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Timmer-Murillo SC, Mowrer A, Wang AZ, Jazinski-Chambers K, Piña I, Rundell MR, Bennett JM, Wagner AJ, deRoon-Cassini TA. Examining emotion regulation and inflammation as predictors of maternal mental health after fetal anomaly diagnosis. Brain Behav Immun 2024:S0889-1591(24)00523-3. [PMID: 39106938 DOI: 10.1016/j.bbi.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/09/2024] [Accepted: 08/01/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE Fetal anomalies occur in approximately 3% of pregnancies and receiving the diagnosis may be a potentially traumatic experience for families. The mental health of mothers receiving diagnoses and what predicts resilience or poor mental health is understudied. Emotion regulation is an important, modifiable, transdiagnostic factor of mental health, and may be protective post-diagnosis. Evaluating biomarkers of stress, including IL-6 and Allostatic Load (AL), can also serve as early indicators of risk, indicative of early intervention. This study assessed whether reappraisal, suppression, IL-6, and AL was associated with mental health outcomes and resilience in women after receiving a fetal anomaly diagnosis. METHODS Pregnant women (N=108) presenting to a fetal concerns clinic for initial consultation completed measures of emotion regulation (i.e., reappraisal and suppression), depression, anxiety, posttraumatic stress symptoms, and resilience between 2019-2022. A blood draw was used to assess IL-6 and create composite allostatic load measure including: IL-6, blood pressure, heart rate, glucose, cortisol, and body mass index. RESULTS Linear regressions controlling for age, gestational age, and perceived fetal diagnosis severity, demonstrated that IL-6 was negatively associated with resilience and positively associated with depression. Reappraisal was positively associated to resilience and negatively associated with depression, anxiety, and PTSD, whereas state insurance status was positively associated to anxiety and PTS symptoms. Suppression and allostatic load were not significant. CONCLUSIONS Women experiencing fetal anomaly diagnosis represent an understudied population with unaddressed mental health needs. Reappraisal serves as not only a protective factor, but one that can be enhanced to promote maternal resilience and mental health. Furthermore, elevated IL-6 may be a critical early indicator of potential intervention needs among women who are pregnant, to mitigate negative psychological states and enhance resilience.
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Affiliation(s)
- Sydney C Timmer-Murillo
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Alyssa Mowrer
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Amy Z Wang
- University of Wisconsin, Milwaukee, Department of Psychology, 2441 E. Hartford Ave. Milwaukee, WI 53211, USA.
| | - Kelley Jazinski-Chambers
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Isela Piña
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Maddie R Rundell
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeanette M Bennett
- UNC Charlotte, Department of Psychological Science, 9201 University City Blvd Charlotte, NC 28223, USA.
| | - Amy J Wagner
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Terri A deRoon-Cassini
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA; Comprehensive Injury Center, Division of Data Surveillance & Informatics, 10000 Innovation Dr. Milwaukee, WI 53226, USA.
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Christensen GM, Marcus M, Naudé PJW, Vanker A, Eick SM, Caudle WM, Malcolm-Smith S, Suglia SF, Chang HH, Zar HJ, Stein DJ, Hüls A. Joint effects of prenatal exposure to indoor air pollution and psychosocial factors on early life inflammation. ENVIRONMENTAL RESEARCH 2024; 252:118822. [PMID: 38565416 PMCID: PMC11188991 DOI: 10.1016/j.envres.2024.118822] [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: 10/31/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
It is hypothesized that air pollution and stress impact the central nervous system through neuroinflammatory pathways Despite this, the association between prenatal exposure to indoor air pollution and psychosocial factors on inflammatory markers in infancy has been underexplored in epidemiology studies. This study investigates the individual and joint effects of prenatal exposure to indoor air pollution and psychosocial factors on early life inflammation (interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)). We analyzed data from the South African Drakenstein Child Health Study (N = 225). Indoor air pollution and psychosocial factor measurements were taken in the 2nd trimester of pregnancy. Circulating inflammatory markers (IL-1β, Il-6, and TNF-α) were measured in serum in the infants at 6 weeks postnatal. Linear regression models were used to investigate associations between individual exposures and inflammatory markers. To investigate joint effects of environmental and psychosocial factors, Self-Organizing Maps (SOM) were used to create exposure profile clusters. These clusters were added to linear regression models to investigate the associations between exposure profiles and inflammatory markers. All models were adjusted for maternal age, maternal HIV status, and ancestry to control for confounding. Most indoor air pollutants were positively associated with inflammatory markers, particularly benzene and TNF-α in single pollutant models. No consistent patterns were found for psychosocial factors in single-exposure linear regression models. In joint effects analyses, the SOM profile with high indoor air pollution, low SES, and high maternal depressive symptoms were associated with higher inflammation. Indoor air pollutants were consistently associated with increased inflammation in both individual and joint effects models, particularly in combination with low SES and maternal depressive symptoms. The trend for individual psychosocial factors was not as clear, with mainly null associations. As we have observed pro- and anti-inflammatory effects, future research should investigate joint effects of these exposures on inflammation and their health effects.
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Affiliation(s)
- Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Petrus J W Naudé
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Stephanie M Eick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - W Michael Caudle
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan Malcolm-Smith
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Silva-Fernandes A, Conde A, Marques M, Caparros-Gonzalez RA, Fransson E, Mesquita AR, Figueiredo B, Skalkidou A. Inflammatory biomarkers and perinatal depression: A systematic review. PLoS One 2024; 19:e0280612. [PMID: 38820411 PMCID: PMC11142563 DOI: 10.1371/journal.pone.0280612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/06/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We performed a systematic review to identify, summarize and discuss studies on inflammatory biomarkers described in relation to PND. METHOD Inclusion criteria defined the selection of observational studies written in English, French, Spanish or Portuguese, that evaluate analytical levels of inflammatory molecules (protein levels) in biological fluids in women, with a diagnosis of depression using ICD/DSM diagnostic criteria or depressive symptoms assessed by standardized psychometric instruments, during pregnancy and/or postpartum. Case reports, experimental studies, reviews, qualitative analysis, meta-analysis, gray literature or replicated data were excluded. Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale. Data extraction included study design; number of subjects; obstetric information; tools and timepoints of depression and inflammatory markers assessment. RESULTS 56 studies (sample size for cross-sectional and case-control studies ranging from 10 to 469; sample size for longitudinal studies ranging from 26 to 467), where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and postpartum period were included in this systematic review. Overall, the findings of our systematic review lend support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms. The associations were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-α among depressed. DISCUSSION In summary, our systematic review findings provide evidence supporting the hypothesis that several inflammatory markers may correlate with peripartum depressive symptoms. However, our work also highlighted notable differences in the timing of biological sampling for inflammatory markers and in the methodologies used to assess depression during the perinatal period. Additionally, variations were observed in how inflammatory biomarkers and depression were approached, including their classification as exposure or outcome variables, and the timing of assessments. It is essential for future research to investigate the influence of biological fluids and the timing of assessments for both inflammatory biomarkers and depression to gain a deeper understanding of their association. This comprehensive exploration is pivotal for elucidating the intricate relationship between inflammation and perinatal depression.
