. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:71-83. [PMID: 35297354 DOI: 10.2174/1871527321666220316122605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Abstract
Pregnancy is a sensitive period when women experience major hormonal and psychological changes. A high prevalence of the symptoms of depression and manifested major depression rates have been reported during this period, leading to negative outcomes both for mothers and the offspring. Despite its prevalence, the aetiology of depression is not yet fully understood. Nonetheless, alterations in cortisol levels have been proposed as a reliable biomarker to identify pregnant women at risk of perinatal depression. Hair cortisol has recently been extensively used in bio-psychological studies as a suitable non-invasive biomarker for several neuropsychiatric disorders. Various studies have published evidence regarding the relationship between cortisol fluctuations during the perinatal period, measured both in hair and in other substrates, and the onset of perinatal symptoms of depression. This current review provides an overview of cortisol level changes measured in women's hair during pregnancy or the postpartum period and its association with perinatal symptoms of depression. Further studies, including repetitive measurement of both hair cortisol and depression throughout the prenatal period, must be performed to clarify the relationship between cortisol levels and perinatal symptoms of depression.
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Affiliation(s)
- Nisrin El Mlili
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Hanan Ahabrach
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia 46010, Spain
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, Valencia 46010, Spain
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Olsson Mägi CA, Wik Despriee Å, Småstuen MC, Almqvist C, Bahram F, Bakkeheim E, Bjerg A, Glavin K, Granum B, Haugen G, Hedlin G, Jonassen CM, Lødrup Carlsen KC, Rehbinder EM, Rolfsjord LB, Staff AC, Skjerven HO, Vettukattil R, Nordlund B, Söderhäll C. Maternal Stress, Early Life Factors and Infant Salivary Cortisol Levels. CHILDREN 2022; 9:children9050623. [PMID: 35626800 PMCID: PMC9139396 DOI: 10.3390/children9050623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
Background: Salivary cortisol (SC), a commonly used biomarker for stress, may be disrupted by negative events in pregnancy, at birth and in infancy. We aimed to explore if maternal perceived stress (PSS) in or after pregnancy and SC levels in pregnancy were associated with SC in early infancy, and, secondly, to identify early life factors associated with infants’ SC levels (iSC). Methods: At 3 months of age, SC was analyzed in 1057 infants participating in a Nordic prospective mother-child birth cohort study. Maternal PSS was available from questionnaires at 18- and 34-week gestational age (GA) and 3-month post-partum, and SC was analyzed at 18-week GA. Early life factors included sociodemographic and infant feeding from questionnaires, and birth data from medical charts. Associations to iSC were analyzed by Spearman correlation and multinomial logistic regression analyses. Results: In this exploratory study neither PSS at any time point nor maternal SC (mSC) were associated with iSC. Higher birth weight was associated with higher levels of iSC, while inverse associations were observed in infants to a mother not living with a partner and mixed bottle/breastfeeding. Conclusions: Maternal stress was not associated with iSC levels, while birth weight, single motherhood and infant feeding may influence iSC levels.
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Affiliation(s)
- Caroline-Aleksi Olsson Mägi
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (A.B.); (G.H.); (B.N.); (C.S.)
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 64 Stockholm, Sweden;
- Correspondence:
| | - Åshild Wik Despriee
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Faculty of Health, VID Specialized University, NO-0424 Oslo, Norway; (M.C.S.); (K.G.)
| | | | - Catarina Almqvist
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 64 Stockholm, Sweden;
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Fuad Bahram
- Research Centre, Stockholm South General Hospital, SE-118 83 Stockholm, Sweden;
| | - Egil Bakkeheim
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424 Oslo, Norway; (E.B.); (L.-B.R.)
| | - Anders Bjerg
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (A.B.); (G.H.); (B.N.); (C.S.)
- Martina Children’s Hospital, SE-114 86 Stockholm, Sweden
| | - Kari Glavin
- Faculty of Health, VID Specialized University, NO-0424 Oslo, Norway; (M.C.S.); (K.G.)
| | - Berit Granum
- Department of Chemical Toxicology, Norwegian Institute of Public Health, NO-0213 Oslo, Norway;
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Division of Obstetrics and Gynaecology, Oslo University Hospital, NO-0424 Oslo, Norway
| | - Gunilla Hedlin
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (A.B.); (G.H.); (B.N.); (C.S.)
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 64 Stockholm, Sweden;
| | - Christine Monceyron Jonassen
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, NO-1430 Ås, Norway;
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, NO-1714 Kalnes, Norway
| | - Karin C. Lødrup Carlsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424 Oslo, Norway; (E.B.); (L.-B.R.)
| | - Eva Maria Rehbinder
- Department of Dermatology and Vaenerology, Oslo University Hospital, NO-0424 Oslo, Norway;
| | - Leif-Bjarte Rolfsjord
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424 Oslo, Norway; (E.B.); (L.-B.R.)
- Department of Paediatric and Adolescent Medicine Elverum, Innlandet Hospital Trust, NO-2381 Brumunddal, Norway
| | - Anne Cathrine Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Division of Obstetrics and Gynaecology, Oslo University Hospital, NO-0424 Oslo, Norway
| | - Håvard Ove Skjerven
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424 Oslo, Norway; (E.B.); (L.-B.R.)
| | - Riyas Vettukattil
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0424 Oslo, Norway; (Å.W.D.); (G.H.); (K.C.L.C.); (A.C.S.); (H.O.S.); (R.V.)
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424 Oslo, Norway; (E.B.); (L.-B.R.)
| | - Björn Nordlund
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (A.B.); (G.H.); (B.N.); (C.S.)
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 64 Stockholm, Sweden;
| | - Cilla Söderhäll
- Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (A.B.); (G.H.); (B.N.); (C.S.)
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 64 Stockholm, Sweden;
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O'Mahen HA, Ramchandani PG, King DX, Lee-Carbon L, Wilkinson EL, Thompson-Booth C, Ericksen J, Milgrom J, Dunkley-Bent J, Halligan SL, Fearon P. Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): report of a feasibility randomized controlled trial. BMC Psychiatry 2022; 22:129. [PMID: 35177019 PMCID: PMC8851863 DOI: 10.1186/s12888-022-03737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We investigated the acceptability and feasibility of a new brief intervention for maternal prenatal anxiety within maternity services in London and Exeter, UK. METHODS One hundred fourteen pregnant individuals attending their 12-week scan at a prenatal clinic with elevated symptoms of anxiety (GAD-7 score of ≥7) were randomly assigned to either the ACORN intervention + Treatment as usual (TAU) (n = 57) or to usual care only (n = 57). The ACORN intervention consisted of 3 2-h group sessions, led by a midwife and psychological therapist, for pregnant individuals and their partners. The intervention included psychoeducation about anxiety, strategies for problem-sovling and tolerating uncertainty during pregnancy, including communicating about these with others, and mindfulness exercises. RESULTS Engagement rates with ACORN met or exceeded those in primary care services in England. In the intervention arm, 77% (n = 44) of participants attended at least one session, 51% (n = 29) were adherent, defined as attending two or more sessions. Feedback was positive, and participants in the ACORN treatment group demonstrated evidence of a larger drop in their levels of anxiety than the participants in the TAU-only group (Cohen's d = 0.42). CONCLUSION The ACORN intervention was acceptable to pregnant individuals and their partners and resulted in reductions in anxiety. With further evaluation in a larger-scale trial with child outcomes, there is significant potential for large scale public health benefit.
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Affiliation(s)
- Heather A O'Mahen
- Mood Disorders Research Centre, University of Exeter, Perry Road, Exeter, EX4 4QG, UK.
| | - Paul G Ramchandani
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
- Centre for Research on Play in Education, Development, and Learning, Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, England
| | - Dorothy X King
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
| | - Leonie Lee-Carbon
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Esther L Wilkinson
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chloe Thompson-Booth
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Essex Partnership University NHS Foundation Trust, Trust Head Office, The Lodge, Lodge Approach, Runwell, Wickford, Essex, SS11 7XX, UK
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Centaur Building, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg Heights, Melbourne, VIC, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Centaur Building, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, Heidelberg Heights, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Level 12, Redmond Barry Building, Parkville, VIC, 3010, Australia
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Grumi S, Provenzi L, Accorsi P, Biasucci G, Cavallini A, Decembrino L, Falcone R, Fazzi EM, Gardella B, Giacchero R, Guerini P, Grossi E, Magnani ML, Mariani EM, Nacinovich R, Pantaleo D, Pisoni C, Prefumo F, Sabatini C, Scelsa B, Spartà MV, Spinillo A, Giorda R, Orcesi S, Borgatti R. Depression and Anxiety in Mothers Who Were Pregnant During the COVID-19 Outbreak in Northern Italy: The Role of Pandemic-Related Emotional Stress and Perceived Social Support. Front Psychiatry 2021; 12:716488. [PMID: 34539466 PMCID: PMC8446509 DOI: 10.3389/fpsyt.2021.716488] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
The COVID-19 pandemic is a collective trauma that is threatening citizens' mental health resulting in increased emotional stress, reduced social support, and heightened risk for affective symptoms. The present study aimed to investigate the effects of antenatal pandemic-related emotional stress and perceived social support on the symptoms of depression and anxiety of mothers who were pregnant during the initial COVID-19 outbreak in northern Italy. A sample of 281 mothers was enrolled at eight maternity units in the first hotspot region of the COVID-19 outbreak in northern Italy. Participants filled out online questionnaires assessing the direct or indirect exposure to the SARS-CoV-2 virus, pandemic-related stress, perceived social support, as well as symptoms of depression and anxiety. Depressive and anxious symptomatology was above clinical concern, respectively, in 26 and 32% of the respondents. Mothers who reported no exposure to SARS-CoV-2 during pregnancy and those who reported at least one direct or indirect exposure did not differ in terms of affective symptoms. Continuous scores and risk for severe depression and anxiety were positively associated with prenatal pandemic-related emotional stress and negatively linked with perceived social support during pregnancy. Women who become mothers during the COVID-19 emergency may be at high risk for affective problems. Dedicated preventive programs are needed to provide adequate preventive support and care for maternal mental health during and after the COVID-19 pandemic.
