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Euclydes V, Braga CI, Gouveia G, Martinez RC, Camilo C, Simões SN, Martins-Jr DC, Fracolli L, Argeu A, Ferraro A, Matijasevich A, Fatori D, Miguel EC, Polanczyk GV, Brentani H. Maternal immune response during pregnancy and neurodevelopmental outcomes: A longitudinal approach. Brain Behav Immun Health 2024; 40:100832. [PMID: 39193418 PMCID: PMC11347843 DOI: 10.1016/j.bbih.2024.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Background and objectives The neurodevelopment of the offspring is suggested to be influenced by the maternal immune system's responses throughout pregnancy, which in turn is also vulnerable to maternal psychosocial stress conditions. Therefore, our main goal was to investigate whether maternal peripheral immunological biomarkers (IB) during two stages of gestation are associated with distinct neurodevelopmental trajectories in the first two years of life. As a second goal, we also explored the association between maternal distal (childhood) and proximal (gestation) stressful experiences and the immunological markers assessed during pregnancy. Methods Maternal childhood trauma, depressive and anxiety symptoms, and peripheral IB (IFNγ, IL-10, IL1β, IL6, IL8, TNFα, EGF, IL13, IL17, IL1Ra and IL4) were measured at baseline (8-16 weeks of pregnancy) and at 30 weeks of pregnancy in 160 women. The participants had the blood samples collected from two randomized clinical trials conducted by the same team and methods in the same community. A Principal Component Analysis (PCA) was implemented to create meaningful composite variables that describe the cytokines joint variation. Finally, linear mixed-effects modeling was used to investigate the influence of inflammatory biomarkers, maternal childhood trauma, anxiety, and depressive symptoms on Bayley's III scores trajectories. Results The IB profile during the 3rd trimester of pregnancy predicted the offspring's neurodevelopmental trajectories in the first two years of life. The components derived from PCA were important predictors and captured different immune responses, reflecting both pro- and anti-inflammatory states. Maternal stressful experiences did not correlate with the immunological markers. Although not a reliable predictor alone, maternal psychosocial stress at the 1st trimester of pregnancy interacted with the mother's immune response while predicting the neurodevelopmental scores during the first two years of life. Conclusions Our results underscore the importance of the maternal immune response during pregnancy in shaping the neurodevelopmental trajectory of the offspring. Additionally, we observed that the maternal distress at the early stages of pregnancy has an incremental effect on the neurodevelopmental outcome but depends upon the immune response.
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Affiliation(s)
- Veronica Euclydes
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio I.S. Braga
- Center for Mathematics, Computation and Cognition, Federal University of ABC (UFABC), Santo André, SP, Brazil
| | - Gisele Gouveia
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Caroline Camilo
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - David C. Martins-Jr
- Center for Mathematics, Computation and Cognition, Federal University of ABC (UFABC), Santo André, SP, Brazil
| | - Lislaine Fracolli
- Escola de Enfermagem, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Argeu
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alexandre Ferraro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Fatori
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Euripedes C. Miguel
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Guilherme V. Polanczyk
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helena Brentani
- Instituto e Departamento de Psiquiatria, Faculdade de Medicina FMUSP, LIM/23, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Kleih TS, Keenan-Devlin LS, Entringer S, Spägele N, Godara M, Heim CM, Kathmann N, Grobman W, Simhan H, Borders AEB, Wadhwa PD, Buss C. C-reactive protein across pregnancy in individuals exposed to childhood maltreatment: The role of psychological and physical sequelae of maltreatment. Brain Behav Immun 2024; 122:313-324. [PMID: 39134185 DOI: 10.1016/j.bbi.2024.08.017] [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: 06/12/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Childhood maltreatment (CM) has long-term consequences for the regulation of stress biology which are particularly pronounced when mental and physical health sequelae have manifested. C-reactive protein (CRP) has been shown to be elevated in the non-pregnant state in association with CM as well as in the setting of CM-associated mental and physical health sequelae. In pregnancy, however, the association between CM and CRP is less clear. We sought to examine this association and consider the moderating role of four common health sequelae of CM (maternal depressive symptoms, overweight/obesity, smoking, and hypertensive disorders during pregnancy). METHODS A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income). RESULTS CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed. CONCLUSIONS These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.
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Affiliation(s)
- Theresa S Kleih
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Humboldt-Universität zu Berlin, Institute of Psychology, 12489 Berlin, Germany
| | - Lauren S Keenan-Devlin
- NorthShore University Health System, Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; UC University of California Irvine, Development, Health and Disease Research Program, USA
| | - Nina Spägele
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
| | - Malvika Godara
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
| | - Christine M Heim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Department of Biobehavioral Health, College of Health & Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Norbert Kathmann
- Humboldt-Universität zu Berlin, Institute of Psychology, 12489 Berlin, Germany
| | - William Grobman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hyagriv Simhan
- University of Pittsburgh School of Medicine, Division of Maternal-Fetal Medicine, USA
| | - Ann E B Borders
- NorthShore University HealthSystem/ Endeavor Health, Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Northwestern University Center for Healthcare Studies - Institute for Public Health and Medicine, USA
| | - Pathik D Wadhwa
- University of California, Irvine, Development, Health and Disease Research Program, Irvine, CA, USA
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; University of California, Irvine, Development, Health and Disease Research Program, Irvine, CA, USA; German Center for Child and Adolescent Health (DZKJ), partner site Berlin, Charité - Universitätsmedizin Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin, Charité - Universitätsmedizin Berlin, Germany.
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Karkoszka N, Gibula-Tarlowska E, Kotlinska J, Bielenica A, Gawel K, Kedzierska E. Selenium Intake and Postnatal Depression-A Short Review. Nutrients 2024; 16:1926. [PMID: 38931280 PMCID: PMC11206929 DOI: 10.3390/nu16121926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Postnatal depression is a common and severe complication of childbirth. It is an important public health problem with significant implications for both mothers and children. The exact mechanisms underlying and the factors influencing the occurrence of postnatal depression remain unclear. The literature suggests that certain dietary deficiencies during pregnancy and the postnatal period may contribute to a greater risk of maternal depression. This review focuses on the role of selenium in postnatal depression. It collects evidence from published interventional and observational studies investigating the relationship between selenium intake during the antenatal and postnatal periods and the mental status of postpartum women and summarises information about biological mechanisms that may underlie the association between selenium status and postnatal depression. The review includes studies identified through electronic searches of Medline (via PubMed) and Google Scholar databases until December 2023. Despite the small number of relevant studies and their potential methodological limitations, the findings suggest that optimizing selenium status may support the prevention and treatment of postnatal depression. Further longitudinal and interventional studies are necessary to confirm the clinical significance of these effects.
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Affiliation(s)
- Natalia Karkoszka
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, 4a Chodźki Street, 20-400 Lublin, Poland; (E.G.-T.); (J.K.); (E.K.)
| | - Ewa Gibula-Tarlowska
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, 4a Chodźki Street, 20-400 Lublin, Poland; (E.G.-T.); (J.K.); (E.K.)
| | - Jolanta Kotlinska
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, 4a Chodźki Street, 20-400 Lublin, Poland; (E.G.-T.); (J.K.); (E.K.)
| | - Anna Bielenica
- Department of Biochemistry, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland;
| | - Kinga Gawel
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, 8b Jaczewskiego Street, 20-090 Lublin, Poland;
| | - Ewa Kedzierska
- Department of Pharmacology and Pharmacodynamics, Medical University of Lublin, 4a Chodźki Street, 20-400 Lublin, Poland; (E.G.-T.); (J.K.); (E.K.)