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Affiliation(s)
- Anabela Silva-Fernandes
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Ana Conde
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, Porto, Portugal
| | - Margarida Marques
- Faculdade de Psicologia, CICPSI, Universidade de Lisboa, Lisboa, Portugal
| | - Rafael A. Caparros-Gonzalez
- Faculty of Health Sciences, Department of Nursing, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain
| | - Emma Fransson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ana Raquel Mesquita
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
- ProChild CoLab Against Poverty and Social Exclusion–Association (ProChild CoLAB) Campus de Couros Rua de Vila Flor, Guimarães, Portugal
| | - Bárbara Figueiredo
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Alkistis Skalkidou
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Zha A, Yan J, Li J, Wang J, Qi M, Liao P, Chun G, Yin Y. Melatonin increased antioxidant capacity to ameliorate growth retardation and intestinal epithelial barrier dysfunction in diquat-challenged piglets. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:2262-2271. [PMID: 37947497 DOI: 10.1002/jsfa.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/16/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Diquat is a common environmental pollutant, which can cause oxidative stress in humans and animals. Diquat exposure causes growth retardation and intestinal damage. Therefore, this study was performed to investigate the effects of melatonin on diquat-challenged piglets. RESULTS Dietary supplementation with 2 mg kg-1 melatonin significantly increased the average daily gain and feed conversion rate in piglets. Melatonin increased antioxidant capacity, and improved intestinal epithelial barrier function of duodenum and jejunum in piglets. Moreover, melatonin was found to regulated the expression of immune and antioxidant-related genes. Melatonin also alleviated diquat-induced growth retardation and anorexia in diquat-challenged piglets. It also increased antioxidant capacity, and ameliorated diquat-induced intestinal epithelial barrier injury. Melatonin also regulated the expression of MnSOD and immuner-elated genes in intestinal. CONCLUSION Dietary supplementation with 2 mg kg-1 melatonin increased antioxidant capacity to ameliorate diquat-induced oxidative stress, alleviate intestinal epithelial barrier injury, and increase growth performance in weaned piglets. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Andong Zha
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jiameng Yan
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, China
| | - Junyao Li
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Jing Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Ming Qi
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
| | - Peng Liao
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
| | - Guo Chun
- Center for Medical Research and Innovation, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yulong Yin
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-Ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
- University of Chinese Academy of Sciences, Beijing, China
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, China
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
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Wu Y, De Asis-Cruz J, Limperopoulos C. Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy. Mol Psychiatry 2024:10.1038/s41380-024-02449-0. [PMID: 38418579 DOI: 10.1038/s41380-024-02449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
In-utero exposure to maternal psychological distress is increasingly linked with disrupted fetal and neonatal brain development and long-term neurobehavioral dysfunction in children and adults. Elevated maternal psychological distress is associated with changes in fetal brain structure and function, including reduced hippocampal and cerebellar volumes, increased cerebral cortical gyrification and sulcal depth, decreased brain metabolites (e.g., choline and creatine levels), and disrupted functional connectivity. After birth, reduced cerebral and cerebellar gray matter volumes, increased cerebral cortical gyrification, altered amygdala and hippocampal volumes, and disturbed brain microstructure and functional connectivity have been reported in the offspring months or even years after exposure to maternal distress during pregnancy. Additionally, adverse child neurodevelopment outcomes such as cognitive, language, learning, memory, social-emotional problems, and neuropsychiatric dysfunction are being increasingly reported after prenatal exposure to maternal distress. The mechanisms by which prenatal maternal psychological distress influences early brain development include but are not limited to impaired placental function, disrupted fetal epigenetic regulation, altered microbiome and inflammation, dysregulated hypothalamic pituitary adrenal axis, altered distribution of the fetal cardiac output to the brain, and disrupted maternal sleep and appetite. This review will appraise the available literature on the brain structural and functional outcomes and neurodevelopmental outcomes in the offspring of pregnant women experiencing elevated psychological distress. In addition, it will also provide an overview of the mechanistic underpinnings of brain development changes in stress response and discuss current treatments for elevated maternal psychological distress, including pharmacotherapy (e.g., selective serotonin reuptake inhibitors) and non-pharmacotherapy (e.g., cognitive-behavior therapy). Finally, it will end with a consideration of future directions in the field.
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Affiliation(s)
- Yao Wu
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA
| | | | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, 20010, USA.
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, 20010, USA.
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Maes M, Abe Y, Sirichokchatchawan W, Suwimonteerabutr J, Sangkomkamhangd U, Almulla AF, Satthapisit S. The Cytokine, Chemokine, and Growth Factor Network of Prenatal Depression. Brain Sci 2023; 13:brainsci13050727. [PMID: 37239199 DOI: 10.3390/brainsci13050727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Neuro-immune pathways are engaged in antenatal and postpartum depression. AIMS To determine if immune profiles influence the severity of prenatal depression above and beyond the effects of adverse childhood experiences (ACE), premenstrual syndrome (PMS), and current psychological stressors. METHODS Using the Bio-Plex Pro human cytokine 27-plex test kit, we assayed M1 macrophage, T helper (Th)-1, Th-2, Th-17, growth factor, chemokine, and T cell growth immune profiles as well as indicators of the immune inflammatory response system (IRS) and compensatory immunoregulatory system (CIRS) in 120 pregnant females in the early (<16 weeks) and late (>24 weeks) pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess severity of antenatal depression. RESULTS Cluster analyses showed that the combined effects of ACE, relationship dissatisfaction, unwanted pregnancy, PMS, and upregulated M1, Th-1, Th-2, and IRS immune profiles and the ensuing early depressive symptoms shape a stress-immune-depression phenotypic class. Elevated IL-4, IL-6, IL-8, IL-12p70, IL-15, IL-17, and GM-CSF are the cytokines associated with this phenotypic class. All immune profiles (except CIRS) were significantly associated with the early EPDS score, independent of the effects of psychological variables and PMS. There was a shift in immune profiles from early to late pregnancy, with an increase in the IRS/CIRS ratio. The late EPDS score was predicted by the early EPDS score, adverse experiences, and immune profiles, mainly the Th-2 and Th-17 phenotypes. CONCLUSIONS Activated immune phenotypes contribute to early and late perinatal depressive symptoms above and beyond the effects of psychological stressors and PMS.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok 10330, Thailand
- Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
- Department of Psychiatry, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- IMPACT Strategic Research Center, Barwon Health, Geelong 3220, Australia
| | - Yoshiko Abe
- College of Public Health Sciences (CPHS), Chulalongkorn University, Bangkok 10330, Thailand
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
| | - Wandee Sirichokchatchawan
- College of Public Health Sciences (CPHS), Chulalongkorn University, Bangkok 10330, Thailand
- Health and Social Sciences and Addiction Research Unit, Chulalongkorn University, Bangkok 10330, Thailand
| | - Junpen Suwimonteerabutr
- Department of Obstetrics, Gynaecology and Reproduction, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Abbas F Almulla
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
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Naudé PJW, Pariante C, Hoffman N, Koopowitz SM, Donald KA, Zar HJ, Stein DJ. Antenatal maternal depression, early life inflammation and neurodevelopment in a South African birth cohort. Brain Behav Immun 2022; 105:160-168. [PMID: 35803482 DOI: 10.1016/j.bbi.2022.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Antenatal exposure to maternal psychological adversity, including depression, increases the risk of impaired neurodevelopment in children. The underlying biological mechanisms remain unclear, especially in early life during critical windows of development and maturation. This study investigated the association of antenatal maternal depression, maternal and early life inflammatory markers and neurodevelopmental outcomes in children at 2 years of age. METHODS A subgroup of mothers and their children (n = 255) that were enrolled in a South African birth cohort study, the Drakenstein Child Health Study, were followed from the antenatal period through to 2 years of child age. Maternal depressive symptoms were measured by the Beck Depression Inventory (BDI-II) at 26 weeks gestation. Serum inflammatory markers [granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ), interleukin IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, tumour necrosis factor-α (TNF-α), neutrophil gelatinase-associated lipocalin (NGAL) and metalloproteinase-9 (MMP-9)] were measured in mothers at enrolment and in their children at 6-10 weeks and at 2 years. Neurodevelopment was assessed at 2 years using the Bayley Scales of Infant and Toddler Development III. RESULTS Antenatal depressive symptoms (present in 25% of the mothers) were significantly associated with higher levels of IL-7 (p = 0.008), IL-8 (p = 0.019) and TNF-α (p = 0.031) in the mothers after correcting for sociodemographic and lifestyle factors. Serum IL-1β and NGAL levels were significantly elevated over time in children born to mothers with depressive symptoms compared to those without depression, after controlling for maternal and child health and sociodemographic factors. Elevated infant IL-1β at 6-10 weeks of age partially mediated the association of maternal depressive symptoms with poorer language scores at 2 years. CONCLUSION Alterations in early life immunity, as reflected by elevated IL-1β, is a potential pathway through which antenatal maternal depressive symptoms may impact language development in young children.
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Affiliation(s)
- Petrus J W Naudé
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa.
| | - Carmine Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Kirsten A Donald
- Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa; SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, South Africa
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8
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Saadat N, Zhang L, Hyer S, Padmanabhan V, Woo J, Engeland CG, Misra DP, Giurgescu C. Psychosocial and behavioral factors affecting inflammation among pregnant African American women. Brain Behav Immun Health 2022; 22:100452. [PMID: 35403067 PMCID: PMC8990056 DOI: 10.1016/j.bbih.2022.100452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023] Open
Abstract
African American women are reported to have greater inflammation compared with women from other racial groups. Higher inflammation during pregnancy has been associated with increased risk of adverse perinatal outcomes. We hypothesized that maternal inflammation is related to depressive symptoms and social and behavioral risk factors among pregnant African American women. Pregnant African American women (n = 187) were recruited at prenatal clinics in the Midwest. Women completed questionnaires and had blood drawn at a prenatal visit. Plasma levels of cytokines (interferon gamma [IFN]-γ, interleukin [IL]-6, IL-8, IL-10, tumor necrosis factor [TNF]-α) and C-reactive protein (CRP) were measured by multiplex assays. Women had a mean age of 26.58±5.42 years and a mean gestational age at data collection of 16.35±5.95 weeks. Twenty-six percent of women had Center for Epidemiological Studies-Depression (CES-D) scores ≥23 (scores that have been correlated with clinical diagnosis of depression), 15.5% smoked cigarettes, 16.6% used marijuana, and 5.3% reported experiencing intimate partner violence (IPV). Higher CES-D scores were correlated with higher plasma CRP levels (r = 0.16, p = 0.046). Women who reported any experiences of IPV during pregnancy had higher levels of IL-8 (p = 0.018) and lower levels of IFN-γ (p = 0.012) compared with women who did not report IPV. Cigarette smoking during pregnancy was associated with lower levels of the anti-inflammatory cytokine IL-10 (p = 0.003). These findings suggest that depressive symptoms, IPV, and cigarette smoking during pregnancy relate to select inflammatory markers in pregnant African American women. The relationships of inflammation with these factors should be further investigated to better understand the mechanisms which influence maternal and fetal health outcomes. Depressive symptoms are related to higher levels of CRP in pregnant African American Women. Intimate partner violence in pregnancy is related to higher interleukin 8 levels. Smoking during pregnancy is associated with lower interleukin 10 levels. Inflammation is related to depressive symptoms, intimate partner violence and smoking in pregnant African American women.