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Patrizia Accorsi
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Anna Cavallini
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | | | | | - Elisa Maria Fazzi
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Paola Guerini
- Pediatric Unit and Neonatal Unit, ASST Pavia, Pavia, Italy
| | - Elena Grossi
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, Università Bicocca, Milan, Italy
| | - Dario Pantaleo
- Pediatric Unit and Neonatal Unit, ASST Pavia, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Prefumo
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Barbara Scelsa
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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7
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Provenzi L, Grumi S, Giorda R, Biasucci G, Bonini R, Cavallini A, Decembrino L, Drera B, Falcone R, Fazzi E, Gardella B, Giacchero R, Nacinovich R, Pisoni C, Prefumo F, Scelsa B, Spartà MV, Veggiotti P, Orcesi S, Borgatti R. Measuring the Outcomes of Maternal COVID-19-related Prenatal Exposure (MOM-COPE): study protocol for a multicentric longitudinal project. BMJ Open 2020; 10:e044585. [PMID: 33384402 PMCID: PMC7780424 DOI: 10.1136/bmjopen-2020-044585] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION COVID-19 is a highly infectious respiratory disease that rapidly emerged as an unprecedented epidemic in Europe, with a primary hotspot in Northern Italy during the first months of 2020. Its high infection rate and rapid spread contribute to set the risk for relevant psychological stress in citizens. In this context, mother-infant health is at risk not only because of potential direct exposure to the virus but also due to high levels of stress experienced by mothers from conception to delivery. Prenatal stress exposure associates with less-than-optimal child developmental outcomes, and specific epigenetic mechanisms (eg, DNA methylation) may play a critical role in mediating this programming association. METHODS AND ANALYSIS We present the methodological protocol for a longitudinal, multicentric study on the behavioural and epigenetic effects of COVID-19-related prenatal stress in a cohort of mother-infant dyads in Northern Italy. The dyads will be enrolled at 10 facilities in Northern Italy. Saliva samples will be collected at birth to assess the methylation status of specific genes linked with stress regulation in mothers and newborns. Mothers will provide retrospective data on COVID-19-related stress during pregnancy. At 3, 6 and 12 months, mothers will provide data on child behavioural and socioemotional outcomes, their own psychological status (stress, depressive and anxious symptoms) and coping strategies. At 12 months, infants and mothers will be videotaped during semistructured interaction to assess maternal sensitivity and infant's relational functioning. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER NCT04540029; Pre-results.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute, IRCCS E. Medea, Bosisi Parini, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Renza Bonini
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Anna Cavallini
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | - Lidia Decembrino
- Pediatric Unit and Neonatal Unit, Ospedale Civile di Vigevano, ASST di Pavia, Vigevano, Italy
| | - Bruno Drera
- Neonatal Intensive Care Unit, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Rossana Falcone
- Pediatric Unit and Neonatal Unit, Ospedale Civile di Vigevano, ASST di Pavia, Vigevano, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | | | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Scelsa
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milano, Italy
| | | | - Pierangelo Veggiotti
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milano, Italy
- Biomedical and Clinical Science Department, University of Milano, Milano, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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8
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Amiel Castro RT, Ehlert U, Dainese SM, Zimmerman R, La Marca-Ghaemmaghami P. Psychological predictors of gestational outcomes in second trimester pregnant women: associations with daily uplifts. Arch Gynecol Obstet 2020; 301:869-874. [PMID: 32200420 DOI: 10.1007/s00404-020-05506-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated whether pregnancy/birth anxiety is associated with shorter gestation while maternal chronic stress and depressive symptoms are associated with lower birth weight; we also examined whether experiencing daily uplifts prenatally may contribute to a more favorable birth outcome. METHODS Thirty-four healthy second trimester pregnant women responded to questions regarding their experience of pregnancy/birth anxiety, chronic stress, depressive symptoms, and daily uplifts. Information on birth outcome was obtained from medical records. RESULTS Maternal pregnancy/birth anxiety, depression, and stress were unrelated to birth outcomes. Daily uplifts were associated with gestational age at birth (B = 2.0, p = 0.01), neonatal weight (B = 46.9, p = 0.00), and size (B = 10.6, p = 0.01). Our results suggest that pregnancy/birth anxiety is not associated with shorter gestation as well as depression and stress seem to not predict lower birth weight. CONCLUSION We expand the literature by showing that experiencing daily uplifts during mid-gestation may further fetal development.
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Affiliation(s)
- R T Amiel Castro
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/26, 8050, Zürich, Switzerland
| | - U Ehlert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/26, 8050, Zürich, Switzerland
| | - S M Dainese
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/26, 8050, Zürich, Switzerland
| | - R Zimmerman
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - P La Marca-Ghaemmaghami
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/26, 8050, Zürich, Switzerland.
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9
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Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neurosci Biobehav Rev 2020; 114:232-270. [DOI: 10.1016/j.neubiorev.2020.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
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10
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Almanza-Sepulveda ML, Fleming AS, Jonas W. Mothering revisited: A role for cortisol? Horm Behav 2020; 121:104679. [PMID: 31927022 DOI: 10.1016/j.yhbeh.2020.104679] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
This selective review first describes the involvement of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy and the postpartum period, and the relation between peripartum HPA axis function and maternal behavior, stress reactivity and emotional dysregulation in human mothers. To provide experimental background to this correlational work, where helpful, animal studies are also described. It then explores the association between HPA axis function in mothers and their infants, under ongoing non-stressful conditions and during stressful challenges, the moderating role of mothers' sensitivity and behavior in the mother-child co-regulation and the effects of more traumatic risk factors on these relations. The overarching theme being explored is that the HPA axis - albeit a system designed to function during periods of high stress and challenge - also functions to promote adaptation to more normative processes, shown in the new mother who experiences both high cortisol and enhanced attraction and attention to and recognition of, their infants and their cues. Hence the same HPA system shows positive relations with behavior at some time points and inverse ones at others. However, the literature is not uniform and results vary widely depending on the number, timing, place, and type of samplings and assessments, and, of course, the population being studied and, in the present context, the state, the stage, and the stress levels of mother and infant.
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Affiliation(s)
- Mayra L Almanza-Sepulveda
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Alison S Fleming
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
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11
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Millard SJ, Lum JS, Fernandez F, Weston-Green K, Newell KA. Perinatal exposure to fluoxetine increases anxiety- and depressive-like behaviours and alters glutamatergic markers in the prefrontal cortex and hippocampus of male adolescent rats: A comparison between Sprague-Dawley rats and the Wistar-Kyoto rat model of depression. J Psychopharmacol 2019; 33:230-243. [PMID: 30698051 DOI: 10.1177/0269881118822141] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND With approximately 10% of pregnant women prescribed antidepressant drugs for the treatment of depressive disorders, there is growing concern regarding the potential long-term effects of this exposure on offspring. Research is needed in clinically relevant models to determine the effects on offspring behaviour and associated neurobiological systems. AIM The aim of this study was to determine the effects of maternal fluoxetine treatment on anxiety-like and depressive-like behaviours in adolescent offspring as well as associated glutamatergic markers, using a clinically relevant rodent model of depression. METHODS Wistar-Kyoto (model of innate depression) and Sprague-Dawley rats were treated with fluoxetine (10 mg/kg) from gestational day 0 to postnatal day 14. Male offspring underwent behavioural testing (open field, elevated plus maze, forced swim test) at adolescence followed by quantitative immuno-detection of glutamatergic markers in the prefrontal cortex and ventral hippocampus. RESULTS Perinatal fluoxetine exposure exacerbated the anxiety-like and depressive-like phenotype in Wistar-Kyoto offspring and induced an anxiety-like and depressive-like phenotype in Sprague-Dawley offspring. Wistar-Kyoto offspring showed reductions in NMDA receptor NR1, NR2A and NR2B subunits, as well as post-synaptic density 95 (PSD-95) and metabotropic glutamate receptor subtype 1 (mGluR1) in the prefrontal cortex; perinatal fluoxetine exposure further reduced NR1, NR2A, PSD-95 and mGluR1 expression in Wistar-Kyoto as well as Sprague-Dawley offspring. In the ventral hippocampus perinatal fluoxetine exposure reduced PSD-95 and increased metabotropic glutamate receptor subtype 5 (mGluR5) and Homer1b/c in both Sprague-Dawley and Wistar-Kyoto strains. CONCLUSION These findings suggest that maternal fluoxetine treatment exacerbates effects of underlying maternal depression on offspring behaviour, which may be mediated through alterations in the glutamatergic system. Further research investigating how to minimise these effects, whilst ensuring optimal treatment for mothers, is essential to move the field forward.