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Rajasekera TA, Galley JD, Mackos AR, Chen HJ, Mitchell JG, Kleinman JJ, Cappelucci P, Mashburn-Warren L, Lauber CL, Bailey MT, Worly BL, Gur TL. Stress and depression-associated shifts in gut microbiota: A pilot study of human pregnancy. Brain Behav Immun Health 2024; 36:100730. [PMID: 38323225 PMCID: PMC10844036 DOI: 10.1016/j.bbih.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Background Psychosocial stress and mood-related disorders, such as depression, are prevalent and vulnerability to these conditions is heightened during pregnancy. Psychosocial stress induces consequences via several mechanisms including the gut microbiota-brain axis and associated signaling pathways. Previous preclinical work indicates that prenatal stress alters maternal gut microbial composition and impairs offspring development. Importantly, although the fecal and vaginal microenvironments undergo alterations across pregnancy, we lack consensus regarding which shifts are adaptive or maladaptive in the presence of prenatal stress and depression. Clinical studies interrogating these relationships have identified unique taxa but have been limited in study design. Methods We conducted a prospective cohort study of pregnant individuals consisting of repeated administration of psychometrics (Perceived Stress Scale (PSS) and Center for Epidemiological Studies Depression Scale (CES-D)) and collection of fecal and vaginal microbiome samples. Fecal and vaginal microbial community composition across psychometric responses were interrogated using full-length 16S rRNA sequencing followed by α and β-diversity metrics and taxonomic abundance. Results Early pregnancy stress was associated with increased abundance of fecal taxa not previously identified in related studies, and stress from late pregnancy through postpartum was associated with increased abundance of typical vaginal taxa and opportunistic pathogens in the fecal microenvironment. Additionally, in late pregnancy, maternal stress and depression scores were associated with each other and with elevated maternal C-C motif chemokine ligand 2 (CCL2) concentrations. At delivery, concordant with previous literature, umbilical CCL2 concentration was negatively correlated with relative abundance of maternal fecal Lactobacilli. Lastly, participants with more severe depressive symptoms experienced steeper decreases in prenatal vaginal α-diversity. Conclusion These findings a) underscore previous preclinical and clinical research demonstrating the effects of prenatal stress on maternal microbiome composition, b) suggest distinct biological pathways for the consequences of stress versus depression and c) extend the literature by identifying several taxa which may serve critical roles in mediating this relationship. Thus, further interrogation of the role of specific maternal microbial taxa in relation to psychosocial stress and its sequelae is warranted.
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Affiliation(s)
- Therese A. Rajasekera
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey D. Galley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amy R. Mackos
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Helen J. Chen
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
| | | | | | - Paige Cappelucci
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Christian L. Lauber
- Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Michael T. Bailey
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brett L. Worly
- Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tamar L. Gur
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, USA
- College of Medicine, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
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Mancuso RA, Ross KM, Accortt E, Coussons-Read M, Okun ML, Irwin J, Carroll J, Hobel CJ, Schetter CD. Prenatal mood and anxiety disorders and associated cytokine changes. J Affect Disord 2024; 347:635-644. [PMID: 38070749 PMCID: PMC11375962 DOI: 10.1016/j.jad.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND We examined whether women with prenatal mood and anxiety disorders would exhibit differential pro- and anti-inflammatory marker trajectories during the prenatal and postpartum periods compared to women without these disorders. METHODS Approximately 179 pregnant women participated in a longitudinal study conducted in two urban areas. Blood samples for inflammatory markers were collected at six study visits. The Structured Clinical Interview for the DSM-IV (SCID) was administered to participants scoring above cutoffs on anxiety and depression. Pregnant women with SCID Axis I diagnoses of mood and/or anxiety disorders were compared to other participants on inflammatory markers. Multilevel modeling tested associations between SCID diagnoses and within-person interleukin (IL)6 and IL10 trajectories. RESULTS Prenatal SCID diagnoses were associated with linear, quadratic and cubic change in IL6 from prenatal to postpartum timepoints. Women with a prenatal SCID diagnosis had steeper decreases and increases in IL6 during prenatal and postpartum periods. SCID diagnoses were associated with lower IL10 in mid-pregnancy to postpartum (b = -0.078, SE = 0.019; p = .015). LIMITATIONS Future studies would benefit from a larger sample size and a larger number of participants with SCID diagnoses. Future research should also examine whether different prenatal Axis 1 diagnoses are associated with different patterns of immune response in pregnancy. CONCLUSIONS Pregnant women with prenatal mood and anxiety disorders had greater fluctuations in IL6 across prenatal and postpartum periods and lower IL10 through pregnancy and postpartum. They may have different proinflammatory states that remain after birth without a reciprocal anti-inflammatory response.
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Affiliation(s)
- Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA.
| | - Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Eynav Accortt
- Reproductive Psychology Program, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Michele L Okun
- Sleep and Biobehavioral Health Research Laboratory, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Jessica Irwin
- Department of Psychology, University of La Verne, La Verne, CA, USA
| | - Judith Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Calvin J Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Killeen SL, Mealy G, Brennan K, Cotter PD, Yelverton C, Saldova R, Groeger D, VanSinderen D, Doyle S, McAuliffe FM. Impact of Bifidobacterium longum1714® on maternal cytokine response in peripheral blood mononuclear cells. Cytokine 2024; 174:156458. [PMID: 38071842 DOI: 10.1016/j.cyto.2023.156458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024]
Abstract
PURPOSE The maternal immune system is implicated in adverse pregnancy outcomes. Manipulation of maternal immune response by probiotics holds potential to reduce pregnancy complications. The MicrobeMom2 study investigates the impact of probiotic supplementation on maternal immune responses to pathogen associated molecular patterns (PAMPs) in peripheral blood mononuclear cells (PBMCs) during pregnancy. METHODS This double-blinded randomised-controlled trial involved oral supplementation of Bifidobacterium longum subsp. longum 1714® (B. longum 1714; daily ingestion of a minimum of 1x109 colony forming units) or placebo from 16 to 20-weeks' gestation until delivery in healthy pregnant women. The primary outcome was a change in IL-10 production, after stimulation with Lipopolysaccharide (LPS) or anti-CD3/28/2, in PBMCs isolated from blood samples taken at baseline (11-15 weeks' gestation) and late pregnancy (28-32 weeks' gestation) after 48 h incubation. 68 subjects were needed (34ineachgroup) for 80 % power at an alpha significance of 0.05 to detect differences in IL10. RESULTS 72 women (mean ± SD age 33.17 ± 4.53 years and median (25th, 75th centile) body mass index 24.93 (21.93, 27.57 kg/m2)) were recruited with primary outcome data. Using LPS, late pregnancy fold change in IL-10 in PBMCs after 48 h incubation was median (25th, 75th centile) 88.45 (4.88, 488.78) in the intervention, 24.18 (6.36, 141.17) in the control group, p = 0.183. Using anti-CD3/28/2, values were 189.69 (425.96, 866.57),148.74 (31.67, 887.03) in intervention and control groups, respectively, p = 0.506. No significant differences were observed between the two groups. CONCLUSION Maternal antenatal supplementation with B. longum 1714 did not alter cytokine production by maternal PBMCs in response to PAMPs or anti-CD3/28/2. TRIAL REGISTRATION NUMBER ISRCTN registry ISRCTN43013285.