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Anwer Y, Abbasi F, Dar A, Hafeez A, Valdebenito S, Eisner M, Sikander S, Hafeez A. Feasibility of a birth-cohort in Pakistan: evidence for better lives study. Pilot Feasibility Stud 2022; 8:29. [PMID: 35130958 PMCID: PMC8819840 DOI: 10.1186/s40814-022-00980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Evidence for Better Lives Study Foundational Research (EBLS-FR) is a preliminary endeavor to establish the feasibility of a global birth cohort, and within this feasibility study, piloting the research instrument, with participants from eight lower middle-income countries across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor lower middle-income country (LMIC) taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan.
Method
From March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support-related information, and stress-related biomarkers from bio-samples in a peri-urban area of Islamabad Capital Territory. One hundred fifty of these women gave consent and participated in the study. From October 2019 to December 2019, we re-contacted and were able to follow 121 of these women in the 8–24 weeks postnatal period. All interviews were done after obtaining informed consent and data were collected electronically.
Results
One hundred fifty (98.0%) third trimester pregnant women consented and were successfully interviewed, 111 (74.0%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (SD = 5.18) and 7.77 (SD = 4.79) respectively. A majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers. Ninety-two (61.3%) of the women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (SD = 32.20) and PHQ-9 mean scores 8.23 (SD = 7.0)). Thirty-eight (21.8%) of the women reported four or more adverse childhood experiences; 46 (31.3%) reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 72 (58.0%) of the women reported breastfeeding their infants.
Conclusion
The foundational research demonstrated that Pakistan site could identify, approach, interview, and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Therefore, a future larger-scale pregnancy birth cohort study in Pakistan is feasible.
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da Silveira D, Rabelo NN, de Sena Barbosa MG, Frigeri G, Vellosa JCR. Intracranial pressure and laboratory parameters in high- and low-risk pregnant women. Surg Neurol Int 2021; 12:250. [PMID: 34221581 PMCID: PMC8247669 DOI: 10.25259/sni_109_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pregnancy can trigger several pathological changes, thus representing a great challenge for gynecology and obstetrics. The objective is to evaluate high- and low-risk pregnant women through Intracranial pressure (ICP) and laboratory parameters. Methods: Volunteers clinical and laboratory data were collected from medical records and ICP was monitored through noninvasive method. Results: Statistically significant differences were observed between the group of high-risk and low-risk pregnant women for serum levels of alkaline phosphatase (ALP) and US-C-reactive protein (CRP) and a statistically positive association between blood pressure (BP) levels and plasma glucose. About 12.77% of the volunteers presented altered ICP. Higher BP values were encountered with the higher plasma glucose values. All ICP altered volunteers presented altered BP. ALP is among the most effective biochemical markers for assessing the risk of premature birth before 32 weeks of gestation. Conclusion: We have observed important changes on BP, serum glucose, US-CRP, and ALP thus indicating higher risk of complications during pregnancy. Even more, some of the volunteers presented altered ICP what could indicate cerebral compliance changes.
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Affiliation(s)
- Daniel da Silveira
- Graduate Program of Biomedical Sciences, State University of Ponta Grossa, Ponta Grossa, Paraná, , Brazil
| | - Nícollas Nunes Rabelo
- Department of Neurosurgery, Atenas School of Medicine, Passos, Minas Gerais, Paraná, Brazil
| | | | - Gustavo Frigeri
- Braincare Technological Development and Innovation LTDA, São Carlos-SP, Paraná, Brazil
| | - José Carlos Rebuglio Vellosa
- Graduate Program of Biomedical Sciences, State University of Ponta Grossa, Ponta Grossa, Paraná, , Brazil.,Braincare Technological Development and Innovation LTDA, São Carlos-SP, Paraná, Brazil
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11
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Filatova EV, Shadrina MI, Slominsky PA. Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells 2021; 10:cells10061283. [PMID: 34064233 PMCID: PMC8224372 DOI: 10.3390/cells10061283] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Major depressive disorder (MDD) is a heterogeneous disease affecting one out of five individuals and is the leading cause of disability worldwide. Presently, MDD is considered a multifactorial disease with various causes such as genetic susceptibility, stress, and other pathological processes. Multiple studies allowed the formulation of several theories attempting to describe the development of MDD. However, none of these hypotheses are comprehensive because none of them can explain all cases, mechanisms, and symptoms of MDD. Nevertheless, all of these theories share some common pathways, which lead us to believe that these hypotheses depict several pieces of the same big puzzle. Therefore, in this review, we provide a brief description of these theories and their strengths and weaknesses in an attempt to highlight the common mechanisms and relationships of all major theories of depression and combine them together to present the current overall picture. The analysis of all hypotheses suggests that there is interdependence between all the brain structures and various substances involved in the pathogenesis of MDD, which could be not entirely universal, but can affect all of the brain regions, to one degree or another, depending on the triggering factor, which, in turn, could explain the different subtypes of MDD.
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12
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Yamada K, Kimura T, Cui M, Kubota Y, Tanaka E, Wakaizumi K, Ikehara S, Kimura T, Iso H. Antenatal pain, intimate partner violence, and maternal bonding disorder: data from the Japan Environment and Children's Study. Pain 2021; 162:749-759. [PMID: 32960535 DOI: 10.1097/j.pain.0000000000002084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023]
Abstract
ABSTRACT This prospective study examined (1) whether antenatal pain is associated with postnatal maternal bonding disorder (MBD) through postnatal depression and (2) whether intimate partner violence (IPV) has a moderating effect on the association between antenatal pain and postnatal MBD. We analyzed 77,326 pregnancies of women who completed self-report questionnaires including the SF-8 bodily pain item, the Edinburgh Postnatal Depression Scale, the Mother-to-Infant Bonding Scale, and an assessment of IPV. We conducted a mediation analysis to assess whether postnatal depression mediated the association between antenatal pain and MBD 1 year after delivery. A moderated mediation model was used to examine the conditional effect of IPV during pregnancy on the association between antenatal pain and postnatal MBD, operating through postnatal depression. All analyses were adjusted for demographic factors, socioeconomic factors, perinatal and infant factors, medical history, and psychological status. Of the 77,326 pregnancies, 5420 (7.0%) were characterized by persistent moderate-to-severe pain. The total effect of antenatal pain on MBD was significant (standardized path coefficient = 0.06, 95% confidence interval, 0.05-0.06) and postnatal depression dominantly mediated the association between antenatal pain and postnatal MBD (70.8% mediation). Contrary to our hypothesis, IPV during pregnancy did not moderate the association between antenatal pain and postnatal MBD. However, IPV during pregnancy did have independent negative effects on both postnatal depression and MBD. Our findings suggest that antenatal pain and postnatal depression should be assessed and treated with consideration of the presence of IPV during pregnancy to better monitor and prevent the development of MBD.
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Affiliation(s)
- Keiko Yamada
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Meishan Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan
| | - Eizaburo Tanaka
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Hyogo Institute for Traumatic Stress, Hyogo, Japan
| | - Kenta Wakaizumi
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Management and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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13
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Spence T, Allsopp PJ, Yeates AJ, Mulhern MS, Strain JJ, McSorley EM. Maternal Serum Cytokine Concentrations in Healthy Pregnancy and Preeclampsia. J Pregnancy 2021; 2021:6649608. [PMID: 33680514 PMCID: PMC7925069 DOI: 10.1155/2021/6649608] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
The maternal immune response is essential for successful pregnancy, promoting immune tolerance to the fetus while maintaining innate and adaptive immunity. Uncontrolled, increased proinflammatory responses are a contributing factor to the pathogenesis of preeclampsia. The Th1/Th2 cytokine shift theory, characterised by bias production of Th2 anti-inflammatory cytokine midgestation, was frequently used to reflect the maternal immune response in pregnancy. This theory is simplistic as it is based on limited information and does not consider the role of other T cell subsets, Th17 and Tregs. A range of maternal peripheral cytokines have been measured in pregnancy cohorts, albeit the changes in individual cytokine concentrations across gestation is not well summarised. Using available data, this review was aimed at summarising changes in individual maternal serum cytokine concentrations throughout healthy pregnancy and evaluating their association with preeclampsia. We report that TNF-α increases as pregnancy progresses, IL-8 decreases in the second trimester, and IL-4 concentrations remain consistent throughout gestation. Lower second trimester IL-10 concentrations may be an early predictor for developing preeclampsia. Proinflammatory cytokines (TNF-α, IFN-γ, IL-2, IL-8, and IL-6) are significantly elevated in preeclampsia. More research is required to determine the usefulness of using cytokines, particularly IL-10, as early biomarkers of pregnancy health.