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Affiliation(s)
- Samuel J Millard
- 1 Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Jeremy S Lum
- 1 Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Francesca Fernandez
- 3 School of Science, Australian Catholic University, Brisbane, QLD, Australia
| | - Katrina Weston-Green
- 1 Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Kelly A Newell
- 1 Molecular Horizons and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- 2 Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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12
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Osborne S, Biaggi A, Chua TE, Du Preez A, Hazelgrove K, Nikkheslat N, Previti G, Zunszain PA, Conroy S, Pariante CM. Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood - Depression (PRAM-D) Study. Psychoneuroendocrinology 2018; 98:211-221. [PMID: 30033161 PMCID: PMC6215770 DOI: 10.1016/j.psyneuen.2018.06.017] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Antenatal depression is associated with a broad range of suboptimal outcomes in offspring, although the underlying mechanisms are not yet understood. Animal studies propose inflammation and glucocorticoids as mediators of the developmental programming effect of prenatal stress on offspring stress responses, but studies in humans are not yet at this stage. Indeed, to date no single study has examined the effects of a rigorously defined, clinically significant Major Depressive Disorder (MDD) in pregnancy on maternal antenatal inflammatory biomarkers and hypothalamic-pituitary (HPA) axis, as well as on offspring HPA axis, behavior and developmental outcomes in the first postnatal year. METHODS A prospective longitudinal design was used in 106 women (49 cases vs. 57 healthy controls) to study the effect of MDD in pregnancy and associated antenatal biology (inflammatory and cortisol biomarkers), on offspring stress response (cortisol response to immunization, at 8 weeks and 12 months), early neurobehavior (Neonatal Behavioral Assessment Scale, NBAS, at day 6), and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development at 12 months). RESULTS Compared with healthy controls, women with MDD in pregnancy had raised interleukin (IL) IL-6 (effect size (δ) = 0.53, p = 0.031), IL-10 (δ = 0.53, p = 0.043), tumor necrosis factor alpha (δ = 0.90, p = 0.003) and vascular endothelial growth factor (δ = 0.56, p = 0.008), together with raised diurnal cortisol secretion (δ = 0.89, p = 0.006), raised evening cortisol (δ = 0.64, p = 0.004), and blunted cortisol awakening response (δ = 0.70, p = 0.020), and an 8-day shorter length of gestation (δ = 0.70, p = 0.005). Furthermore, they had neonates with suboptimal neurobehavioral function in four out of five NBAS clusters measured (range of δ = 0.45-1.22 and p = 0.049-<0.001) and increased cortisol response to stress at one year of age (δ = 0.87, p < 0.001). Lastly, maternal inflammatory biomarkers and cortisol levels were correlated with infant stress response, suggesting a mechanistic link. CONCLUSION This study confirms and extends the notion that depression in pregnancy is associated with altered offspring behavior and biological stress response, and demonstrates that changes in maternal antenatal stress-related biology are associated with these infant outcomes.
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Affiliation(s)
- S Osborne
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK.
| | - A Biaggi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - T E Chua
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Psychological Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - A Du Preez
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - K Hazelgrove
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - N Nikkheslat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - G Previti
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Mental Health and Addiction, Via Risorgimento 57 42123, Reggio Emilia, Italy
| | - P A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - S Conroy
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - C M Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
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13
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Liu PZ, Nusslock R. How Stress Gets Under the Skin: Early Life Adversity and Glucocorticoid Receptor Epigenetic Regulation. Curr Genomics 2018; 19:653-664. [PMID: 30532645 PMCID: PMC6225447 DOI: 10.2174/1389202919666171228164350] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/31/2017] [Accepted: 12/17/2017] [Indexed: 11/22/2022] Open
Abstract
Early life adversity is associated with both persistent disruptions in the hypothalamic-pituitary-adrenal (HPA) axis and psychiatric symptoms. Glucocorticoid receptors (GRs), which are encoded by the NR3C1 gene, bind to cortisol and other glucocorticoids to create a negative feedback loop within the HPA axis to regulate the body's neuroendocrine response to stress. Excess methylation of a promoter sequence within NR3C1 that attenuates GR expression, however, has been associated with both early life adversity and psychopathology. As critical regulators within the HPA axis, GRs and their epigenetic regulation may mediate the link between early life adversity and the onset of psychopathology. The present review discusses this work as one mechanism by which stress may get under the skin to disrupt HPA functioning at an epigenetic level and create long-lasting vulnerabilities in the stress regulatory system that subsequently predispose individuals to psychopathology. Spanning prenatal influences to critical periods of early life and adolescence, we detail the impact that early adversity has on GR expression, physiological responses to stress, and their implications for long-term stress management. We next propose a dual transmission hypothesis regarding both genomic and non-genomic mechanisms by which chronic and acute stress propagate through numerous generations. Lastly, we outline several directions for future research, including potential reversibility of methylation patterns and its functional implications, variation in behavior determined solely by NR3C1, and consensus on which specific promoter regions should be studied.
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Affiliation(s)
- Patrick Z. Liu
- Department of Psychology, Northwestern University, Evanston, IL60208, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL60208, USA
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14
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Jonas W, Bisceglia R, Meaney MJ, Dudin A, Fleming AS, Steiner M. The role of breastfeeding in the association between maternal and infant cortisol attunement in the first postpartum year. Acta Paediatr 2018; 107:1205-1217. [PMID: 29405436 DOI: 10.1111/apa.14256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 12/30/2022]
Abstract
AIM To explore the role of breastfeeding as a possible link between maternal and infant cortisol attunement across the first postpartum year. METHODS Mothers (n = 93) provided salivary samples for cortisol levels over a two-day period during mid-pregnancy and at three, six and 12 months and infants at six and 12 months postpartum. Breastfeeding status was established at these same time points. RESULTS Among breastfeeding mothers, positive correlations were found between maternal cortisol levels during pregnancy and at three months postpartum and infant cortisol at six or 12 months postpartum. Among nonbreastfeeding mothers, these same maternal and infant cortisol relations were inverse and less pronounced. Further, in breastfeeding mothers, the relationship between maternal prenatal cortisol and infant cortisol at 12 months was mediated through maternal cortisol at three months postpartum. CONCLUSION These results suggest that maternal cortisol levels are positively associated with cortisol levels of the infant, among mothers who breastfeed. This relationship persists over a one-year period.
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Affiliation(s)
- Wibke Jonas
- Department of Psychology; University of Toronto at Mississauga; Mississauga ON Canada
- Women's Health Concerns Clinic; St. Joseph's Healthcare; Hamilton ON Canada
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Rossana Bisceglia
- Department of Psychology; University of Toronto at Mississauga; Mississauga ON Canada
| | - Michael J. Meaney
- Ludmer Centre for Neuroinformatics and Mental Health; Douglas Institute; McGill University; Montreal QC Canada
| | - Aya Dudin
- Department of Psychology; University of Toronto at Mississauga; Mississauga ON Canada
| | - Alison S. Fleming
- Department of Psychology; University of Toronto at Mississauga; Mississauga ON Canada
| | - Meir Steiner
- Women's Health Concerns Clinic; St. Joseph's Healthcare; Hamilton ON Canada
- Departments of Psychiatry, Behavioral Neurosciences and Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
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15
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Frasch MG, Lobmaier SM, Stampalija T, Desplats P, Pallarés ME, Pastor V, Brocco MA, Wu HT, Schulkin J, Herry CL, Seely AJE, Metz GAS, Louzoun Y, Antonelli MC. Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis. Neurosci Biobehav Rev 2018; 117:165-183. [PMID: 29859198 DOI: 10.1016/j.neubiorev.2018.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023]
Abstract
Prenatal stress (PS) impacts early postnatal behavioural and cognitive development. This process of 'fetal programming' is mediated by the effects of the prenatal experience on the developing hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). We derive a multi-scale multi-species approach to devising preclinical and clinical studies to identify early non-invasively available pre- and postnatal biomarkers of PS. The multiple scales include brain epigenome, metabolome, microbiome and the ANS activity gauged via an array of advanced non-invasively obtainable properties of fetal heart rate fluctuations. The proposed framework has the potential to reveal mechanistic links between maternal stress during pregnancy and changes across these physiological scales. Such biomarkers may hence be useful as early and non-invasive predictors of neurodevelopmental trajectories influenced by the PS as well as follow-up indicators of success of therapeutic interventions to correct such altered neurodevelopmental trajectories. PS studies must be conducted on multiple scales derived from concerted observations in multiple animal models and human cohorts performed in an interactive and iterative manner and deploying machine learning for data synthesis, identification and validation of the best non-invasive detection and follow-up biomarkers, a prerequisite for designing effective therapeutic interventions.