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Affiliation(s)
- Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Grace Mealy
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Kiva Brennan
- Department of Clinical Medicine, Trinity College Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Paul D Cotter
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Cara Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Radka Saldova
- The National Institute for Bioprocessing, Research, and Training (NIBRT), Dublin, Ireland; UCD School of Medicine, College of Health and Agricultural Science (CHAS), University College Dublin (UCD), Dublin, Ireland
| | - David Groeger
- PrecisionBiotics Group Ltd (Novozymes), Cork Airport Business Park, Kinsale Road, Cork, Ireland
| | - Douwe VanSinderen
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland; School of Microbiology, University College Cork, Cork, Ireland
| | - Sarah Doyle
- Department of Clinical Medicine, Trinity College Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Lozowchuk A, Carroll JE, Hobel C, Coussons-Read M, Dunkel Schetter C, Ross KM. Partner relationship quality and IL-6:IL-10 trajectories from pregnancy to a year after-birth. Brain Behav Immun 2023; 114:407-413. [PMID: 37704011 DOI: 10.1016/j.bbi.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Inflammatory activity during pregnancy and the postpartum period shifts systematically due to pregnancy progression, delivery, and postpartum recovery. Factors that deregulate inflammatory activity increase the risk for adverse pregnancy outcomes and slower postpartum recovery. The IL-6:IL-10 or TNF-α:IL-10 ratio is potentially one way to capture peripheral inflammatory regulation; higher values indicate that anti-inflammatory IL-10 is less effective at regulating pro-inflammatory TNF-α or IL-6, skewing towards maladaptive pro-inflammatory profiles. Associations between partner relationship quality and IL-6:IL-10 or TNF-α:IL-10 trajectories during pregnancy and the postpartum period have not been assessed. The purpose of this study was to test whether partner relationship quality (support, conflict) is associated with attenuated IL-6, IL-10, TNF-α, TNF-α:IL-10 or IL-6:IL-10 trajectories from the third trimester to the postpartum period. METHODS A sample of 162 women from the Healthy Babies Before Birth study reported on partner relationship quality (support and conflict) using the Social Support Effectiveness Questionnaire during the third trimester. Plasma samples were collected in the third trimester and at 1-, 6- and 12-months postpartum, and assayed for TNF-α, IL-6 and IL-10. Associations between both indicators of relationship quality (support and conflict) and TNF-α, IL-6, IL-10, IL-6:IL-10, TNF-α:IL-10 trajectories were tested using multi-level modelling, controlling for sociodemographic, pregnancy and health variables. RESULTS Partner support interacted with time to predict IL-6:IL-10 trajectories, linear: b = -0.176, SE = 0.067, p =.010, quadratic: b = 0.012, SE = 0.005, p =.009. Lower partner support was associated with steeper increases in IL-6:IL-10 from the third trimester to 6 months postpartum, followed by steeper decreases in IL-6:IL-10 from 6 months postpartum to a year after birth. Partner conflict was not associated with IL-6:IL-10 levels at study entry, b = 0.233, SE = 0.219, p =.290, or over time, p's > 0.782. Neither indicator of partner relationship quality was associated with TNF-α, IL-6, IL-10, or TNF-α:IL-10 trajectories, p's > 0.205. CONCLUSION Lower partner support may be associated with reduced moderation of IL-6 by IL-10 between pregnancy and a year postpartum, with possible consequences for maternal health and well-being.
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Affiliation(s)
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Calvin Hobel
- Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado-Colorado Springs, Colorado Springs, CO, United States
| | | | - Kharah M Ross
- Psychology Department, University of Calgary, Calgary, AB, Canada; Department of Psychology, Athabasca University, Athabasca, AB, Canada.
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Silvano A, Niccolai E, Baldi S, Seravalli V, Strambi N, Nannini G, Pallecchi M, Bartolucci G, Parenti A, Amedei A, Di Tommaso M. Exploring Plasma-Level Gut Microbiota Mediators and Pro-Inflammatory Markers in Pregnant Women with Short Cervix and Gestational Diabetes Mellitus. Int J Mol Sci 2023; 24:13653. [PMID: 37686463 PMCID: PMC10487736 DOI: 10.3390/ijms241713653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
The composition of the gut microbiota (GM) undergoes significant changes during pregnancy, influenced by metabolic status, energy homeostasis, fat storage, and hormonal and immunological modifications. Moreover, dysbiosis during pregnancy has been associated with preterm birth, which is influenced by factors such as cervical shortening, infection, inflammation, and oxidative stress. However, dysbiosis also affects the levels of lipopolysaccharide-binding protein (LBP), short-chain fatty acids (SCFAs), and free fatty acids (FFA) in other tissues and the bloodstream. In this study, we investigated the plasmatic levels of some pro-inflammatory cytokines, such as matrix metalloproteinases-8 (MMP-8), interleukin-8 (IL-8), heat shock protein 70 (Hsp70), and microbial markers in pregnant women with a short cervix (≤25 mm) compared to those with normal cervical length (>25 mm). We examined the differences in the concentration of these markers between the two groups, also assessing the impact of gestational diabetes mellitus. Understanding the relationship between GM dysbiosis, inflammatory mediators, and cervical changes during pregnancy may contribute to the identification of potential biomarkers and therapeutic targets for the prevention and management of adverse pregnancy outcomes, including preterm birth.
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Affiliation(s)
- Angela Silvano
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, 50139 Florence, Italy; (A.S.); (V.S.); (N.S.)
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (S.B.); (G.N.); (A.A.)
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (S.B.); (G.N.); (A.A.)
| | - Viola Seravalli
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, 50139 Florence, Italy; (A.S.); (V.S.); (N.S.)
| | - Noemi Strambi
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, 50139 Florence, Italy; (A.S.); (V.S.); (N.S.)
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (S.B.); (G.N.); (A.A.)
| | - Marco Pallecchi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50019 Sesto Fiorentino, Italy; (M.P.); (G.B.)
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50019 Sesto Fiorentino, Italy; (M.P.); (G.B.)
| | - Astrid Parenti
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, 50139 Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (S.B.); (G.N.); (A.A.)
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, 50139 Florence, Italy; (A.S.); (V.S.); (N.S.)