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Affiliation(s)
- Toni Spence
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Philip J. Allsopp
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Alison J. Yeates
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Maria S. Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J. J. Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Emeir M. McSorley
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
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14
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Nazzari S, Fearon P, Rice F, Ciceri F, Molteni M, Frigerio A. The biological underpinnings of perinatal depressive symptoms: A multi-systems approach. J Affect Disord 2020; 274:1004-1012. [PMID: 32663926 DOI: 10.1016/j.jad.2020.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/29/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Well-established evidence exists of an association between depressive symptoms and alterations in the stress and inflammatory response systems; however, the picture is far less coherent during the perinatal period. This study combines the assessment of multiple stress and inflammatory biomarkers in late pregnancy and after delivery in order to investigate cross-sectional and prospective associations with perinatal depressive symptoms. METHODS One-hundred-ten healthy women were assessed in late pregnancy (mean gestational age=34.76; SD=1.12) and 89 were re-evaluated after delivery (mean hours after delivery=52.36; SD=19.70) for depressive and anxiety symptoms through the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. Serum Interleukin-6 (IL-6), C-Reactive Protein (CRP) and diurnal salivary cortisol levels were measured on both occasions, while diurnal salivary alpha amylase (sAA) levels were assessed in late pregnancy. RESULTS Using Hierarchical Linear Models, higher depressive symptoms were found to be associated with higher IL-6 levels, lower morning cortisol levels and a flatter cortisol diurnal slope during pregnancy, while adjusting for potential confounders. No significant associations were found after delivery or with change in biomarker levels from pre- to post-partum. Furthermore, preliminary evidence of a positive association between inflammation and stress markers in women with higher antenatal depressive symptoms was found. LIMITATIONS The sample was relatively small and highly selected, thus limiting generalizability of the findings. CONCLUSIONS Results emphasize the need for an integrated multi-systems approach to the understanding of the biological underpinnings of perinatal depression and suggest that the stress-immune interactions represent a promising avenue for future endeavor.
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Affiliation(s)
- S Nazzari
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - P Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - F Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, United Kingdom
| | - F Ciceri
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - M Molteni
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - A Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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15
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Freedman R, Hunter SK, Noonan K, Wyrwa A, Christians U, Law AJ, Hoffman MC. Maternal Prenatal Depression in Pregnancies With Female and Male Fetuses and Developmental Associations With C-reactive Protein and Cortisol. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:310-320. [PMID: 33060035 DOI: 10.1016/j.bpsc.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/01/2020] [Accepted: 08/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prenatal depression has lasting effects on development in offspring, including later mental illness risk. Maternal responses to depression include inflammation and hypothalamic-pituitary-adrenal axis stimulation. Effects on development of cerebral inhibitory neurocircuits may differ for female and male fetuses. METHODS Mothers (N = 181) were assessed periodically, beginning at 16 weeks' gestation, using the Center for Epidemiologic Studies-Depression Scale. Maternal prenatal C-reactive protein and hair cortisol and cortisone levels were determined. Cortisone was determined in neonatal hair. Development of cerebral inhibitory neurocircuits was assessed in 162 1-month-old newborns by inhibition of P50 electrophysiological responses to repeated sounds. RESULTS Maternal depression was associated with decreased newborn P50 inhibition in both sexes. Maternal C-reactive protein levels were significantly associated with depression only in pregnancies with male fetuses and with decreased newborn P50 inhibition only in male newborns. Maternal cortisol levels were significantly associated with depression only in pregnancies with female fetuses and with decreased newborn P50 inhibition only in female newborns. In pregnancies with male fetuses compared with pregnancies with female fetuses, cortisol was more robustly metabolized to cortisone, which does not activate cortisol receptors. CONCLUSIONS This study finds sex-specific associations of C-reactive protein and cortisol levels with prenatal depression in women and with decreased development of newborn P50 inhibition. Sex-based differences in maternal response to depression with inflammation or cortisol and their developmental effects may reflect evolutionary influences to promote survival in adversity. Decreased newborn P50 inhibition is associated with later childhood behavioral problems, and decreased P50 inhibition is a pathophysiological feature of several mental illnesses.
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Affiliation(s)
- Robert Freedman
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado.
| | - Sharon K Hunter
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
| | - Kathleen Noonan
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
| | - Anna Wyrwa
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
| | - Uwe Christians
- Department of Psychiatry, iC42 Clinical Research and Development, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
| | - Amanda J Law
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado; Department of Anesthesiology, Department of Cell and Developmental Biology, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
| | - M Camille Hoffman
- Institute for Children's Mental Disorders, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado; Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Anschutz Medical Center F-546, Aurora, Colorado
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16
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Lahti-Pulkkinen M, Girchenko P, Robinson R, Lehto SM, Toffol E, Heinonen K, Reynolds RM, Kajantie E, Laivuori H, Villa PM, Hämäläinen E, Lahti J, Räikkönen K. Maternal depression and inflammation during pregnancy. Psychol Med 2020; 50:1839-1851. [PMID: 31439060 DOI: 10.1017/s0033291719001909] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Maternal depression during pregnancy increases the risk for adverse developmental outcomes in children. However, the underpinning biological mechanisms remain unknown. We tested whether depression was associated with levels of and change in the inflammatory state during pregnancy, if early pregnancy overweight/obesity or diabetes/hypertensive pregnancy disorders accounted for/mediated these effects, and if depression added to the inflammation that typically accompanies these conditions. METHODS We analyzed plasma high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls at three consecutive stages during pregnancy, derived history of depression diagnoses before pregnancy from Care Register for Healthcare (HILMO) (N = 375) and self-reports (N = 347) and depressive symptoms during pregnancy using the Center for Epidemiological Studies Depression Scale completed concurrently to blood samplings (N = 295). Data on early pregnancy body mass index (BMI) and diabetes/hypertensive pregnancy disorders came from medical records. RESULTS Higher overall hsCRP levels, but not change, during pregnancy were predicted by history of depression diagnosis before pregnancy [HILMO: mean difference (MD) = 0.69 standard deviation (s.d.) units; 95% confidence interval (CI) 0.26-1.11, self-report: MD = 0.56 s.d.; 95% CI 0.17-0.94] and higher depressive symptoms during pregnancy (0.06 s.d. per s.d. increase; 95% CI 0.00-0.13). History of depression diagnosis before pregnancy also predicted higher overall glycoprotein acetyls (HILMO: MD = 0.52 s.d.; 95% CI 0.12-0.93). These associations were not explained by diabetes/hypertensive disorders, but were accounted for and mediated by early pregnancy BMI. Furthermore, in obese women, overall hsCRP levels increased as depressive symptoms during pregnancy increased (p = 0.006 for interaction). CONCLUSIONS Depression is associated with a proinflammatory state during pregnancy. These associations are mediated by early pregnancy BMI, and depressive symptoms during pregnancy aggravate the inflammation related to obesity.
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Affiliation(s)
- Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rachel Robinson
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Soili M Lehto
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Elena Toffol
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, OuluFinland
| | - Hannele Laivuori
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, Helsinki, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Pia M Villa
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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17
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Trifu SC, Popescu A, Marian MA. Affective disorders: A question of continuing treatment during pregnancy (Review). Exp Ther Med 2020; 20:3474-3482. [PMID: 32905103 PMCID: PMC7465051 DOI: 10.3892/etm.2020.8989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022] Open
Abstract
Fetal development, especially in the first trimester, has proven to be heavily influenced by external factors, such as chemical intake of medication. Chronic psychiatric treatment might interfere with the anatomical and physiological wellbeing of the fetus, because psychotropic medication proceeds past the placenta, into the amniotic fluid, and can enter breast milk. Hence some of the medications prescribed for mood disorders should be reconsidered during pregnancy, without sub-optimally treating when it is needed. A literature review is presented which systematically collects modern data and synthesizes previous interdisciplinary research findings on the safety of psychiatric treatment for affective disorders during pregnancy (term-based) and lactation. Antidepressants and mood stabilizers, fundamental strategies in treating affective disorders, have been classified by the FDA as C respectively D drugs pertaining to their risk, with some exception. Most guidelines recommend pharmacologically treating moderate-severe depression, preferably with SSRIs. Evidence advocates that drugs should be used during pregnancy only if clearly needed and the benefit outweighs the risk to the fetus. However, guidelines the American College of Obstetricians and Gynecologists state that antidepressants are a preferred first course of treatment and does not take into account the severity of the depression. Among mood-stabilizers, lithium is considered to be the safest option for pregnant women. Anticonvulsants have a higher risk of teratogenicity compared with lithium, with lamotrigine being the safest one. All mood stabilizers should be recommended in the lowest effective doses. There is controversy regarding the safety of second-generation antipsychotics during pregnancy and further research is required. Several case reports and meta-reviews have been published in order to emphasize the safety of electroconvulsive therapy (ECT) during pregnancy, but practitioners still stigmatize this procedure. Evaluating the overall risk-benefit ratio should be assessed by the medical care provider, taking into consideration current findings.