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Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
| | - Silvia M Lobmaier
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Mother and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Paula Desplats
- University of California, Departments of Neurosciences and Pathology, San Diego, USA
| | - María Eugenia Pallarés
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Verónica Pastor
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Marcela A Brocco
- Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín - Consejo Nacional de Investigaciones Científicas y Técnicas (UNSAM-CONICET), San Martín, Buenos Aires, Argentina
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA; Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | | | | | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Yoram Louzoun
- Bar-Ilan University, Department of Applied Mathematics, Israel
| | - Marta C Antonelli
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina
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16
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Zhou F, Chen C, Huang Y, Hu H, Li L, Tan Y. The Effects of Enriched Environmental Intervention on the Parturition Outcome and Filial Health of Pregnant Mice With Chronic Pain. Biol Res Nurs 2018; 20:264-271. [PMID: 29409343 DOI: 10.1177/1099800418754303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Chronic pain (CP) adversely impacts people's health. However, the influence of CP on pregnant women and their fetuses remains unclear. Few reasonable interventions have been offered to these women. This study aimed to examine the effects of enriched environmental intervention (EEI) on the delivery outcome and offspring health of pregnant mice with CP. Forty pregnant mice were equally and randomly divided into four groups (control, sham, CP, and CP + EEI). Monoarthritis was induced by subcutaneous injection of the complete Freund's adjuvant (100 μg/100 μl) into the left hind paw of mice on Day 0 of gestation. Sham mice received 100 µl of sterile phosphate-buffered saline subcutaneously. General health status and delivery outcomes of pregnant mice and general physical status, growth, and development of offspring were observed and compared between groups. CP mice exhibited less weight gain, higher rate of premature delivery, smaller litter size, lower live birth rate, lower filial birth weight, shorter filial tail length, and lower filial rates of achieving righting reflex and crawling compared to mice in the control/sham/CP + EEI groups. There were no significant differences between mice in the CP + EEI group and those in the control and sham groups. CP during pregnancy led to serious adverse impacts on both the mother and fetus mice in this study, and EEI was an effective treatment for these effects.
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Affiliation(s)
- Fang Zhou
- 1 School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cui Chen
- 2 ICU, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yue Huang
- 1 School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Huihui Hu
- 1 School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Li Li
- 1 School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yingchun Tan
- 1 School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It? J Pregnancy 2018; 2018:4857065. [PMID: 29484210 PMCID: PMC5816839 DOI: 10.1155/2018/4857065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
Gestational stress is believed to increase the risk of pregnancy failure and perinatal and adult morbidity and mortality in both the mother and her child or children. However, some contradictions might arise from methodological issues or even from differences in the philosophical grounds that guide the studies on gestational stress. Biased perspectives could lead us to use and/or design inadequate/incomplete panels of biochemical determinations and/or psychological instruments to diagnose it accurately during pregnancy, a psychoneuroimmune-endocrine state in which allostatic loads may be significant. Here, we review these notions and propose a model to evaluate and diagnose stress during pregnancy.
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18
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Zhang W, Finik J, Dana K, Glover V, Ham J, Nomura Y. Prenatal Depression and Infant Temperament: The Moderating Role of Placental Gene Expression. INFANCY 2017; 23:211-231. [PMID: 30393466 DOI: 10.1111/infa.12215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Prior research has demonstrated the link between maternal depression during pregnancy (i.e., prenatal depression) and increased neurodevelopmental dysregulation in offspring. However, little is known about the roles of key hypothalamic-pituitary axis regulatory genes in the placenta modulating this association. This study will examine whether placental gene expression levels of 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2), glucocorticoid receptor (NR3C1), and mineralocorticoid receptor (NR3C2) can help elucidate the underlying mechanisms linking prenatal depression to infant temperament, particularly in infants with high negativity and low emotion regulation. Stored placenta tissues (N = 153) were used to quantify messenger ribonucleic acid levels of HSD11B2, NR3C1, and NR3C2. Assessments of prenatal depression and infant temperament at 6 months of age were ascertained via maternal report. Results found that prenatal depression was associated with increased Negative Affectivity (p < .05) after controlling for postnatal depression and psychosocial characteristics. Furthermore, the association between prenatal depression and Negative Affectivity was moderated by gene expression levels of HSD11B2, NR3C1, and NR3C2 such that greater gene expression significantly lessened the association between prenatal depression and Negative Affectivity. Our findings suggest that individual differences in placental gene expression may be used as an early marker of susceptibility or resilience to prenatal adversity.
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Affiliation(s)
| | - Jackie Finik
- Queens College, CUNY and Icahn School of Medicine at Mount Sinai and Graduate School of Public Health and Health Policy, CUNY
| | - Kathryn Dana
- Queens College, CUNY and The Graduate Center, CUNY
| | | | - Jacob Ham
- Icahn School of Medicine at Mount Sinai
| | - Yoko Nomura
- Queens College, CUNY and Icahn School of Medicine at Mount Sinai and The Graduate Center, CUNY
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19
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Stroud LR, Papandonatos GD, Parade SH, Salisbury AL, Phipps MG, Lester B, Padbury JF, Marsit CJ. Prenatal Major Depressive Disorder, Placenta Glucocorticoid and Serotonergic Signaling, and Infant Cortisol Response. Psychosom Med 2017; 78:979-990. [PMID: 27763986 PMCID: PMC6541396 DOI: 10.1097/psy.0000000000000410] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Extending prior studies of prenatal adversity and depressive symptoms, we tested associations between maternal prenatal major depressive disorder (MDD) and infant cortisol regulation. Based on prior findings by our group, we also tested placenta glucocorticoid (HSD11B2 methylation) and serotonin (SLC6A4 gene expression) signaling as moderators of links between prenatal MDD and infant cortisol. METHODS Participants were 153 mother-infant pairs from a low-income, diverse sample (M [SD] age = 26 [6] years). Repeated structured diagnostic interviews were used to identify mothers with (a) prenatal MDD, (b) preconception-only MDD, and (c) controls. Placenta samples were assayed for HSD11B2 methylation and SLC6A4 gene expression. Infant salivary cortisol response to a neurobehavioral examination was assessed at 1 month. RESULTS Daughters of prenatal MDD mothers had 51% higher baseline (ratio = 1.51; 95% confidence interval [CI] = 1.01-2.27; p = .045) and 64% higher stress responsive cortisol (ratio = 1.64; 95% CI = 1.05-2.56; p = .03) than daughters of controls and 75% higher stress-responsive cortisol (ratio = 1.75; 95% CI = 1.04-2.94; p = .04) than daughters of preconception-only MDD mothers. HSD11B2 methylation moderated links between prenatal MDD and baseline cortisol (p = .02), with 1% methylation decreases associated with 9% increased baseline cortisol in infants of prenatal MDD mothers (ratio = 1.09; 95% CI = 1.01-1.16). SLC6A4 expression moderated links between prenatal MDD and cortisol response among boys alone (p = .007), with 10-fold increases in expression associated with threefold increases in stress-responsive cortisol (ratio = 2.87; 95% CI = 1.39-5.93) in sons of control mothers. CONCLUSIONS Results highlight specificity of associations between prenatal versus preconception MDD and cortisol regulation and the importance and complexity of placenta glucocorticoid and serotonergic pathways underlying the intergenerational transmission of risk from maternal adversity.
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Affiliation(s)
- Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
| | | | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Bradley/Hasbro Children’s Research Center, Department of Psychology
| | - Amy L. Salisbury
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
| | - Maureen G. Phipps
- Women & Infants’ Hospital of Rhode Island
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University
| | - Barry Lester
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
| | - James F. Padbury
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
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20
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Haselbeck C, Niederberger U, Kulle A, Wache K, Brauner E, Gutermuth M, Holterhus PM, Gerber WD, Siniatchkin M. Prenatal maternal distress seems to be associated with the infant's temperament and motor development: an explorative study. J Neural Transm (Vienna) 2017; 124:881-890. [PMID: 28361282 DOI: 10.1007/s00702-017-1712-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/15/2017] [Indexed: 12/31/2022]
Abstract
According to the concept of fetal programming, prenatal distress has long-lasting consequences on the offspring's health later in life. The hypothalamic-pituitary-adrenal axis is considered a mediating system by which maternal distress is transferred to the fetus in intrauterine environment. In this longitudinal explorative study on 30 mother-child-dyads, reported maternal distress and salivary cortisol were collected during pregnancy. Infant temperament, motor and cognitive development were assessed at 16 months. Additionally, infant cortisol levels throughout the day and in reaction to a psycho-social stressor where measured. As expected, infants whose mothers had experienced higher prenatal distress expressed a more difficult temperament and lower fine motor development at 16 months. No association could be shown between prenatal maternal distress and infant salivary cortisol.
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Affiliation(s)
- Christin Haselbeck
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany.
| | - Uwe Niederberger
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Alexandra Kulle
- Department of General Paediatrics, University Hospital of Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105, Kiel, Germany
| | - Katharina Wache
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Ellen Brauner
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Merlin Gutermuth
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital of Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105, Kiel, Germany
| | - Wolf-Dieter Gerber
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein, Campus Kiel, Preußerstraße 1-9, 24105, Kiel, Germany
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21
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Kamin HS, Kertes DA. Cortisol and DHEA in development and psychopathology. Horm Behav 2017; 89:69-85. [PMID: 27979632 DOI: 10.1016/j.yhbeh.2016.11.018] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/19/2016] [Accepted: 11/30/2016] [Indexed: 01/01/2023]
Abstract
Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.
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Affiliation(s)
- Hayley S Kamin
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Darlene A Kertes
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; University of Florida Genetics Institute, University of Florida, Gainesville, FL 32611, USA.