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9
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Takahashi N, Nishimura T, Harada T, Okumura A, Iwabuchi T, Rahman MS, Kuwabara H, Takagai S, Usui N, Makinodan M, Matsuzaki H, Ozaki N, Itoh H, Nomura Y, Newcorn JH, Tsuchiya KJ. Interaction of genetic liability for attention deficit hyperactivity disorder (ADHD) and perinatal inflammation contributes to ADHD symptoms in children. Brain Behav Immun Health 2023; 30:100630. [PMID: 37251547 PMCID: PMC10213186 DOI: 10.1016/j.bbih.2023.100630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Genetic and environmental factors contribute to the development of Attention Deficit/Hyperactivity Disorder (ADHD). Perinatal inflammation is one of the promising environmental risk factors for ADHD, but the relationship between the genetic risk for ADHD and perinatal inflammation requires further examination. Methods A possible gene-environmental interaction between perinatal inflammation and ADHD polygenic risk score (ADHD-PRS) on ADHD symptoms was investigated in children aged 8-9 from the Hamamatsu Birth Cohort for Mothers and Children (N = 531). Perinatal inflammation was evaluated by the level of concentration of three cytokines assayed in umbilical cord blood. The genetic risk for ADHD was assessed by calculating ADHD-PRS for each individual using a previously collected genome-wide association study of ADHD. Results Perinatal inflammation (β [SE], 0.263 [0.017]; P < 0.001), ADHD-PRS (β [SE], 0.116[0.042]; P = 0.006), and an interaction between the two (β [SE], 0.031[0.011]; P = 0.010) were associated with ADHD symptoms. The association between perinatal inflammation and ADHD symptoms measured by ADHD-PRS was evident only in the two higher genetic risk groups (β [SE], 0.623[0.122]; P < 0.001 for the medium-high risk group; β [SE], 0.664[0.152]; P < 0.001 for the high-risk group). Conclusion Inflammation in the perinatal period both directly elevated ADHD symptoms and magnified the impact of genetic vulnerability on ADHD risk particularly among children aged 8-9 with genetically higher risk for ADHD.
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Affiliation(s)
- Nagahide Takahashi
- Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Tomoko Nishimura
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Taeko Harada
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Akemi Okumura
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Toshiki Iwabuchi
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
| | - Hitoshi Kuwabara
- Department of Psychiatry, Saitama University School of Medicine, Japan
| | - Shu Takagai
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
- Department of Child and Adolescent Psychiatry, Hamamatsu University School of Medicine, Japan
| | - Noriyoshi Usui
- Department of Neuroscience and Cell Biology, Graduate School of Medicine, Osaka University, Japan
| | | | - Hideo Matsuzaki
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
- Research Center for Child Mental Development, University of Fukui, Japan
| | - Norio Ozaki
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Japan
| | - Yoko Nomura
- Queens College and Graduate Center, City University of New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey H. Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenji J. Tsuchiya
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Japan
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10
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Chagas AP, da Silva NG, Ribeiro CM, Amato AA. Early-life exposure to antibiotics and excess body weight in childhood and adolescence: A systematic review and meta-analysis. Obes Res Clin Pract 2023; 17:318-334. [PMID: 37573229 DOI: 10.1016/j.orcp.2023.07.001] [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: 01/10/2023] [Revised: 06/05/2023] [Accepted: 07/29/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The association between early-life exposure to antibiotics and overweight/obesity is unclear. We conducted a systematic review and meta-analysis to address this issue. METHODS We searched PubMed, Web of Science, Scopus, and grey literature from inception to August 10, 2022, for cohort studies investigating the association between early-life exposure to antibiotics and weight outcomes. Two independent reviewers screened studies for eligibility, extracted data, assessed risk of bias, and examined the certainty of the evidence. Random-effects meta-analyses was used for pooling the data. The review was registered in PROSPERO, CRD42021265417. RESULTS We included 42 studies and data from 28 of them were pooled in the quantitative synthesis. Overall antenatal (OR 1.10, 95% CI 1.04-1.16; 518,095 children, very low certainty) and second trimester (OR 1.11, 95% CI 1.08-1.14, 248,469 children, low certainty) exposure to antibiotics were associated with increased risk of overweight/obesity in childhood/adolescence. Overall early postnatal antibiotic exposure was also associated with increased likelihood of overweight/obesity in childhood/adolescence (OR 1.09, 95% CI 1.05-1.12, 1,488,316 children, very low certainty). The magnitude of the association increased from exposure to one (OR 1.07, 95% CI 1.00-1.15, 512,954 children) to four or more courses of antibiotics (OR 1.31, 95% CI 1.17-1.46, 543,627 children). CONCLUSION Antenatal and early postnatal exposure to antibiotics is associated increased likelihood of overweight/obesity, although the findings are limited by the very low certainty of evidence. We highlight the need for homogeneous prospective studies addressing potential confounding factors to further explore the link between exposure to antibiotics and the risk of excess body weight.
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Affiliation(s)
| | | | - Carolina Martins Ribeiro
- Laboratory of Molecular Pharmacology, Department of Pharmaceutical Sciences, University of Brasilia, Brazil
| | - Angélica Amorim Amato
- Laboratory of Molecular Pharmacology, Department of Pharmaceutical Sciences, University of Brasilia, Brazil.
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11
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Keenan-Devlin LS, Borders AEB, Freedman A, Miller GE, Grobman W, Entringer S, Simhan H, Wadhwa P, Buss C. Maternal exposure to childhood maltreatment and adverse birth outcomes. Sci Rep 2023; 13:10380. [PMID: 37369688 DOI: 10.1038/s41598-023-36831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Exposure to traumatic events during pregnancy may influence pregnancy and birth outcomes. Growing evidence suggests that exposure to traumatic events well before pregnancy, such as childhood maltreatment (CM), also may influence the course of pregnancy and risk of adverse birth outcomes. We aimed to estimate associations between maternal CM exposure and small-for-gestational-age birth (SGA) and preterm birth (PTB) in a diverse US sample, and to examine whether common CM-associated health and behavioral sequelae either moderate or mediate these associations. The Measurement of Maternal Stress (MOMS) Study was a prospective cohort study that enrolled 744 healthy English-speaking participants ≥ 18 years with a singleton pregnancy, who were < 21 weeks at enrollment, between 2013 and 2015. CM was measured via the Childhood Trauma Questionnaire (CTQ) and participants above the moderate/severe cut-off for any of the five childhood abuse and neglect scales were assigned to the CM-exposed group. Common CM-associated health (obesity, depressive symptoms, hypertensive disorders) and behavioral (substance use) sequelae were obtained from standardized questionnaires and medical records. The main outcomes included PTB (gestational age < 37 weeks at birth) and SGA (birthweight < 10%ile for gestational age) abstracted from the medical record. Multivariable logisitic regression was used to test associations between CM, sequeale, and birth outcomes, and both moderation and mediation by CM-related sequelae were tested. Data were available for 657/744 participants. Any CM exposure was reported by 32% of participants. Risk for SGA birth was 61% higher among those in the CM group compared to the non-CM group (14.1% vs. 7.6%), and each subsequent form of CM that an individual was exposed to corresponded with a 27% increased risk for SGA (aOR 1.27, 95% CI 1.05, 1.53). There was no significant association between CM and PTB (9.3% vs. 13.0%, aOR 1.07, 95% CI 0.58, 1.97). Of these sequelae only hypertensive disorders were associated with both CM and SGA and hypertensive disorders of pregnancy did not mediate the association between CM and SGA. Our findings indicate that maternal CM exposure is associated with increased risk for SGA birth and highlight the importance of investigating the mechanisms whereby childhood adversity sets the trajectory for long-term and intergenerational health issues.