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Affiliation(s)
- Simona Corina Trifu
- Department of Neurosciences, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandra Popescu
- Department of Psychiatry, 'Alex. Obregia̓ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Maria Alina Marian
- Department of Psychiatry, 'Alex. Obregia̓ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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18
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Tirumalaraju V, Suchting R, Evans J, Goetzl L, Refuerzo J, Neumann A, Anand D, Ravikumar R, Green CE, Cowen PJ, Selvaraj S. Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e208783. [PMID: 32602910 PMCID: PMC7327545 DOI: 10.1001/jamanetworkopen.2020.8783] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood. OBJECTIVE To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring. DATA SOURCES A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019. STUDY SELECTION A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression. MAIN OUTCOMES AND MEASURES Offspring depression was evaluated using standardized depression scales or clinical interviews. RESULTS Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31). CONCLUSIONS AND RELEVANCE In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.
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Affiliation(s)
- Vaishali Tirumalaraju
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Jonathan Evans
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, University of Texas Health Science Center at Houston
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Deepa Anand
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rekha Ravikumar
- Department of Internal Medicine, Mercy Health St Vincent Medical Center, Toledo, Ohio
| | - Charles E. Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Philip J. Cowen
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
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Nishi D, Su KP, Usuda K, Chang JPC, Hamazaki K, Ishima T, Sano Y, Ito H, Isaka K, Tachibana Y, Tanigaki S, Suzuki T, Hashimoto K, Matsuoka YJ. Plasma estradiol levels and antidepressant effects of omega-3 fatty acids in pregnant women. Brain Behav Immun 2020; 85:29-34. [PMID: 30776476 DOI: 10.1016/j.bbi.2019.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Omega-3 polyunsaturated fatty acids (PUFAs) reduce depressive symptoms through an anti-inflammatory effect, and injection of both omega-3 PUFAs and estradiol (E2) induces antidepressant-like effects in rats by regulating the expression of inflammatory cytokines. The aims of this study were to examine the association of increased E2 during pregnancy with depressive symptoms and with inflammatory cytokines in women who were and were not supplemented with omega-3 PUFAs. METHODS Pregnant women with Edinburgh Postnatal Depression Scale scores ≥9 were recruited at 12-24 weeks of gestation. The participants were randomly assigned to receive 1800 mg omega-3 fatty acids (containing 1206 mg eicosapentaenoic acid [EPA]) or placebo for 12 weeks. E2, omega-3 PUFAs, high-sensitivity C-reactive protein, interleukin-6, and adiponectin were measured at baseline and at the 12-week follow-up. Multivariable regression analyses were conducted to examine the association of the changes of E2 and omega-3 PUFAs with the changes in depressive symptoms and with the changes of inflammatory cytokines at follow-up by intervention group. RESULTS Of the 108 participants in the trial, 100 (92.6%) completed the follow-up assessment including blood sampling. Multivariable regression analyses revealed that the increase of EPA and E2 was significantly associated with a decrease in depressive symptoms among the participants assigned to the omega-3 group, but not among those assigned to the placebo group. Neither E2 nor any PUFAs were associated with a change in inflammatory cytokines. CONCLUSION Supplementation with EPA and increased levels of E2 during pregnancy might function together to alleviate antenatal depression through a mechanism other than anti-inflammation.
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Affiliation(s)
- Daisuke Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan; Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Kentaro Usuda
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan; Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jane Pei-Chen Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Tamaki Ishima
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yo Sano
- Toda Chuo Women's Hospital, Saitama, Japan
| | - Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Keiich Isaka
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, Japan
| | - Shinji Tanigaki
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomo Suzuki
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yutaka J Matsuoka
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan; Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Association of antenatal depression with oxidative stress and impact on spontaneous preterm birth. J Perinatol 2019; 39:554-562. [PMID: 30723278 PMCID: PMC6463284 DOI: 10.1038/s41372-019-0317-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether antenatal depression is associated with oxidative stress and inflammation, and secondarily, whether the association between antenatal depression and spontaneous preterm birth (SPTB) is mediated by these biomarkers. STUDY DESIGN The primary outcome included urine oxidative stress biomarkers 8-hydroxydeoxyguanosine (8-OHdG) and 8-isoprostane and plasma inflammatory biomarkers measured at 10, 18, and 26 weeks and averaged within individual. Linear and logistic regression models were used, adjusting for age, race, parity, and pre-pregnancy body mass index. RESULTS Among 462 women, 8-isoprostane was higher among depressed women (geometric mean: 299.96 pg/mL vs. 237.01 pg/mL; p = 0.001). In multivariable analyses, antenatal depression was significantly associated with an increase in average 8-isoprostane (β: 0.25; 95% CI: 0.05-0.44; p = 0.01). The association of antenatal depression with SPTB was partially mediated by 8-isoprostane. Antenatal depression was not associated with 8-OHdG or inflammatory biomarkers. CONCLUSIONS Antenatal depression was associated with higher oxidative stress across pregnancy, namely 8-isoprostane, and may impact SPTB via oxidative stress.
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Gao W, Wang W, Peng Y, Deng Z. Antidepressive effects of kaempferol mediated by reduction of oxidative stress, proinflammatory cytokines and up-regulation of AKT/β-catenin cascade. Metab Brain Dis 2019; 34:485-494. [PMID: 30762138 DOI: 10.1007/s11011-019-0389-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022]
Abstract
Kaempferol (KFL), the major constituent of various fruits and vegetables, could attenuate oxidaitve stress and inflammation. The aims of the present study were to explore the ameliorative abilities of KFL on the depressive-like behaviors in a chronic social defeat stress (CSDS) mouse model, and to determine the potential mechanisms on oxidative stress, neuroinflammation, and AKT/β-catenin signaling pathway. Three behavioral tests, sucrose preference test (SPT), social interaction test (SIT), and tail suspension test (TST), were used to evaluate the antidepressive effects of KFL in CSDS mice. Activity levels of antioxidant enzyme, superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), glutathione s-transferase (GST), and concentrations of malonaldehyde (MDA) and protein carbonylation in the prefrontal cortex were assessed by commercial kits, respectively. Elisa was used to detect the levels of interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α). Q-PCR was used to determine the mRNA level of CD-11b. Furthermore, activity level of AKT/β-catenin signaling in the prefrontal cortex of CSDS mice was investigated by western blot. In addition, LY294002, a PI3-K inhibitor, was used to investigate the role of AKT/β-catenin signaling in the antidepressant effects of KFL. Social defeat stress reduced the bodyweights, sucrose consumptions, social interaction times, and the tail suspension mobility times in mice. CSDS mice were also exhibited remarkablely increased levels in oxidative stress markers, inflammatory mediators, and decreased activity of AKT/β-catenin cascade in the prefrontal cortex, which were reversed by treatment with KFL. Interestingly, LY294002 appeared to partly inhibit the overall KFL-mediated protective effects in the CSDS mice. These results confirmed that KFL exerted antidepressive effects, which might be mediated, at least in part, by enhanced antioxidant abilities and anti-inflammation effects via up-regulation AKT/β-catenin cascade activity in the prefrontal cortex of CSDS mice. Thus, KFL might be a promising, effective, and safe food medicine for depression treatment.
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Affiliation(s)
- Wenqi Gao
- Department of Central Experimental Laboratory, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Wei Wang
- Department of Central Experimental Laboratory, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Yan Peng
- Department of Pharmacy, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China.
| | - Zhifang Deng
- Department of Central Experimental Laboratory, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China.
- Department of Pharmacy, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China.
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Oriolo G, Huet L, Dexpert S, Beau C, Forestier D, Ledaguenel P, Magne E, Martin-Santos R, Capuron L. History of major depression is associated with neuropsychiatric symptoms but not systemic inflammation in a cross-sectional study in obese patients. Brain Behav Immun 2019; 76:215-222. [PMID: 30476563 DOI: 10.1016/j.bbi.2018.11.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/05/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022] Open
Abstract
Obesity is a major public health burden associated with neuropsychiatric comorbidities leading to social and occupational impairment. Given the growing prevalence of both obesity and mental disorders worldwide, understanding the risk factors of obesity-related neuropsychiatric comorbidities is crucial to develop preventive strategies and individualized treatments. Recent findings suggest that adiposity-driven inflammation contributes to neuropsychiatric comorbidities in obesity. However, not all obese subjects afflicted with chronic inflammation develop neuropsychiatric symptoms, suggesting additional risk factors. The aim of this study was to investigate the impact of personal history of major depressive disorder (MDD) on obesity-related inflammation and neuropsychiatric symptoms, and their relationship. A case-control study was conducted comparing 66 obese patients (body mass index > 35 kg/m2) and 22 healthy non-obese participants, free of any current neuropsychiatric diseases including MDD. Neuropsychiatric symptoms were assessed using the Neurotoxicity Rating Scale (NRS). Sociodemographic and clinical variables were gathered and blood was collected for the measurement of serum levels of high-sensitivity C-reactive protein (hs-CRP). Multiple regression analyses were performed to assess the contribution of obesity and personal history of MDD to clinical outcomes and inflammatory status in study participants. Hs-CRP levels as well as NRS scores were significantly increased in the obese group. Overall, personal history of depression accounted for increased NRS scores but no significant association was found with inflammatory status. In addition, history of depression did not significantly modulate the relationship of obesity-related inflammation with NRS scores. Interestingly, obese individuals with history of recurrent MDD (n = 13) exhibited higher scores in the cognitive and sickness symptoms dimensions of the NRS compared to obese subjects with history of one depressive episode only. Findings indicate that history of depression contributes to neuropsychiatric symptoms, but not to systemic inflammation, in obese subjects free of current depressive episode. These results provide relevant information on the risk factors that may help identify obese subjects with increased risk of neuropsychiatric comorbidity.