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22
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Hermansen TK, Yrttiaho S, Røysamb E, Melinder A. Perceptual interference processing in preschool children, with and without prenatal exposure to selective serotonin reuptake inhibitors. Psychopharmacology (Berl) 2017; 234:339-351. [PMID: 27826628 DOI: 10.1007/s00213-016-4467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prenatal exposure to maternal depression, with or without maternal medical antidepressant treatment, may pose a risk to the child's cognitive and behavioral development. Targeting one of the core functions of behavioral regulation, we investigated both behavioral and neural indices of interference suppression in both exposed and control participants at preschool age. METHODS Children (N = 80, M = 68.60 months, SD = 5.57) with prenatal exposure to maternal depression with (SSRI, N = 21) and without (DEP, N = 33) antidepressant treatment were tested together with unexposed children (CON, N = 26) on a behavioral flanker task while recording event-related potentials (ERPs). ERPs were extracted from trials with congruent/incongruent flankers and speeded/slow response times (RT). FINDINGS Effects of flanker congruence were found in both behavioral indices and the late slow wave ERP (LSW, 500-800 ms), across all groups in the expected directions. Further, increased amplitude of the N2 (350-450 ms) and the LSW potential was found in trials with speeded vs slow RT. Interestingly, the parietal N2 in speeded trials showed decreased latency among children in the CON group but not among the other children. No other effects of group on ERP or behavioral measures were found. CONCLUSION While interference effects were evident in behavioral and ERP measures, prenatal exposure to SSRIs and DEP was not directly associated with abilities of interference suppression. However, RT in the flanker task was associated with N2 and LSW potentials. Importantly, the interaction between RT and participant group upon parietal N2 latency may suggest effects of prenatal exposure on neural efficiency.
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Affiliation(s)
- Tone Kristine Hermansen
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway.
| | - Santeri Yrttiaho
- Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland
| | - Espen Røysamb
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway.,Division of Mental Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Annika Melinder
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway
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23
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Antenatal exposure to antidepressants is associated with altered brain development in very preterm-born neonates. Neuroscience 2017; 342:252-262. [DOI: 10.1016/j.neuroscience.2016.11.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
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24
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Increased symptoms of illness following prenatal stress: Can it be prevented by fluoxetine? Behav Brain Res 2017; 317:62-70. [DOI: 10.1016/j.bbr.2016.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/18/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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25
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Rash JA, Thomas JC, Campbell TS, Letourneau N, Granger DA, Giesbrecht GF. Developmental origins of infant stress reactivity profiles: A multi-system approach. Dev Psychobiol 2016; 58:578-99. [DOI: 10.1002/dev.21403] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Joshua A. Rash
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Jenna C. Thomas
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Tavis S. Campbell
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine (Pediatrics and Psychiatry); University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Saliva Bioscience Research; Arizona State University; Tempe AZ 85287
- Bloomberg School of Public Health and School of Medicine; The John Hopkins University School of Nursing; Baltimore MD 21205
| | - Gerald F. Giesbrecht
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Department of Pediatrics, Cumming School of Medicine; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
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26
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Kasap E, Aksu EE, Gur EB, Genc M, Eskicioğlu F, Gökduman A, Güçlü S. Investigation of the relationship between salivary cortisol, dehydroepiandrosterone sulfate, anxiety, and depression in patients with hyperemesis gravidarum. J Matern Fetal Neonatal Med 2016; 29:3686-9. [PMID: 26752270 DOI: 10.3109/14767058.2016.1140741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to determine the relationship of the salivary levels of dehydroepiandrosterone sulfate (DHEA-S) and cortisol with factors related to depression and anxiety in patients with hyperemesis gravidarum (HG). METHODS Forty patients with a diagnosis of HG were selected for the study and matched with 40 control patients according to body mass index, parity, and age. Symptoms of depression and anxiety were investigated using the Beck Depression Inventory and Beck Anxiety Inventory for Adults, respectively. Saliva samples were collected in the morning and at night and subjected to enzyme-linked immunosorbent assay for the determination of DHEA-S and cortisol levels. RESULTS We observed a positive correlation between increased levels of depression and anxiety and increased salivary levels of cortisol and DHEA-S in patients with HG. CONCLUSIONS Salivary cortisol and DHEA-S levels, as well as mood disorders, should be monitored in patients with HG, although further large, prospective studies are needed to confirm our results.
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Affiliation(s)
- Esin Kasap
- a Department of Obstetrics and Gynecology
| | - Ebru Emine Aksu
- b Department of Psychiatry , Sifa University School of Medicine , İzmir , Turkey
| | | | - Mine Genc
- a Department of Obstetrics and Gynecology
| | - Fatma Eskicioğlu
- c Department of Obstetrics and Gynecology , Merkez Efendi State Hospital , Manisa , Turkey , and
| | - Ayşe Gökduman
- d Department of Biochemistry , Sifa University School of Medicine , İzmir , Turkey
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27
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Brummelte S, Mc Glanaghy E, Bonnin A, Oberlander TF. Developmental changes in serotonin signaling: Implications for early brain function, behavior and adaptation. Neuroscience 2016; 342:212-231. [PMID: 26905950 DOI: 10.1016/j.neuroscience.2016.02.037] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 02/07/2023]
Abstract
The neurotransmitter serotonin (5-HT) plays a central role in brain development, regulation of mood, stress reactivity and risk of psychiatric disorders, and thus alterations in 5-HT signaling early in life have critical implications for behavior and mental health across the life span. Drawing on preclinical and emerging human evidence this narrative review paper will examine three key aspects when considering the consequences of early life changes in 5-HT: (1) developmental origins of variations of 5-HT signaling; (2) influence of genetic and epigenetic factors; and (3) preclinical and clinical consequences of 5-HT-related changes associated with antidepressant exposure (SSRIs). The developmental consequences of altered prenatal 5-HT signaling varies greatly and outcomes depend on an ongoing interplay between biological (genetic/epigenetic variations) and environmental factors, both pre and postnatally. Emerging evidence suggests that variations in 5-HT signaling may increase sensitivity to risky home environments, but may also amplify a positive response to a nurturing environment. In this sense, factors that change central 5-HT levels may act as 'plasticity' rather than 'risk' factors associated with developmental vulnerability. Understanding the impact of early changes in 5-HT levels offers critical insights that might explain the variations in early typical brain development that underlies behavioral risk.
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Affiliation(s)
- S Brummelte
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, Detroit, MI 48202, USA.
| | - E Mc Glanaghy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Child & Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - A Bonnin
- Zilkha Neurogenetic Institute and Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Child & Family Research Institute, University of British Columbia, Vancouver, BC, Canada
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28
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Vänskä M, Punamäki RL, Lindblom J, Tolvanen A, Flykt M, Unkila-Kallio L, Tulppala M, Tiitinen A. Timing of Early Maternal Mental Health and Child Cortisol Regulation. INFANT AND CHILD DEVELOPMENT 2015. [DOI: 10.1002/icd.1948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mervi Vänskä
- Psychology/School of Social Sciences and Humanities; University of Tampere; Tampere Finland
| | - Raija-Leena Punamäki
- Psychology/School of Social Sciences and Humanities; University of Tampere; Tampere Finland
| | - Jallu Lindblom
- Psychology/School of Social Sciences and Humanities; University of Tampere; Tampere Finland
| | - Asko Tolvanen
- Department of Psychology; University of Jyvaskyla; Jyvaskyla Finland
| | - Marjo Flykt
- Psychology/School of Social Sciences and Humanities; University of Tampere; Tampere Finland
| | - Leila Unkila-Kallio
- Department of Obstetrics and Gynaecology; Helsinki University Central Hospital; Helsinki Finland
- Department of Obstetrics and Gynaecology; University of Helsinki; Helsinki Finland
| | - Maija Tulppala
- Department of Obstetrics and Gynaecology; University of Helsinki; Helsinki Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology; Helsinki University Central Hospital; Helsinki Finland
- Department of Obstetrics and Gynaecology; University of Helsinki; Helsinki Finland
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29
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Milgrom J, Holt C, Holt CJ, Ross J, Ericksen J, Gemmill AW. Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up. Arch Womens Ment Health 2015; 18:717-30. [PMID: 25709044 DOI: 10.1007/s00737-015-0512-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 02/08/2015] [Indexed: 02/03/2023]
Abstract
Substantial evidence links antenatal depression, anxiety and stress with negative effects on foetal development, resulting in enduring problems in child development. Despite this, there is a paucity of research on intervention programmes designed to address depression and anxiety, and none that include infant outcomes. We aimed to evaluate the efficacy of a brief treatment for maternal depression and anxiety in pregnancy in a sample of women with a diagnosed depressive disorder. We developed a cognitive behavioural therapy treatment for antenatal depression and anxiety and evaluated it in a feasibility trial. This was followed by a pilot randomised controlled trial (RCT) which collected data on the efficacy of the brief intervention and follow-up data on infants. The feasibility study (n = 25) yielded promising results for adherence, acceptability and improvements in depression and anxiety (Beck Depression Inventory and Beck Anxiety Inventory). The RCT (n = 54) again showed excellent adherence and acceptability and supported the efficacy of the treatment. Strong reductions in anxiety were observed during pregnancy, and improvements in depression were maintained at 9 months representing a moderately large effect size. Nine-month infant outcomes showed several medium to large effects favouring the intervention in domains including problem solving, self-regulation and stress reactivity, which were independent of maternal postnatal mood. Treating severe depression and anxiety during pregnancy with a brief cognitive behavioural therapy (CBT) intervention appears feasible and worthwhile. To reliably detect clinically meaningful effects on infant outcomes, larger RCTs are likely to be required.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia
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30
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Park JH, Karmaus W, Zhang H. Prevalence of and Risk Factors for Depressive Symptoms in Korean Women throughout Pregnancy and in Postpartum Period. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:219-25. [DOI: 10.1016/j.anr.2015.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 02/12/2015] [Accepted: 03/23/2015] [Indexed: 11/27/2022] Open
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31
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Rash JA, Campbell TS, Letourneau N, Giesbrecht GF. Maternal cortisol during pregnancy is related to infant cardiac vagal control. Psychoneuroendocrinology 2015; 54:78-89. [PMID: 25686804 DOI: 10.1016/j.psyneuen.2015.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prenatal exposure to maternal psychological distress and glucocorticoids result in neurobiological adaptations within the fetus that increase risk for developing exaggerated emotional, behavioral, and stress responses to novelty and challenges in childhood. The current study investigated the influence of maternal depressed mood and cortisol during pregnancy on infant cardiac vagal control (CVC) to standardized laboratory challenge tasks. METHODS The sample comprised 194 women and their infants. Maternal reports of depressed mood and salivary cortisol were assessed at 14 and 32 weeks gestational age. Linear regression was used to examine associations between maternal measures during early and late pregnancy, and infant CVC indexed via respiratory sinus arrhythmia (RSA) at rest and in response to laboratory tasks designed to elicit frustration when infants were 6 months of age. It was hypothesized that maternal depressed mood and cortisol would be associated with lower basal RSA and smaller decreases in RSA from baseline to challenge. RESULTS A significant decrease in infant RSA from baseline to frustration tasks indicated that laboratory tasks elicited a reliable decrease in RSA from baseline to frustration among infants which is characterized by reduction in vagal efferent activity on the heart in response to challenge. Higher maternal cortisol, but not depressed mood, was associated with lower basal RSA and greater decrease in RSA from baseline to frustration. Associations between maternal cortisol and infant basal RSA were observed for both early and late pregnancy whereas the associations between prenatal cortisol and decrease in RSA from baseline to frustration were observed for early, but not late, pregnancy. CONCLUSIONS Maternal cortisol during pregnancy was associated with infant CVC at 6-months of age. Such influences may have enduring impacts on the child and important implications for the development of physical and mental health outcomes.