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Affiliation(s)
- Lauren S Keenan-Devlin
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Ann E B Borders
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- University of Chicago Pritzker School of Medicine, Chicago, USA
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, USA
| | - Alexa Freedman
- , Evanston, IL, USA
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, USA
- Department of Psychology, Northwestern University, Evanston, USA
- Institute for Policy Research, Northwestern University, Evanston, USA
| | - Gregory E Miller
- , Evanston, IL, USA
- Department of Psychology, Northwestern University, Evanston, USA
- Institute for Policy Research, Northwestern University, Evanston, USA
| | - William Grobman
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, USA
- , Chicago, IL, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Evanston, USA
| | - Sonja Entringer
- , Berlin, Germany
- Department of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA
| | - Hyagriv Simhan
- , Pittsburgh, PA, USA
- Division of Maternal-Fetal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Pathik Wadhwa
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA
- , Irvine, CA, USA
| | - Claudia Buss
- , Berlin, Germany.
- Department of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Development, Health and Disease Research Program, UC University of California Irvine, California, USA.
- Department of Pediatrics, Development, Health and Disease Research Program, University of California Irvine, 1001 Health Sciences Road, Irvine, CA, 92697-3950, USA.
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12
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Kyathanahalli C, Snedden M, Singh L, Regalia C, Keenan-Devlin L, Borders AE, Hirsch E. Maternal plasma and salivary anelloviruses in pregnancy and preterm birth. Front Med (Lausanne) 2023; 10:1191938. [PMID: 37396897 PMCID: PMC10309558 DOI: 10.3389/fmed.2023.1191938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Human anelloviruses, including torque teno virus (TTV) and torque teno mini virus (TTMV), are ubiquitous in the general population and have no known pathogenicity. We investigated the prevalence and viral load of TTV and TTMV in plasma and saliva over pregnancy, and assessed their association with spontaneous or medically indicated preterm birth. Methods This is a secondary analysis of the Measurement of Maternal Stress (MOMS) study, which recruited 744 individuals with singleton pregnancies from 4 US sites (Chicago, Pittsburgh, San Antonio, and rural Pennsylvania). Baseline outpatient visits took place in the second trimester (between 12'0 and 20'6/7 weeks' gestation), and follow-up visits in the third trimester (between 32'0 and 35'6/7 weeks' gestation). In a case-control study design, participants who delivered preterm (<37 weeks) resulting from spontaneous labor and/or preterm premature rupture of membranes ("sPTB") were compared with participants experiencing medically indicated preterm birth ("iPTB"), or delivery at term ("controls"). Plasma and saliva samples obtained during the second and third trimesters were tested for the presence and quantity of TTV and TTMV using real-time PCR. Demographic data were obtained via self-report, and clinical data via medical record review by trained research personnel. Results TTV was detected in plasma from 81% (second trimester) and 77% (third trimester) of participants, and in saliva from 64 and 60%. Corresponding detection rates for TTMV were 59 and 41% in plasma, and 35 and 24% in saliva. TTV and TTMV concentrations were similar between matched plasma and saliva samples. TTV prevalence and concentrations were not significantly different between groups (sPTB, iPTB, and controls). However, plasma TTMV in the third trimester was associated with sPTB and earlier gestational age at delivery. The iPTB group was not different from either the sPTB or the control group. In saliva, concentrations of TTV and TTMV were similar among the three groups. Both TTV and TTMV were more prevalent with increasing parity and were more common in Black and Hispanic participants compared to non-Hispanic White participants. Conclusion Anellovirus presence (specifically, TTMV) in the third trimester may be associated with preterm birth. Whether this association is causative remains to be determined.
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Affiliation(s)
- Chandrashekara Kyathanahalli
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Madeline Snedden
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Lavisha Singh
- Department of Statistics, NorthShore University HealthSystem, Evanston, IL, United States
| | - Camilla Regalia
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Ann E. Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
- Center for Healthcare Studies, Institute for Public Health and Medicine, University of Chicago Pritzker School of Medicine, Northwestern University, Evanston, IL, United States
| | - Emmet Hirsch
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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13
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Pinto Y, Frishman S, Turjeman S, Eshel A, Nuriel-Ohayon M, Shrossel O, Ziv O, Walters W, Parsonnet J, Ley C, Johnson EL, Kumar K, Schweitzer R, Khatib S, Magzal F, Muller E, Tamir S, Tenenbaum-Gavish K, Rautava S, Salminen S, Isolauri E, Yariv O, Peled Y, Poran E, Pardo J, Chen R, Hod M, Borenstein E, Ley RE, Schwartz B, Louzoun Y, Hadar E, Koren O. Gestational diabetes is driven by microbiota-induced inflammation months before diagnosis. Gut 2023; 72:918-928. [PMID: 36627187 PMCID: PMC10086485 DOI: 10.1136/gutjnl-2022-328406] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a condition in which women without diabetes are diagnosed with glucose intolerance during pregnancy, typically in the second or third trimester. Early diagnosis, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing incidence and associated short-term and long-term morbidities. DESIGN We comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy, before GDM diagnosis. We then built a model that can predict GDM onset weeks before it is typically diagnosed. Further, we demonstrated the role of the microbiome in disease using faecal microbiota transplant (FMT) of first trimester samples from pregnant women across three unique cohorts. RESULTS We found elevated levels of proinflammatory cytokines in women who later developed GDM, decreased faecal short-chain fatty acids and altered microbiome. We next confirmed that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin resistance more than 10 weeks prior to GDM diagnosis using FMT experiments. Following these observations, we used a machine learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers with high accuracy. CONCLUSION GDM onset can be identified in the first trimester of pregnancy, earlier than currently accepted. Furthermore, the gut microbiome appears to play a role in inflammation-induced GDM pathogenesis, with interleukin-6 as a potential contributor to pathogenesis. Potential GDM markers, including microbiota, can serve as targets for early diagnostics and therapeutic intervention leading to prevention.