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Affiliation(s)
- Giovanni Oriolo
- INRA, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France; University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, Spain; Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain
| | - Lison Huet
- INRA, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France; University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France
| | - Sandra Dexpert
- INRA, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France; University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France
| | - Cédric Beau
- Service de Chirurgie Digestive et Pariétale, Clinique Tivoli, 33000 Bordeaux, France; Clinique Jean Villar, 33520 Bruges, France
| | - Damien Forestier
- Service de Chirurgie Digestive et Pariétale, Clinique Tivoli, 33000 Bordeaux, France; Clinique Jean Villar, 33520 Bruges, France
| | - Patrick Ledaguenel
- Service de Chirurgie Digestive et Pariétale, Clinique Tivoli, 33000 Bordeaux, France; Clinique Jean Villar, 33520 Bruges, France
| | - Eric Magne
- Service de Chirurgie Digestive et Pariétale, Clinique Tivoli, 33000 Bordeaux, France; Clinique Jean Villar, 33520 Bruges, France
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, Spain; Department of Medicine, University of Barcelona, Barcelona, Catalonia, Spain
| | - Lucile Capuron
- INRA, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France; University of Bordeaux, Nutrition and Integrative Neurobiology (NutriNeuro), UMR 1286, 33076 Bordeaux, France.
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Osborne LM, Brar A, Klein SL. The role of Th17 cells in the pathophysiology of pregnancy and perinatal mood and anxiety disorders. Brain Behav Immun 2019; 76:7-16. [PMID: 30465878 PMCID: PMC6359933 DOI: 10.1016/j.bbi.2018.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/19/2018] [Accepted: 11/18/2018] [Indexed: 12/27/2022] Open
Abstract
T cells play a key role in adaptive immune responses, and shifts among T cell classes occur in normal pregnancy. There is evidence for the role of TH17 cells and dysregulation of the TH17/Treg cell balance in morbidities and autoimmune diseases during pregnancy. Because TH17 responses may play a role in depression and anxiety outside of pregnancy, we hypothesize that TH17 responses and the balance of TH17/Treg activity may also contribute to the development of depression and anxiety during pregnancy. To explore this hypothesis, this review has three main aims: 1) to evaluate systematically the role of TH17 cells and cytokines during pregnancy; 2) to compare changes in the ratio of TH17/Treg cells during pregnancy morbidities with the changes that occur in depression and anxiety outside of pregnancy; and 3) to provide a basis for further research on TH17 cells in perinatal mood and anxiety disorders, with an eye toward the development of novel therapeutics. We also review the limited literature concerning perinatal mood and anxiety disorders, and hypothesize about the potential role of TH17 cells in these illnesses. Understanding the pathophysiology of perinatal mood and anxiety disorders will aid development of novel therapeutics that address immunological mechanisms, in addition to the serotonin system, which are targetable molecules in treating depression and anxiety during pregnancy.
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Affiliation(s)
- Lauren M. Osborne
- Women’s Mood Disorders Center, Departments of Psychiatry & Behavioral Sciences, and of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Amitoj Brar
- Women’s Mood Disorders Center, Departments of Psychiatry & Behavioral Sciences, and of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
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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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Buglione-Corbett R, Deligiannidis KM, Leung K, Zhang N, Lee M, Rosal MC, Moore Simas TA. Expression of inflammatory markers in women with perinatal depressive symptoms. Arch Womens Ment Health 2018; 21:671-679. [PMID: 29603018 DOI: 10.1007/s00737-018-0834-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/21/2018] [Indexed: 01/05/2023]
Abstract
Perinatal depression affects 10-20% of women and is associated with poor outcomes for mother and child. Inflammation is associated with depression in non-pregnant adults. Perinatal depression and inflammation in pregnancy are independently associated with morbidities including obesity, gestational diabetes, preeclampsia, and preterm birth. The role of inflammation in perinatal depression has received little attention. We hypothesized an association between self-reported perinatal depressive symptoms and serum inflammatory biomarkers TNF-α, IL-6, IL-1β, and CRP. 110 healthy gravidas were recruited in third trimester from an academic medical center, with a baseline study visit at a mean of 32.5 (SD ± 1.8) weeks gestational age. Sixty-three participants completed the Edinburgh Postnatal Depression Scale (EPDS) and provided demographic information and serum samples upon enrollment and at 3 and 6 months postpartum. Serum inflammatory markers were quantified by multiplex array. Multiple linear mixed effects models were used to evaluate trends of biomarkers with the EPDS score in the third trimester of pregnancy and the postpartum period. Elevated serum TNF-α was associated with lower EPDS total score (β = - 0.90, p = 0.046) after adjusting for demographics and medication use. In contrast, IL-6, CRP, and IL-1β did not demonstrate statistically significant associations with depressive symptoms by the EPDS in either crude or adjusted models. Study findings showed no association or an inverse (TNF-α) association between inflammatory markers and perinatal depressive symptoms. Relevant literature evaluating a role for inflammation in depression in the unique context of pregnancy is both limited and inconsistent, and further exploration is merited.
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Affiliation(s)
- R Buglione-Corbett
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA.
| | - K M Deligiannidis
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - K Leung
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
| | - N Zhang
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - M Lee
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - M C Rosal
- Department of Medicine, Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - T A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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26
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Huang MH, Chen MH, Tu PC, Bai YM, Su TP, Yang BH, Liu RS, Li CT. Elevated tumor necrosis factor-alpha receptor subtype 1 and the association with abnormal brain function in treatment-resistant depression. J Affect Disord 2018; 235:250-256. [PMID: 29660639 DOI: 10.1016/j.jad.2018.04.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) patients have shown elevated plasma levels of pro-inflammatory biomarkers compared to healthy controls. We hypothesized increased serum tumor necrosis factor-alpha receptor subtype 1 (TNF-α R1) is more associated with impaired brain function in patients with treatment-resistant depression (TRD) than those without TRD. METHODS 34 MDD patients and 34 healthy subjects were recruited and we separated MDD patients to TRD group (n = 20) and non-TRD (n = 14) group. Pro-inflammatory cytokines were assessed by enzyme-linked immunosorbent assays. A standardized uptake values (SUV) of glucose metabolism measured by 18F-FDG positron-emission-tomography (PET) was applied to all subjects for subsequent region-of- interest analyses and whole-brain voxel-wise analyses. 18F-FDG-PET measures glucose uptake into astrocytes in response to glutamate release from neuronal cells, and was thus used as a proxy measure to quantify glutamatergic neurotransmission in the human brain. RESULTS Post-hoc analysis revealed that TRD group had higher serum concentrations of TNF-α R1 compared to healthy control or non-TRD group. In the MDD group, higher serum concentrations of TNF-α R1 significantly correlated with decreased SUV in anterior cingulate cortex (ACC) and bilateral caudate nucleus. The ROI analysis further supported the negative correlations of plasma TNF-α R1 and SUV in the ACC and caudate nucleus. Such correlation is more consistent in TRD group than in non-TRD and HC groups. LIMITATION Glutamate neurotransmission and the effect of chronic stress on glutamate release in the brain were not measured directly. CONCLUSIONS Increased TNF-α R1 was associated with impaired glutamatergic neurotransmission of caudate nucleus and ACC in MDD patients, particularly in the TRD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Ya Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan; Department of Psychiatry, Cheng-Hsin General Hospital, Taiwan 112
| | - Bang-Hung Yang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ren-Shyan Liu
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, 112, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, 112, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan.
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McKee KS, Seplaki C, Fisher S, Groth SW, Fernandez ID. Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes. Matern Child Health J 2018; 21:147-155. [PMID: 27439420 DOI: 10.1007/s10995-016-2103-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N = 111). Results CPD scores ranged from 0 to 6, out of a total of 8 parameters (Mean 2.09; SD = 1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3397 g (SD = 522.89), and the mean gestational age was 39.64 weeks (SD = 1.08). CPD was not significantly associated with either birth weight or gestational age (p = 0.42 and p = 0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.