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Affiliation(s)
- Joshua A Rash
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4
| | - Nicole Letourneau
- Faculties of Nursing & Medicine (Pediatrics & Psychiatry), University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada T2N 1N4.
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32
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Slykerman RF, Thompson J, Waldie K, Murphy R, Wall C, Mitchell EA. Maternal stress during pregnancy is associated with moderate to severe depression in 11-year-old children. Acta Paediatr 2015; 104:68-74. [PMID: 25174703 DOI: 10.1111/apa.12787] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/29/2014] [Accepted: 08/20/2014] [Indexed: 11/27/2022]
Abstract
AIM Maternal stress during pregnancy has been associated with negative outcomes in children. We examined the risk factors for symptoms of depression in 11-year-old children, including the interaction between birthweight and other variables. METHODS We collected maternal, obstetric and demographic information from birth through to the age of 11. Approximately, half of the 609 children were born small-for-gestational-age (SGA). Information collected at 3.5 and 7 years of age included intelligence testing and parent-reported behavioural and emotional development. At 11 years of age, the children completed the Center for Epidemiological Studies Depression Scale for Children. Multivariable logistic regression analysis examined the relationship between self-reported symptoms of moderate to severe depression at the age of 11 and explanatory variables. RESULTS Symptoms of moderate to severe depression were related to increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at 7-years-old and being bullied at school in the previous 6 months. There was also a significant interaction between maternal stress in pregnancy and symptoms of depression in 11-year-old children born SGA. CONCLUSION Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those who were born SGA.
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Affiliation(s)
- Rebecca F Slykerman
- Starship Children's Hospital; Auckland District Health Board; Auckland New Zealand
| | - John Thompson
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
| | - Karen Waldie
- School of Psychology; University of Auckland; Auckland New Zealand
| | - Rinki Murphy
- Department of Medicine; University of Auckland; Auckland New Zealand
| | - Clare Wall
- Department of Nutrition; University of Auckland; Auckland New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health; University of Auckland; Auckland New Zealand
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33
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Babineau V, Green CG, Jolicoeur-Martineau A, Minde K, Sassi R, St-André M, Carrey N, Atkinson L, Meaney M, Wazana A. Prenatal depression and 5-HTTLPR interact to predict dysregulation from 3 to 36 months--a differential susceptibility model. J Child Psychol Psychiatry 2015; 56:21-9. [PMID: 24827922 PMCID: PMC5398894 DOI: 10.1111/jcpp.12246] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Childhood dysregulation, which reflects deficits in the capacity to regulate or control one's thoughts, emotions and behaviours, is associated with psychopathology throughout childhood and into adulthood. Exposures to adversity during the prenatal period, including prenatal depression, can influence the development of dysregulation, and a number of candidate genes have been suggested as moderators of prenatal exposure, including polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR). We examined whether prenatal depression and child 5-HTTLPR interact to predict childhood dysregulation. METHOD Sample of N = 213 mother-child pairs from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project. Mothers reported the IBQ-R at 3 and 6 months, and the ECBQ at 18 and 36 months, from which measures of dysregulation were extracted. Mothers' self-reported symptoms of depression on the CES-D at 24-36 weeks of gestation, and at 6, 12, 24 and 36 months postnatal. 5-HTTLPR genotype was extracted from buccal swabs. Mixed-model and confirmatory analyses were conducted. RESULTS Prenatal depression and 5-HTTLPR interacted to predict dysregulation from 3 to 36 months, within a model of strong differential susceptibility. CONCLUSION Children with S or LG alleles, when exposed to prenatal depression, have higher levels of dysregulation, and when exposed to lower or little prenatal depression, have higher capacity for regulation. Our findings support efforts to identify, support and treat prenatal depression.
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Babb JA, Deligiannidis KM, Murgatroyd CA, Nephew BC. Peripartum depression and anxiety as an integrative cross domain target for psychiatric preventative measures. Behav Brain Res 2015; 276:32-44. [PMID: 24709228 PMCID: PMC4185260 DOI: 10.1016/j.bbr.2014.03.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022]
Abstract
Exposure to high levels of early life stress has been identified as a potent risk factor for neurodevelopmental delays in infants, behavioral problems and autism in children, but also for several psychiatric illnesses in adulthood, such as depression, anxiety, autism, and posttraumatic stress disorder. Despite having robust adverse effects on both mother and infant, the pathophysiology of peripartum depression and anxiety are poorly understood. The objective of this review is to highlight the advantages of using an integrated approach addressing several behavioral domains in both animal and clinical studies of peripartum depression and anxiety. It is postulated that a greater focus on integrated cross domain studies will lead to advances in treatments and preventative measures for several disorders associated with peripartum depression and anxiety.
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Affiliation(s)
- Jessica A Babb
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | - Kristina M Deligiannidis
- Departments of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA 01605, USA.
| | | | - Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA.
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Abstract
Complex interactions between biological, behavioral and environmental factors are involved in mediating individual differences in health and disease. In this review, we present evidence suggesting that increased vulnerability to infectious disease may be at least, in part, due to long-lasting effects of early life psychosocial adversities. Studies have shown that maternal psychosocial stress during pregnancy is associated with long lasting changes in immune function and disease resistance in the offspring. Studies further indicated that harsh environmental conditions during the neonatal period may also cause lasting changes in host response to infectious disease. Although the mechanisms involved in these effects have not been fully examined, several potential mediators have been described, including changes in the development of the offspring hypothalamic-pituitary-adrenal axis, alterations in epigenetic pathways, stress-related maternal health risk behavior and infection during pregnancy. Although there are ample literature indicating that perinatal psychosocial stress increases vulnerability to disease, other reports suggest that mild predictable stressors may benefit the organism and allow better coping with future stressors. Thus, understanding the possible consequences of perinatal adversities and the mechanisms that are involved in immune regulation is important for increasing awareness to the potential outcomes of early negative life events and providing insight into potential therapies to combat infection in vulnerable individuals.