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Affiliation(s)
- Yishay Pinto
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sigal Frishman
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sondra Turjeman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Adi Eshel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Oshrit Shrossel
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Oren Ziv
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - William Walters
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Julie Parsonnet
- Department of Medicine, Stanford University, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Catherine Ley
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Krithika Kumar
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Ron Schweitzer
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Soliman Khatib
- Department of Natural Compounds and Analytical Chemistry, Migal-Galilee Research Institute, Kiryat Shmona, Israel
- Analytical Chemistry Laboratory, Tel-Hai College, Upper Galilee, Israel
| | - Faiga Magzal
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Efrat Muller
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Snait Tamir
- Laboratory of Human Health and Nutrition Sciences, Migal-Galilee Technology Center, Kiryat Shmona, Israel
- Nutritional Science Department, Tel Hai College, Upper Galilee, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuli Rautava
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
- University of Helsinki & Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki, Finland
| | - Seppo Salminen
- Functional Foods Forum, University of Turku, Turku, Finland
| | - Erika Isolauri
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Or Yariv
- Clalit Health Services, Tel Aviv, Israel
| | - Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Eran Poran
- Clalit Health Services, Tel Aviv, Israel
| | - Joseph Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elhanan Borenstein
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Ruth E Ley
- Department of Microbiome Science, Max Planck Institute for Developmental Biology, Tubingen, Germany
| | - Betty Schwartz
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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14
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Méndez Leal AS, Silvers JA, Carroll JE, Cole SW, Ross KM, Ramey SL, Shalowitz MU, Dunkel Schetter C. Maternal early life stress is associated with pro-inflammatory processes during pregnancy. Brain Behav Immun 2023; 109:285-291. [PMID: 36280180 PMCID: PMC10035632 DOI: 10.1016/j.bbi.2022.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
Early life stress (ELS) is common in the United States and worldwide, and contributes to the development of psychopathology in individuals with these experiences and their offspring. A growing body of research suggests that early life stress may contribute to adverse health partly through modulation of immune (and particularly inflammatory) responses. Therefore, increased maternal prenatal inflammation has been proposed as a mechanistic pathway by which the observed cross-generational effects of parental early life stress on child neuropsychiatric outcomes may be exerted. We examined associations between early life stress and molecular markers of inflammation (specifically pro-inflammatory gene expression and receptor-mediated transcription factor activity) and a commonly studied circulating marker of inflammation (C-Reactive Protein) in a diverse group of women in or near their third trimester of pregnancy, covarying for age, race/ethnicity, BMI, concurrent infection, concurrent perceived stress, and per capita household income. Mothers who experienced higher levels of early life stress had significantly increased pro-inflammatory (NF-κB) and decreased anti-viral (IRF) transcription factor activity. Transcripts that were up or down regulated in mothers with high ELS were preferentially derived from both CD16+ and CD16- monocytes. Early life stress was not associated with elevated CRP. Taken together, these findings provide preliminary evidence for an association between ELS and a pro-inflammatory transcriptional phenotype during pregnancy that may serve as a mechanistic pathway for cross-generational transmission of the effects of early life stress on mental and physical health.
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Affiliation(s)
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Sharon L Ramey
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA
| | - Madeleine U Shalowitz
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL; Department of Pediatrics, Rush University Medical Center, Chicago, IL
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15
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Lampiasi N, Bonaventura R, Deidda I, Zito F, Russo R. Inflammation and the Potential Implication of Macrophage-Microglia Polarization in Human ASD: An Overview. Int J Mol Sci 2023; 24:2703. [PMID: 36769026 PMCID: PMC9916462 DOI: 10.3390/ijms24032703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous collection of neurodevelopmental disorders, difficult to diagnose and currently lacking treatment options. The possibility of finding reliable biomarkers useful for early identification would offer the opportunity to intervene with treatment strategies to improve the life quality of ASD patients. To date, there are many recognized risk factors for the development of ASD, both genetic and non-genetic. Although genetic and epigenetic factors may play a critical role, the extent of their contribution to ASD risk is still under study. On the other hand, non-genetic risk factors include pollution, nutrition, infection, psychological states, and lifestyle, all together known as the exposome, which impacts the mother's and fetus's life, especially during pregnancy. Pathogenic and non-pathogenic maternal immune activation (MIA) and autoimmune diseases can cause various alterations in the fetal environment, also contributing to the etiology of ASD in offspring. Activation of monocytes, macrophages, mast cells and microglia and high production of pro-inflammatory cytokines are indeed the cause of neuroinflammation, and the latter is involved in ASD's onset and development. In this review, we focused on non-genetic risk factors, especially on the connection between inflammation, macrophage polarization and ASD syndrome, MIA, and the involvement of microglia.
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Affiliation(s)
- Nadia Lampiasi
- Istituto per la Ricerca e l’Innovazione Biomedica IRIB, Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, 90146 Palermo, Italy
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16
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Fernandes GM, Sasaki LMP, Jardim-Santos GP, Schulte HL, Motta F, da Silva ÂP, de Carvalho AO, Pereira YR, Alves CDO, de Araújo Júnior DA, Mendonça-Silva DL, Costa KN, de Castro MEC, Lauand L, Nery RDR, Tristão R, Kurizky PS, Nóbrega ODT, Espindola LS, de Castro LCG, Alpoim PN, Godoi LC, Dusse LMSA, Coelho-dos-Reis JGA, do Amaral LR, Gomes MDS, Bertarini PLL, Brito-de-Sousa JP, da Costa-Rocha IA, Campi-Azevedo AC, Peruhype-Magalhães V, Teixeira-Carvalho A, Zaconeta AM, Soares AADSM, Valim V, Gomes CM, de Albuquerque CP, Martins-Filho OA, da Mota LMH. Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study. Front Immunol 2023; 14:1176898. [PMID: 37122732 PMCID: PMC10130456 DOI: 10.3389/fimmu.2023.1176898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction SARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators. Methods A sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array. Results In the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester. Discussion and conclusion From an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women.
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Affiliation(s)
- Geraldo Magela Fernandes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Lizandra Moura Paravidine Sasaki
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Heidi Luise Schulte
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Felipe Motta
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | | | | | | | | | | | | | | | - Maria Eduarda Canellas de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Lucas Lauand
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Rosana Tristão
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Patricia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Laila Salmen Espindola
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luiz Cláudio Gonçalves de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Lara Carvalho Godoi
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Laurence Rodrigues do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Pedro Luiz Lima Bertarini
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | | | | | | | | | | | | | - Alexandre Anderson de Sousa Munhoz Soares
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Valéria Valim
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, Brazil
- Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Centro de Ciências Médicas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
| | - Cleandro Pires de Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Olindo Assis Martins-Filho
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
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17
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Vilotić A, Nacka-Aleksić M, Pirković A, Bojić-Trbojević Ž, Dekanski D, Jovanović Krivokuća M. IL-6 and IL-8: An Overview of Their Roles in Healthy and Pathological Pregnancies. Int J Mol Sci 2022; 23:ijms232314574. [PMID: 36498901 PMCID: PMC9738067 DOI: 10.3390/ijms232314574] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Interleukin-6 (IL-6) is an acknowledged inflammatory cytokine with a pleiotropic action, mediating innate and adaptive immunity and multiple physiological processes, including protective and regenerative ones. IL-8 is a pro-inflammatory CXC chemokine with a primary function in attracting and activating neutrophils, but also implicated in a variety of other cellular processes. These two ILs are abundantly expressed at the feto-maternal interface over the course of a pregnancy and have been shown to participate in numerous pregnancy-related events. In this review, we summarize the literature data regarding their role in healthy and pathological pregnancies. The general information related to IL-6 and IL-8 functions is followed by an overview of their overall expression in cycling endometrium and at the feto-maternal interface. Further, we provide an overview of their involvement in pregnancy establishment and parturition. Finally, the implication of IL-6 and IL-8 in pregnancy-associated pathological conditions, such as pregnancy loss, preeclampsia, gestational diabetes mellitus and infection/inflammation is discussed.