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Affiliation(s)
- Kimberly Schmitt McKee
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA. .,Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.
| | - Christopher Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Susan Fisher
- Temple Clinical Research Institute, Department of Clinical Sciences, Temple University School of Medicine, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.,Population Research, Fox Chase Cancer Center, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Susan W Groth
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd. Box SON, Rochester, NY, 14642, USA
| | - I Diana Fernandez
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
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Roomruangwong C, Anderson G, Berk M, Stoyanov D, Carvalho AF, Maes M. A neuro-immune, neuro-oxidative and neuro-nitrosative model of prenatal and postpartum depression. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:262-274. [PMID: 28941769 DOI: 10.1016/j.pnpbp.2017.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 02/06/2023]
Abstract
A large body of evidence indicates that major affective disorders are accompanied by activated neuro-immune, neuro-oxidative and neuro-nitrosative stress (IO&NS) pathways. Postpartum depression is predicted by end of term prenatal depressive symptoms whilst a lifetime history of mood disorders appears to increase the risk for both prenatal and postpartum depression. This review provides a critical appraisal of available evidence linking IO&NS pathways to prenatal and postpartum depression. The electronic databases Google Scholar, PubMed and Scopus were sources for this narrative review focusing on keywords, including perinatal depression, (auto)immune, inflammation, oxidative, nitric oxide, nitrosative, tryptophan catabolites (TRYCATs), kynurenine, leaky gut and microbiome. Prenatal depressive symptoms are associated with exaggerated pregnancy-specific changes in IO&NS pathways, including increased C-reactive protein, advanced oxidation protein products and nitric oxide metabolites, lowered antioxidant levels, such as zinc, as well as lowered regulatory IgM-mediated autoimmune responses. The latter pathways coupled with lowered levels of endogenous anti-inflammatory compounds, including ω3 polyunsaturated fatty acids, may also underpin the pathophysiology of postpartum depression. Although increased bacterial translocation, lipid peroxidation and TRYCAT pathway activation play a role in mood disorders, similar changes do not appear to be relevant in perinatal depression. Some IO&NS biomarker characteristics of mood disorders are found in prenatal depression indicating that these pathways partly contribute to the association of a lifetime history of mood disorders and perinatal depression. However, available evidence suggests that some IO&NS pathways differ significantly between perinatal depression and mood disorders in general. This review provides a new IO&NS model of prenatal and postpartum depression.
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Affiliation(s)
- Chutima Roomruangwong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Michael Berk
- Impact Strategic Research Center, Deakin University, Geelong, Australia; Orygen, the National Centre of Excellence in Youth Mental Health and Orygen Research, Australia
| | - Drozdstoy Stoyanov
- Medical University of Plovdiv, Department of Psychiatry and Medical Psychology, Technology Center for Emergency Medicine, Bulgaria
| | - André F Carvalho
- Department of Clinical Medicine, Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Impact Strategic Research Center, Deakin University, Geelong, Australia; Medical University of Plovdiv, Department of Psychiatry and Medical Psychology, Technology Center for Emergency Medicine, Bulgaria.
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Misra DP, Slaughter-Acey J, Giurgescu C, Sealy-Jefferson S, Nowak A. Why Do Black Women Experience Higher Rates of Preterm Birth? CURR EPIDEMIOL REP 2017. [DOI: 10.1007/s40471-017-0102-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Simpson W, Steiner M, Coote M, Frey BN. Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study. BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 38:190-6. [PMID: 27579595 PMCID: PMC7194265 DOI: 10.1590/1516-4446-2015-1899] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/18/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1) to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2) to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3) to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum. METHODS Thirty-three healthy pregnant women were recruited from the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression. RESULTS Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p > 0.001), IL-6 (p = 0.025), and IL-10 (p = 0.006) were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS) score. CONCLUSIONS Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.
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Affiliation(s)
- William Simpson
- McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Meir Steiner
- McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada.,Institute for Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Marg Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Benicio N Frey
- McMaster Integrated Neuroscience Discovery and Study (MiNDS), McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
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Cassano P, Bui E, Rogers AH, Walton ZE, Ross R, Zeng M, Nadal-Vicens M, Mischoulon D, Baker AW, Keshaviah A, Worthington J, Hoge EA, Alpert J, Fava M, Wong KK, Simon NM. Inflammatory cytokines in major depressive disorder: A case-control study. Aust N Z J Psychiatry 2017; 51:23-31. [PMID: 27313138 PMCID: PMC5731241 DOI: 10.1177/0004867416652736] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is mixed evidence in the literature on the role of inflammation in major depressive disorder. Contradictory findings are attributed to lack of rigorous characterization of study subjects, to the presence of concomitant medical illnesses, to the small sample sizes, and to the limited number of cytokines tested. METHODS Subjects aged 18-70 years, diagnosed with major depressive disorder and presenting with chronic course of illness, as well as matched controls ( n = 236), were evaluated by trained raters and provided blood for cytokine measurements. Cytokine levels in EDTA plasma were measured with the MILLIPLEX Multi-Analyte Profiling Human Cytokine/Chemokine Assay employing Luminex technology. The Wilcoxon rank-sum test was used to compare cytokine levels between major depressive disorder subjects and healthy volunteers, before (interleukin [IL]-1β, IL-6, and tumor necrosis factor-α) and after Bonferroni correction for multiple comparisons (IL-1α, IL-2, IL-3, IL-4, IL-5, IL-7, IL-8, IL-10, IL-12(p40), IL-12(p70), IL-13, IL-15, IFN-γ-inducible protein 10, Eotaxin, interferon-γ, monotype chemoattractant protein-1, macrophage inflammatory protein-1α, granulocyte-macrophage colony-stimulating factor and vascular endothelial growth factor). RESULTS There were no significant differences in cytokine levels between major depressive disorder subjects and controls, both prior to and after correction for multiple analyses (significance set at p ⩽ 0.05 and p ⩽ 0.002, respectively). CONCLUSION Our well-characterized examination of cytokine plasma levels did not support the association of major depressive disorder with systemic inflammation. The heterogeneity of major depressive disorder, as well as a potential sampling bias selecting for non-inflammatory depression, might have determined our findings discordant with the literature.
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Affiliation(s)
- Paolo Cassano
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew H Rogers
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Rachel Ross
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mary Zeng
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mireya Nadal-Vicens
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - David Mischoulon
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda W Baker
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Aparna Keshaviah
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - John Worthington
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth A Hoge
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Alpert
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Maurizio Fava
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kwok K Wong
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Sun Y, Narayan VA, Wittenberg GM. Side effect profile similarities shared between antidepressants and immune-modulators reveal potential novel targets for treating major depressive disorders. BMC Pharmacol Toxicol 2016; 17:47. [PMID: 27765060 PMCID: PMC5073882 DOI: 10.1186/s40360-016-0090-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background Side effects, or the adverse effects of drugs, contain important clinical phenotypic information that may be useful in predicting novel or unknown targets of a drug. It has been suggested that drugs with similar side-effect profiles may share common targets. The diagnostic class, Major Depressive Disorder, is increasingly viewed as being comprised of multiple depression subtypes with different biological root causes. One ‘type’ of depression generating substantial interest today focuses on patients with high levels of inflammatory burden, indicated by elevated levels of C-reactive proteins (CRP) and pro-inflammatory cytokines such as interleukin 6 (IL-6). It has been suggested that drugs targeting the immune system may have beneficial effect on this subtype of depressed patients, and several studies are underway to test this hypothesis directly. However, patients have been treated with both anti-inflammatory and antidepressant compounds for decades. It may be possible to exploit similarities in clinical readouts to better understand the antidepressant effects of immune-related drugs. Methods Here we explore the space of approved drugs by comparing the drug side effect profiles of known antidepressants and drugs targeting the immune system, and further examine the findings by comparing the human cell line expression profiles induced by them with those induced by antidepressants. Results We found 7 immune-modulators and 14 anti-inflammatory drugs sharing significant side effect profile similarities with antidepressants. Five of the 7 immune modulators share most similar side effect profiles with antidepressants that modulate dopamine release and/or uptake. In addition, the immunosuppressant rapamycin and the glucocorticoid alclometasone induces transcriptional changes similar to multiple antidepressants. Conclusions These findings suggest that some antidepressants and some immune-related drugs may affect common molecular pathways. Our findings support the idea that certain medications aimed at the immune system may be helpful in relieving depressive symptoms, and suggest that it may be of value to test immune-modulators for antidepressant-like activity in future proof-of-concept studies.
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Affiliation(s)
- Yu Sun
- Neuroscience Integrative Solutions and Informatics, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA.
| | - Vaibhav A Narayan
- Neuroscience Integrative Solutions and Informatics, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA
| | - Gayle M Wittenberg
- Neuroscience Integrative Solutions and Informatics, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA
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Thyroid peroxidase autoantibodies and perinatal depression risk: A systematic review. J Affect Disord 2016; 198:108-21. [PMID: 27011366 DOI: 10.1016/j.jad.2016.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND While thyroid autoantibodies have been linked to depression in general population samples, it is unclear if the immunological milieu of pregnancy alters this association. As a result, we systematically reviewed the literature to determine if abnormal levels of autoantibodies that target thyroperoxidase (TPO-AB) during the perinatal period are associated with an increased risk of antenatal and postnatal depression. METHODS MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched through February 2016. Primary studies that examined TPO-AB titers during pregnancy or the postpartum period, and antenatal or postnatal depression were eligible. The quality of each study was assessed using the Newcastle-Ottawa Scale. RESULTS Among the eleven articles selected for synthesis, three of these examined associations between TPO-AB and depression both during pregnancy and in the postpartum period. Three of five studies reported statistically significant associations between elevated TPO-AB titers (TPO-AB+) and concurrent depression at 12-25 weeks gestation. Four of five studies found significant associations between TPO-AB+ status at 12-25 weeks gestation and depression in the postpartum period. Two of four studies found links between postpartum TPO-AB and depression concurrently in the puerperium. LIMITATIONS Lack of adjustment for confounding variables limits causal inference and conclusions about the predictive power of TPO-AB. CONCLUSIONS Studies suggest that TPO-AB+ in early to mid-pregnancy is associated with concurrent depression and may be predictive of depression in the postpartum period. Future studies with improved methodology are required to better understand the full pathophysiological implications and predictive utility of TPO-AB in perinatal depression.