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Affiliation(s)
- Ronit Avitsur
- a School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo , Yaffo , Israel
| | - Sigal Levy
- a School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo , Yaffo , Israel
| | - Naama Goren
- a School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo , Yaffo , Israel
| | - Rachel Grinshpahet
- a School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo , Yaffo , Israel
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Desplats PA. Perinatal programming of neurodevelopment: epigenetic mechanisms and the prenatal shaping of the brain. ADVANCES IN NEUROBIOLOGY 2015; 10:335-61. [PMID: 25287548 DOI: 10.1007/978-1-4939-1372-5_16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The recent years have witnessed an exponential growth in the knowledge of epigenetic mechanisms, and piling evidence now links DNA methylation and histone modifications with a wide range of physiological processes from embryonic development to memory formation and behavior. Not surprisingly, deregulation of epigenetic modifications is associated with human diseases as well.An important feature of epigenetics is the ability of transducing environmental input into biological signaling, mainly by modulation of the transcriptome in response to a particular scenario. This characteristic generates developmental plasticity and allows the manifestation of a variety of phenotypes from the same genome.The early-life years represent a period of particular susceptibility to epigenetic alteration, as active changes in DNA methylation and histone marks are occurring as part of developmental programs and in response to environmental cues, which notably include psychosocial stimulation and maternal behavior. Memory formation and storage, response to stress in adult life, behavior, and manifestation of neurodegenerative conditions can all be imprinted in the organism by epigenetic modifications that contribute to shape the brain during prenatal or early postnatal life. Moreover, if these epigenetic alterations are preserved in the germ line, changes induced in one generation are likely inherited by future offspring. Programming by transgenerational inheritance thus represents a central mechanism by which environmental conditions may influence disease risk across multiple generations.As novel techniques emerge and as genome-wide profiling of disease-associated methylomes is achieved, epigenetic marks open a new source for biomarker discovery.
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Affiliation(s)
- Paula A Desplats
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA,
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24-h urinary free cortisol from mid-pregnancy to 3-months postpartum: gender and parity differences and effects. Psychoneuroendocrinology 2014; 50:264-73. [PMID: 25247747 DOI: 10.1016/j.psyneuen.2014.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pregnancy and postpartum have been associated to several physiological changes; however, empirical evidence was almost exclusively obtained in primiparous women and few studies focus on hormonal changes in men and second-time parents. The main aim of this study is to examine 24-h urinary free cortisol from mid-pregnancy to 3-months postpartum, comparing women/men and first/second-time parents. METHODS Twenty-six women and 22 men (N=48) were recruited from an antenatal obstetric unit in Porto, Portugal. 24-h urinary free cortisol was measured at the 2nd and 3rd trimester and at 3-months postpartum. Repeated measures analyses of variance were conducted, in order to analyze 24-h urinary free cortisol patterns of change over this period. Gender and parity were included in the analyses as potential modifiers, in order to compare women and men, and first- and second-time parents. RESULTS An increase from the 2nd to the 3rd trimester (p=.006) and a decrease from the 3rd trimester to 3-months postpartum (p=.005) were reported in all parents' 24-h urinary free cortisol. The interaction effects for Time*Gender (p=.03) and Time*Parity (p=.02) were found. Women and first-time parents revealed higher levels, while men and second-time parents showed lower 24-h urinary free cortisol levels at the 2nd trimester than at 3-months postpartum. CONCLUSIONS Findings appear to clarify the direction, as well as, the timing, gender and parity extension of 24-h urinary free cortisol changes from mid-pregnancy to 3-months postpartum. The same pattern of change in all parents' 24-h urinary free cortisol from mid-pregnancy to 3-months postpartum is consistent with the proposed role of hormones in preparation to parenting. Gender and parity differences and effects on 24-h urinary free cortisol are also consistent with cortisol as a stress biomarker for higher challenges associated to pregnancy and childbirth in women and first-time parents versus higher demands related to after childbirth parenting in men and second-time parents.
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Hermansen TK, Melinder A. Prenatal SSRI exposure: Effects on later child development. Child Neuropsychol 2014; 21:543-69. [DOI: 10.1080/09297049.2014.942727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Antenatal depression and antidepressants during pregnancy: unraveling the complex interactions for the offspring. Eur J Pharmacol 2014; 753:257-62. [PMID: 25094036 DOI: 10.1016/j.ejphar.2014.07.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/18/2014] [Accepted: 07/24/2014] [Indexed: 02/01/2023]
Abstract
During pregnancy the risk for a woman to develop a depressive episode is as high as 20%. Antenatal depression is not harmless for the developing child as several changes, including neurodevelopmental alterations, have been reported. Sometimes it is unavoidable to treat a pregnant mother with antidepressants, especially when she is suicidal. Currently, selective serotonin reuptake inhibitors (SSRIs) are the pharmacological choice of antidepressant treatment. SSRIs do not cause gross teratogenic alterations and are generally considered safe for use in pregnancy. However, although SSRIs may relieve the maternal symptoms, they definitively cross the placenta partially influencing the neurodevelopment of the fetus. In this review an overview is given of the effects on the offspring of maternal antenatal depression and the putative neurodevelopmental effects of SSRI treatment during pregnancy. Although we primarily focus on human data, some animal data are discussed to describe possible mechanisms on how SSRIs are affecting underlying biological mechanisms associated with depression. In summary, maternal depression may have long-lasting effects on the offspring, whereas prenatal SSRI exposure also increases the risk for long-lasting effects. It remains to be determined whether the effects found after SSRI treatment in pregnant women are only due to the SSRI exposure or if the underlying depression is also contributing to these effects. The possibility of epigenetic alterations as one of the underlying mechanisms that is altered by SSRI exposure is discussed. However much more research in this area is needed to explain the exact role of epigenetic mechanisms in SSRI exposure during pregnancy.
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Rosenquist SE. When the bough breaks: rethinking treatment strategies for perinatal depression. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2013; 55:291-323. [PMID: 23488254 DOI: 10.1080/00029157.2012.723284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Awareness of depression among OB-GYN physicians has increased with the result that more than 13% of pregnant women in the United States receive prescriptions for antidepressant medications. But the safety and effectiveness of these compounds has been exaggerated while the effectiveness of psychotherapy has been overlooked and distorted and various medical guidelines for treatment of perinatal depression have been downplayed or ignored. This article addresses the common fears and misconceptions surrounding treatment of depression during pregnancy and after childbirth. The effectiveness of strategic cognitive-behavioral therapy enhanced with hypnosis offers excellent results without the risks associated with these medications. Targets for focused intervention are identified and discussed.
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Abstract
AbstractThe science of genetics is undergoing a paradigm shift. Recent discoveries, including the activity of retrotransposons, the extent of copy number variations, somatic and chromosomal mosaicism, and the nature of the epigenome as a regulator of DNA expressivity, are challenging a series of dogmas concerning the nature of the genome and the relationship between genotype and phenotype. According to three widely held dogmas, DNA is the unchanging template of heredity, is identical in all the cells and tissues of the body, and is the sole agent of inheritance. Rather than being an unchanging template, DNA appears subject to a good deal of environmentally induced change. Instead of identical DNA in all the cells of the body, somatic mosaicism appears to be the normal human condition. And DNA can no longer be considered the sole agent of inheritance. We now know that the epigenome, which regulates gene expressivity, can be inherited via the germline. These developments are particularly significant for behavior genetics for at least three reasons: First, epigenetic regulation, DNA variability, and somatic mosaicism appear to be particularly prevalent in the human brain and probably are involved in much of human behavior; second, they have important implications for the validity of heritability and gene association studies, the methodologies that largely define the discipline of behavior genetics; and third, they appear to play a critical role in development during the perinatal period and, in particular, in enabling phenotypic plasticity in offspring. I examine one of the central claims to emerge from the use of heritability studies in the behavioral sciences, the principle of minimal shared maternal effects, in light of the growing awareness that the maternal perinatal environment is a critical venue for the exercise of adaptive phenotypic plasticity. This consideration has important implications for both developmental and evolutionary biology.
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Relaxation during pregnancy: what are the benefits for mother, fetus, and the newborn? A systematic review of the literature. J Perinat Neonatal Nurs 2012; 26:296-306. [PMID: 23111717 DOI: 10.1097/jpn.0b013e31823f565b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Previous studies have reported associations between maternal stress during pregnancy and obstetric outcomes as well as fetal development and neonatal adaptation. These findings highlight the importance of identifying pregnant women who experience severe stress and the need for interventions that commence early in pregnancy. The aim of this study was to review studies that investigated the effects of relaxation techniques during pregnancy, including maternal, fetal, and neonatal outcomes. In addition, studies examining maternal endocrine and physiological alterations were reviewed. PubMed was searched using the following key words: maternal well-being, maternal stress, relaxation techniques, pregnancy, fetal neurobehavior, fetal heart rate, neonatal adaptation, and neonatal behavior. (1) Relaxation had a positive impact on women's emotional state. (2) Pregnancy outcomes improved with fewer admissions to the hospital, fewer obstetric complications, longer gestation, reduction of caesarean sections, and fewer postpartum complications. (3) Fetal heart rate and fetal motor activity were reduced as a result of relaxation and therefore interpreted as improved result. (4) Higher-birth-weight and improved performance on the Neonatal Behavioral Assessment Scale was related to relaxation. (5) Relaxation training was associated with reductions in maternal physiological and endocrine measures. Relaxation during pregnancy is associated with salutogenic effects that include regulation of emotional states and physiology. Relaxation is also associated with positive effects both on fetal behavior and on obstetric and neonatal outcomes. Identifying pregnant women at risk and instituting treatment early in pregnancy could improve obstetric and developmental outcomes for both the mother and her fetus.