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18
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Xia H, Zhu X, Zhu C. Associations between pro-inflammatory cytokines and fatigue in pregnant women. PeerJ 2022; 10:e13965. [PMID: 36193420 PMCID: PMC9526404 DOI: 10.7717/peerj.13965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Fatigue is one of the most prevalent symptoms among pregnant women. In patients with various diseases, pro-inflammatory cytokines are associated with fatigue; however, such associations are unknown in pregnant women. Objectives The objective of this study was to examine the associations between pro-inflammatory cytokines and prenatal fatigue. Methods A cross-sectional study was conducted on 271 pregnant Chinese women in their third trimester of pregnancy. Patient-reported Outcome Measurement Information System (PROMIS) was used to evaluate women's prenatal fatigue. Using enzyme-linked immunosorbent assay (ELISA), the serum concentrations of four pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8), were measured. The data was analyzed by correlation analysis and general linear regression analysis. Results In this sample, the mean (standard deviation) of fatigue scores was 51.94 (10.79). TNF-α (r = 0.21, p < 0.001), IL-6 (r = 0.134, p = 0.027) and IL-8 (r = 0.209, p = 0.001) were positively correlated to prenatal fatigue, although IL-1β was not. TNF-α (β = 0.263, p < 0.001), along with sleep quality (β = 0.27, p < 0.001) and depression (β = 0.376, p < 0.001) independently predicted prenatal fatigue. Conclusions TNF-α was identified as an independent biomarker for prenatal fatigue in our study. Reducing pro-inflammatory cytokines may be a unique method for lowering prenatal fatigue and, consequently, enhancing mother and child health.
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Affiliation(s)
- Haiou Xia
- School of Nursing, Fudan University, Shanghai, China
| | - Xiaoxiao Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Obstetrical Ward, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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19
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Kaushal K, Ayushi, Sharma N, Wadhwa N, Misra S, Bhatnagar S, Desiraju BK, Thiruvengadam R, Sopory S. Longitudinal changes in serum immune markers during normal pregnancy in a North-Indian population. Am J Reprod Immunol 2022; 87:e13531. [PMID: 35312132 DOI: 10.1111/aji.13531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 01/20/2023] Open
Abstract
PROBLEM The objective of this study was to examine levels of cytokines across normal term pregnancy in an Indian population. Additionally we have also explored for possible associations between inflammatory markers and fetal growth parameters. METHOD OF STUDY A multiplex panel of 24 analytes was used to examine levels of inflammatory markers in maternal serum at three time points during pregnancy and in cord blood from women with no reported comorbidities who delivered a singleton live baby at term (N = 23), enrolled in the GARBH-Ini pregnancy cohort. Linear mixed models were applied to construct longitudinal cytokine trajectories with gestational age. Pearson correlation was used to calculate intra-visit correlation between cytokines. Principal component analysis (PCA) was performed to examine cytokine combinations prevalent across pregnancy, and their association with fetal growth parameters was determined by multivariable regression. RESULTS Significant increase in sFLT-1, Flt3L, PLGF, IL-4, and IL-18 and a decrease in VCAM-1 concentrations was seen across pregnancy. The cytokine concentrations in cord blood differed substantially as compared to maternal levels across gestation. Some cytokines were closely correlated with each other in distinct patterns across pregnancy. Gestational age specific combination of cytokines were seen to be associated with different fetal growth parameters. CONCLUSIONS This study for the first time provides reference concentrations for the longitudinal expression of immune markers across pregnancy in an Indian population providing a much needed baseline to compare with pregnancies leading to adverse outcomes. Growth factors showed maximum longitudinal variation with gestational age and strong correlations were identified between various cytokines at all time points across pregnancy.
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Affiliation(s)
- Khushboo Kaushal
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Ayushi
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Nikhil Sharma
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Nitya Wadhwa
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sumit Misra
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shinjini Bhatnagar
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Bapu Koundinya Desiraju
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shailaja Sopory
- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
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- Maternal and Child Health, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
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20
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Keenan-Devlin L, Smart BP, Grobman W, Adams E, Freedman A, Buss C, Entringer S, Miller GE, Borders AEB. The intersection of race and socioeconomic status is associated with inflammation patterns during pregnancy and adverse pregnancy outcomes. Am J Reprod Immunol 2021; 87:e13489. [PMID: 34958140 DOI: 10.1111/aji.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Preterm birth rates are higher among individuals of lower socioeconomic status and non-White race, which is possibly related to life-course stressors. It is important to better understand the underlying mechanisms of these health disparities, and inflammation is a possible pathway to explain the disparities in birth outcomes. OBJECTIVE In this study, we aimed to determine whether patterns of inflammation differed by maternal race and socioeconomic status. STUDY DESIGN 744 participants in a multi-site, prospective study of pregnancy and birth outcomes provided biological and psychological data between 12'0-20'6 weeks gestation. Participants with recent infection, fever, antibiotics or steroid treatment were excluded. Cytokines including INFɣ, IL-10, IL-13, IL-6, IL-8, and TNFα, and the acute phase protein CRP were measured in serum and values and were log-transformed for normality when appropriate and a non-orthogonal rotation (Oblimid) was performed to allow the extracted factor to inter-correlate. IFNγ, IL-8, IL-10, IL-6, TNF-a, and IL-13 loaded onto Inflammatory Factor 1 (IF-1), while CRP and IL-6 loaded onto Inflammatory Factor 2 (IF-2). Race and education were collected via self-report during an in-person study visit. Multivariable models were used to determine the association of race and SES with IF-1 and IF-2 during the second trimester, and a mediation model to examine if inflammation is on the causal pathway. Models were adjusted for study site, prenatal age, pre-pregnancy BMI, smoking during pregnancy, and gestational age at the time of blood collection. RESULTS 605 participants were included in our final analysis, with 61.2 % of low or moderate SES, and 35.5% identifying as a person of color (POC). Identifying as a POC, being of low and moderate SES, and being both low-SES and POC or Moderate-SES and POC were associated with higher odds of preterm birth and lower birth weight percentile infants. Low SES POC participants had significantly higher IF-1 and IF-2 scores when compared to high-SES White participants. Additionally, higher IF-1and IF-2 were associated with shorter gestation. In the mediation analysis, we observed a significant direct effect of race/SES on preterm birth, however the results did not support an indirect pathway where IF-1 or IF-2 acted as mediators. CONCLUSION Maternal race and SES are significantly associated with inflammatory biomarkers during pregnancy, and when race and SES are considered in combination, they are stronger predictors of adverse pregnancy outcomes than when evaluated separately. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - William Grobman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine; Center for Healthcare Studies - Institute for Public Health and Medicine, Northwestern University, Chicago, IL
| | - Emma Adams
- Institute for Policy Research, Northwestern University, Evanston, IL
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Institute for Policy Research, Northwestern University, Evanston, IL
| | - Claudia Buss
- UC Irvine Development, Health and Disease Research Program, University of California Irvine; Department of Medical Psychology, Charité, University Medicine Berlin, Germany
| | - Sonja Entringer
- Department of Medical Psychology, Charité, University Medicine Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Institute for Policy Research, Northwestern University, Evanston, IL
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine; Center for Healthcare Studies-Institute for Public Health and Medicine, Northwestern University, Evanston, IL
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21
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Sawyer KM. The role of inflammation in the pathogenesis of perinatal depression and offspring outcomes. Brain Behav Immun Health 2021; 18:100390. [PMID: 34877551 PMCID: PMC8633814 DOI: 10.1016/j.bbih.2021.100390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022] Open
Abstract
The role of inflammation in the pathogenesis of depression is becoming increasingly apparent, but its role in perinatal depression is less well-studied. Pregnancy and the postpartum are characterised by distinct and changing inflammatory profiles throughout, which makes the study of depression-related alterations in this period complex. This review presents literature discussing a role for the immune system in both antenatal and postnatal depression. Furthermore, literature investigating the role of the maternal immune system on breast milk composition and offspring immunological and behavioural outcomes is discussed, before concluding with suggestions for future work as this developing field grows.