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Serati M, Redaelli M, Buoli M, Altamura AC. Perinatal Major Depression Biomarkers: A systematic review. J Affect Disord 2016; 193:391-404. [PMID: 26802316 DOI: 10.1016/j.jad.2016.01.027] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/04/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression.
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Affiliation(s)
- M Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy.
| | - M Redaelli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - M Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
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Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Mahieu B, Nowak G, Maes M. Lower Serum Zinc and Higher CRP Strongly Predict Prenatal Depression and Physio-somatic Symptoms, Which All Together Predict Postnatal Depressive Symptoms. Mol Neurobiol 2016; 54:1500-1512. [PMID: 26846364 DOI: 10.1007/s12035-016-9741-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
Pregnancy and delivery are associated with activation of immune-inflammatory pathways which may prime parturients to develop postnatal depression. There are, however, few data on the associations between immune-inflammatory pathways and prenatal depression and physio-somatic symptoms. This study examined the associations between serum zinc, C-reactive protein (CRP), and haptoglobin at the end of term and prenatal physio-somatic symptoms (fatigue, back pain, muscle pain, dyspepsia, obstipation) and prenatal and postnatal depressive and anxiety symptoms as measured using the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), and Spielberger's State Anxiety Inventory (STAI). Zinc and haptoglobin were significantly lower and CRP increased at the end of term as compared with non-pregnant women. Prenatal depression was predicted by lower zinc and lifetime history of depression, anxiety, and premenstrual tension syndrome (PMS). The latter histories were also significantly and inversely related to lower zinc. The severity of prenatal EDPS, HAMD, BDI, STAI, and physio-somatic symptoms was predicted by fatigue in the first and second trimesters, a positive life history of depression, anxiety, and PMS, and lower zinc and higher CRP. Postnatal depressive symptoms are predicted by prenatal depression, physio-somatic symptoms, zinc and CRP. Prenatal depressive and physio-somatic symptoms have an immune-inflammatory pathophysiology, while postnatal depressive symptoms are highly predicted by prenatal immune activation, prenatal depression, and a lifetime history of depression and PMS. Previous episodes of depression, anxiety disorders, and PMS may prime pregnant females to develop prenatal and postnatal depressive symptoms via activated immune pathways.
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Affiliation(s)
- Chutima Roomruangwong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Buranee Kanchanatawan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Sirivichayakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Boris Mahieu
- Laboratory of Biochemistry, Antwerp Hospital Network, Antwerp, Belgium
| | - Gabriel Nowak
- Laboratory of Trace Elements Neurobiology, Institute of Pharmacology PAS, Krakow, Poland.,Department of Pharmacobiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria. .,Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil. .,Revitalis Clinic, Waalre, Netherlands. .,IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia.
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Garfield L, Mathews HL, Janusek LW. Inflammatory and Epigenetic Pathways for Perinatal Depression. Biol Res Nurs 2015; 18:331-43. [DOI: 10.1177/1099800415614892] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression during the perinatal period is common and can have adverse consequences for women and their children. Yet, the biobehavioral mechanisms underlying perinatal depression are not known. Adverse early life experiences increase the risk for adult depression. One potential mechanism by which this increased risk occurs is epigenetic embedding of inflammatory pathways. The purpose of this article is to propose a conceptual model that explicates the linkage between early life adversity and the risk for maternal depression. The model posits that early life adversity embeds a proinflammatory epigenetic signature (altered DNA methylation) that predisposes vulnerable women to depression during pregnancy and the postpartum period. As proposed, women with a history of early life adversity are more likely to exhibit higher levels of proinflammatory cytokines and lower levels of oxytocin in response to the demands of pregnancy and new motherhood, both of which are associated with the risk for perinatal depression. The model is designed to guide investigations into the biobehavioral basis for perinatal depression, with emphasis upon the impact of early life adversity. Testing this model will provide a better understanding of maternal depressive risk and improve identification of vulnerable women who would benefit from targeted interventions that can reduce the impact of perinatal depression on maternal–infant health.
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Affiliation(s)
- Lindsey Garfield
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Herbert L. Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
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Young JJ, Bruno D, Pomara N. A review of the relationship between proinflammatory cytokines and major depressive disorder. J Affect Disord 2014; 169:15-20. [PMID: 25128861 DOI: 10.1016/j.jad.2014.07.032] [Citation(s) in RCA: 279] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/10/2014] [Accepted: 07/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Determining etiological factors and reviewing advances in diagnostic modalities sensitive and specific to Major Depressive Disorder (MDD) is of importance in its evaluation and treatment. The inflammatory hypothesis is one of the most prevalent topics concerning MDD and may provide insight into the pathogenesis of depression, development of biomarkers, and ultimately production of more effective depression therapies. METHOD We reviewed several studies to evaluate contemporary concepts concerning proinflammatory cytokines and their relationship to various depressive disorders, the use of anti-inflammatory therapies in MDD treatment, and the application of neuroimaging in conjunction with cytokine profiles from both plasma and CSF as possible diagnostic tools. RESULTS Proinflammatory cytokines in both plasma and CSF have been found to influence the progression and severity of depressive disorders in different populations. Studies have shown elevated serum levels of IL-1, IL-6, TNF-α, CRP, and MCP-1 in depressed patients, but have presented mixed results with IL-8 serum levels, and with IL-6 and MCP-1 CSF levels. Anti-inflammatory treatment of MDD may have adjuvant properties with current depression medications. MRI and NIRS neuroimaging confirm neurological abnormalities in the presence of elevated proinflammatory cytokines in depressed or stressed patients. LIMITATIONS Heterogeneity of MDD and limited CSF cytokine research complicate the study of MDD pathogenesis. CONCLUSION There is significant evidence that inflammatory processes influence the development and progression of MDD. Future studies with larger arrays of cytokine profiles aided by neuroimaging may provide more sensitive and specific modes of diagnostics in determining MDD etiology and provide guidance in individual therapies.
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Affiliation(s)
- Juan Joseph Young
- Geriatric Psychiatry Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Davide Bruno
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Nunzio Pomara
- Geriatric Psychiatry Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Langone Medical Center, New York University, New York, NY, USA.
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Inflammatory cytokine-associated depression. Brain Res 2014; 1617:113-25. [PMID: 25003554 DOI: 10.1016/j.brainres.2014.06.032] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023]
Abstract
Inflammatory cytokines can sometimes trigger depression in humans, are often associated with depression, and can elicit some behaviors in animals that are homologous to major depression. Moreover, these cytokines can affect monoaminergic and glutamatergic systems, supporting an overlapping pathoetiology with major depression. This suggests that there could be a specific major depression subtype, inflammatory cytokine-associated depression (ICAD), which may require different therapeutic approaches. However, most people do not develop depression, even when exposed to sustained elevations in inflammatory cytokines. Thus several vulnerabilities and sources of resilience to inflammation-associated depression have been identified. These range from genetic differences in neurotrophic and serotonergic systems to sleep quality and omega-3 fatty acid levels. Replicating these sources of resilience as treatments could be one approach for preventing "ICAD". This article is part of a Special Issue entitled SI: Neuroimmunology in Health And Disease.
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Blackmore ER, Groth SW, Chen DGD, Gilchrist MA, O'Connor TG, Moynihan JA. Depressive symptoms and proinflammatory cytokines across the perinatal period in African American women. J Psychosom Obstet Gynaecol 2014; 35:8-15. [PMID: 24350831 DOI: 10.3109/0167482x.2013.868879] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comparatively few studies have examined the biological mechanisms that may underlie the reported racial disparities in antenatal and postpartum depression. OBJECTIVE To examine the associations among race, depressive symptoms and the proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α across the perinatal period in a diverse sample of healthy pregnant women at elevated psychosocial risk. METHODS 171 subjects were enrolled. Women were interviewed and blood samples drawn at 18 and 32 weeks gestation and 6 weeks and 6 months postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Serum levels of IL-6 and TNF-α were assayed using high sensitivity enzyme-linked immunosorbent assay kits. RESULTS Compared with non-African American (AA) women, AA women had significantly higher levels of IL-6 (est. diff = 0.521, p = 0.02, confidence interval (CI): 0.088-0.954) but not TNF-α across all time points (est. diff = -0.060, p = 0.80, CI: -0.517 to 0.397). IL-6 was not associated with depressive symptoms but differences in IL-6 were accounted for by greater Body Mass Index in AA women. CONCLUSIONS Compared with non-AA women, AA women entered pregnancy with elevated inflammatory cytokine levels that persisted across the perinatal period. This group difference in inflammation did not suggest increased risk for depression, but suggests other implications for long-term health.
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