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Developmental fluoxetine exposure differentially alters central and peripheral measures of the HPA system in adolescent male and female offspring. Neuroscience 2012; 220:131-41. [DOI: 10.1016/j.neuroscience.2012.06.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/27/2012] [Accepted: 06/13/2012] [Indexed: 11/20/2022]
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Oberlander TF. Fetal serotonin signaling: setting pathways for early childhood development and behavior. J Adolesc Health 2012; 51:S9-16. [PMID: 22794534 DOI: 10.1016/j.jadohealth.2012.04.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 02/07/2023]
Abstract
Finely tuning levels of the key neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) during early life is essential for brain development and setting pathways for health and disorder across the early life span. Given the central role of 5-HT in brain development, regulation of mood, stress reactivity, and risk for psychiatric disorders, alterations in 5-HT signaling early in life have critical implications for behavior and mental health in childhood and adolescence. This article reviews the developmental consequences of two key influences that alter fetal 5-HT signaling: (1) in utero exposure to 5-HT reuptake inhibitor antidepressants, and (2) genetic variations in the 5-HT transporter gene (SLC6A4). The consequences of altered prenatal 5-HT signaling vary greatly, and developmental outcomes depend on an ongoing interplay between biological (genetic/epigenetic variations), experiential (prenatal drug or maternal mood exposure), and contextual (postnatal social environment) variables. Emerging evidence suggests both exposure to 5-HT reuptake inhibitors and genetic variations that affect 5-HT signaling may increase sensitivity to negative social contexts for some individuals, whereas for others, they may confer sensitivity to positive life circumstances. In this sense, factors that change central 5-HT levels may function less like influences that predict "vulnerability," but rather act like "plasticity factors." Understanding the impact of early changes in serotonergic programming offers critical insights that might explain patterns of individual differences in developmental risk and resilience.
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Affiliation(s)
- Tim F Oberlander
- Department of Pediatrics, Child and Family Research Institute, Vancouver, British Columbia, Canada.
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Pawluski JL, Brain UM, Underhill CM, Hammond GL, Oberlander TF. Prenatal SSRI exposure alters neonatal corticosteroid binding globulin, infant cortisol levels, and emerging HPA function. Psychoneuroendocrinology 2012; 37:1019-28. [PMID: 22177580 DOI: 10.1016/j.psyneuen.2011.11.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 11/16/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Serotonin influences the development of the hypothalamic-pituitary-adrenal (HPA) system; therefore prenatal exposure to selective serotonin reuptake inhibitor antidepressants (SSRIs) may alter HPA axis development and function. To address this, prenatal exposure to SSRIs and maternal mood were examined in relation to neonatal and infant levels of cortisol and its binding protein, corticosteroid-binding globulin (CBG). METHODS Serum cortisol and CBG levels were assayed from SSRI-exposed and non-exposed mothers and their neonates at delivery. Maternal mood symptoms were documented at 36 weeks gestation. To determine the long-term implications of changes in CBG, levels of salivary cortisol were assessed in infants at 3 months of age. RESULTS Prenatal SSRI exposure significantly increased serum CBG levels in neonates after vaginal delivery (p ≤ 0.038), even when controlling for maternal depression. Neonatal serum cortisol levels did not vary with SSRI exposure or antenatal maternal mood, but were significantly higher following vaginal delivery (p ≤ 0.003). Neonatal serum CBG levels were associated with infant salivary levels of evening cortisol (p ≤ 0.051). In SSRI-exposed infants, increased levels of neonatal CBG predicted a smaller diurnal change in infant salivary cortisol (p ≤ 0.028), regardless of maternal depression. CONCLUSIONS Prenatal SSRI exposure affects the developing HPA system by altering serum CBG levels in neonates and infant salivary cortisol levels. Further research is warranted on the long-term functional implications of the effect of prenatal SSRI exposure on fetal hepatic CBG gene expression and the developing HPA system.
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Affiliation(s)
- Jodi L Pawluski
- Early Human Experience Unit, Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
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Liu Y, Murphy SK, Murtha AP, Fuemmeler BF, Schildkraut J, Huang Z, Overcash F, Kurtzberg J, Jirtle R, Iversen ES, Forman MR, Hoyo C. Depression in pregnancy, infant birth weight and DNA methylation of imprint regulatory elements. Epigenetics 2012; 7:735-46. [PMID: 22677950 PMCID: PMC3414394 DOI: 10.4161/epi.20734] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Depressed mood in pregnancy has been linked to low birth weight (LBW, < 2,500 g), a risk factor for adult-onset chronic diseases in offspring. We examined maternal depressed mood in relation to birth weight and evaluated the role of DNA methylation at regulatory sequences of imprinted genes in this association. We measured depressed mood among 922 pregnant women using the CES-D scale and obtained birth weight data from hospital records. Using bisulfite pyrosequencing of cord blood DNA from 508 infants, we measured methylation at differentially methylated regions (DMRs) regulating imprinted genes IGF2/H19, DLK1/MEG3, MEST, PEG3, PEG10/SGCE, NNAT and PLAGL1. Multiple regression models were used to examine the relationship between depressed mood, birth weight and DMR methylation levels. Depressed mood was associated with a more that 3-fold higher risk of LBW, after adjusting for delivery mode, parity, education, cigarette smoking, folic acid use and preterm birth. The association may be more pronounced in offspring of black women and female infants. Compared with infants of women without depressed mood, infants born to women with severe depressed mood had a 2.4% higher methylation at the MEG3 DMR. Whereas LBW infants had 1.6% lower methylation at the IGF2 DMR, high birth weight (> 4,500 g) infants had 5.9% higher methylation at the PLAGL1 DMR compared with normal birth weight infants. Our findings confirm that severe maternal depressed mood in pregnancy is associated with LBW, and that MEG3 and IGF2 plasticity may play important roles.
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Affiliation(s)
- Ying Liu
- School of Medicine; Duke University; Durham, NC USA
| | - Susan K. Murphy
- Department of Obstetrics and Gynecology; Division of Gynecologic Oncology; Duke University Medical Center; Durham, NC USA
| | - Amy P. Murtha
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; School of Medicine; Duke University; Durham, NC USA
| | - Bernard F. Fuemmeler
- Department of Community and Family Medicine; Division of Prevention; School of Medicine; Duke University; Durham, NC USA
- Department of Psychology and Neurosciences; Duke University; Durham, NC USA
| | - Joellen Schildkraut
- Department of Community and Family Medicine; Division of Prevention; School of Medicine; Duke University; Durham, NC USA
- Duke Comprehensive Cancer Center; School of Medicine; Duke University; Durham, NC USA
| | - Zhiqing Huang
- Department of Obstetrics and Gynecology; Division of Gynecologic Oncology; Duke University Medical Center; Durham, NC USA
| | - Francine Overcash
- Department of Obstetrics and Gynecology; Division of Epidemiology; School of Medicine; Duke University; Durham, NC USA
| | - Joanne Kurtzberg
- Duke Comprehensive Cancer Center; School of Medicine; Duke University; Durham, NC USA
- Department of Pediatrics; School of Medicine; Duke University; Durham, NC USA
| | - Randy Jirtle
- Department of Radiation Oncology; School of Medicine; Duke University; Durham, NC USA
| | - Edwin S. Iversen
- Department of Statistical Science; Duke University; Durham, NC USA
| | - Michele R. Forman
- Department of Nutritional Sciences; University of Texas at Austin; Austin, TX USA
| | - Cathrine Hoyo
- Duke Comprehensive Cancer Center; School of Medicine; Duke University; Durham, NC USA
- Department of Obstetrics and Gynecology; Division of Epidemiology; School of Medicine; Duke University; Durham, NC USA
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Hanley GE, Oberlander TF. Neurodevelopmental outcomes following prenatal exposure to serotonin reuptake inhibitor antidepressants: A “social teratogen” or moderator of developmental risk? ACTA ACUST UNITED AC 2012; 94:651-9. [DOI: 10.1002/bdra.23032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/28/2012] [Accepted: 04/19/2012] [Indexed: 11/10/2022]
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Bigelow A, Power M, MacLellan‐Peters J, Alex M, McDonald C. Effect of Mother/Infant Skin‐to‐Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress. J Obstet Gynecol Neonatal Nurs 2012; 41:369-82. [DOI: 10.1111/j.1552-6909.2012.01350.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Delayed reactive cries demonstrate emotional and physiological dysregulation in newborns of depressed mothers. Biol Psychol 2012; 89:374-81. [DOI: 10.1016/j.biopsycho.2011.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 11/21/2011] [Accepted: 11/27/2011] [Indexed: 11/20/2022]
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Brandon AR, Freeman MP. When she says "no" to medication: psychotherapy for antepartum depression. Curr Psychiatry Rep 2011; 13:459-66. [PMID: 21877161 DOI: 10.1007/s11920-011-0230-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many women suffering from major depressive disorder during pregnancy are hesitant to initiate or continue antidepressant treatment during preconception planning, conception, pregnancy, and lactation (perinatal period). Over the past few decades, various psychotherapeutic approaches have been found to be efficacious for depression in general population research. Several observational and quasi-experimental studies also suggest that psychotherapy can be a safe first-line treatment for perinatal women with mild to moderate depression. This article summarizes findings to date regarding the use of psychotherapy for depression occurring during pregnancy and describes the adaptations made to tailor the treatment to the unique needs of women in the perinatal period.
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Affiliation(s)
- Anna R Brandon
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Campus Box 7160, Chapel Hill, NC 27599-7160, USA.
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