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Affiliation(s)
- Kristi M Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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22
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Ross KM, Dunkel Schetter C, Carroll JE, Mancuso RA, Breen EC, Okun ML, Hobel C, Coussons-Read M. Inflammatory and immune marker trajectories from pregnancy to one-year post-birth. Cytokine 2021; 149:155758. [PMID: 34773858 DOI: 10.1016/j.cyto.2021.155758] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/10/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is an immunomodulatory state, with reported systematic changes in inflammatory and immune activity by pregnancy stage. Published data are inconsistent as to how inflammatory and immune markers change and recover across pregnancy and the postpartum period, or the sociodemographic, health and pregnancy-related factors that could affect biomarker trajectories. The purpose of this study is to describe inflammatory and immune marker trajectories from pregnancy to a year post-birth, and to test associations with sociodemographic, health and pregnancy-related variables. METHODS A sample of 179 pregnant women were assessed three times during pregnancy (between 8 and 36 weeks gestation) and three times during the postpartum period (between 1 and 12 months). Maternal sociodemographic characteristics, health, and pregnancy factors were obtained at study entry. Blood samples from each assessment were assayed for interleukin(IL)-6, tumor necrosis factor(TNF)α, IL-8, IL-10, and interferon(IFN)γ. Multilevel modelling was used to characterize biomarker trajectories and associations with sociodemographic and health variables. RESULTS Distinct trajectories over time emerged for each biomarker. Male pregnancies were associated with higher TNFα, IL-10, and IFNγ; higher pre-pregnancy BMI was associated with higher IL-6 and IFNγ. Nulliparity was associated with greater increases in IL-6 and TNFα. CONCLUSIONS Patterns observed for inflammatory and immune markers from pregnancy to a year postpartum support the hypothesis that the maternal immune system changes systematically across pregnancy and through an extended postpartum period. Parity, pre-pregnancy BMI and child sex are associated with inflammatory marker patterns over time. These results contribute to our understanding of how immune system activity changes from pregnancy to the post-birth period, and the factors that could affect those changes.
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Affiliation(s)
- Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada.
| | | | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michele L Okun
- University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Calvin Hobel
- Cedars-Sinai Medical Centre, Los Angeles, CA, USA
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Caplan M, Keenan-Devlin LS, Freedman A, Grobman W, Wadhwa PD, Buss C, Miller GE, Borders AEB. Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy. Am J Perinatol 2021; 38:1412-1419. [PMID: 32615616 DOI: 10.1055/s-0040-1713368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. STUDY DESIGN A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. RESULTS Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed. CONCLUSION Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. KEY POINTS · This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..
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Affiliation(s)
- Madeleine Caplan
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, School of Medicine, Duke University, Durham, North Carolina
| | - Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Institute for Policy Research, Northwestern University, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pathik D Wadhwa
- Department of Psychiatry and Human Behavior, University of California, School of Medicine, UC Irvine Development, Health and Disease Research Program, Irvine, California
| | - Claudia Buss
- UC Irvine Development, Health and Disease Research Program, University of California Irvine, Irvine, California.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University Health System, Center for Healthcare Studies, Institute for Public Health and Medicine, University of Chicago Pritzker School of Medicine, Northwestern University, Evanston, Illinois
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Jarmund AH, Giskeødegård GF, Ryssdal M, Steinkjer B, Stokkeland LMT, Madssen TS, Stafne SN, Stridsklev S, Moholdt T, Heimstad R, Vanky E, Iversen AC. Cytokine Patterns in Maternal Serum From First Trimester to Term and Beyond. Front Immunol 2021; 12:752660. [PMID: 34721426 PMCID: PMC8552528 DOI: 10.3389/fimmu.2021.752660] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022] Open
Abstract
Pregnancy implies delicate immunological balance between two individuals, with constant changes and adaptions in response to maternal capacity and fetal demands. We performed cytokine profiling of 1149 longitudinal serum samples from 707 pregnant women to map immunological changes from first trimester to term and beyond. The serum levels of 22 cytokines and C-reactive protein (CRP) followed diverse but characteristic trajectories throughout pregnancy, consistent with staged immunological adaptions. Eotaxin showed a particularly robust decrease throughout pregnancy. A strong surge in cytokine levels developed when pregnancies progressed beyond term and the increase was amplified as labor approached. Maternal obesity, smoking and pregnancies with large fetuses showed sustained increase in distinct cytokines throughout pregnancy. Multiparous women had increased cytokine levels in the first trimester compared to nulliparous women with higher cytokine levels in the third trimester. Fetal sex affected first trimester cytokine levels with increased levels in pregnancies with a female fetus. These findings unravel important immunological dynamics of pregnancy, demonstrate how both maternal and fetal factors influence maternal systemic cytokines, and serve as a comprehensive reference for cytokine profiles in normal pregnancies.
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Affiliation(s)
- Anders Hagen Jarmund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Guro Fanneløb Giskeødegård
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mariell Ryssdal
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørg Steinkjer
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Live Marie Tobiesen Stokkeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torfinn Støve Madssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Women’s Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Runa Heimstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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25
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Keenan-Devlin LS, Caplan M, Freedman A, Kuchta K, Grobman W, Buss C, Adam EK, Entringer S, Miller GE, Borders AEB. Using principal component analysis to examine associations of early pregnancy inflammatory biomarker profiles and adverse birth outcomes. Am J Reprod Immunol 2021; 86:e13497. [PMID: 34477256 DOI: 10.1111/aji.13497] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Inflammation as a risk factor for preterm birth is well-established. The primary objective of this analysis was to examine whether individual cytokines versus a composite indicator of mid-pregnancy inflammation are significantly associated with risk for adverse birth outcomes. STUDY DESIGN A multi-site prospective study was conducted in a socio-demographically diverse cohort of 610 pregnant participants. At a study visit between 12 and 20 6/7 weeks' gestation, low-grade inflammation was measured via log-transformed serum concentrations of the biomarkers IFN-γ, IL-10, IL-13, IL-6, IL-8, TNF-α, and CRP. Principal component analysis (PCA) was used to identify underlying dimensions of inflammatory activity from the seven biomarkers measured. Gestational age and birth weight at delivery were obtained from medical chart review. The associations between inflammatory profiles and birth outcomes were assessed via linear and logistic regression models. Results were compared with those from individual inflammatory biomarkers, and model fit was assessed using Akaike's Information Criterion (AIC). RESULTS Principal component analysis analysis yielded a two-factor solution, with the first factor (IF1) composed of IL-8, IL-10, IL-13, IFN-ɣ, and TNF-α, and the second factor (IF2) containing IL-6 and CRP. When adjusted for race, education, BMI, smoking status, gestational age at time of blood draw, and study site, a one standard deviation (SD) increase in IF1 remained significantly associated with a decrease in standardized gestational age (β = -.13, 95% CI: -.21, -.05) and an increase in odds of preterm delivery (OR = 1.46, 95% CI: 1.13, 1.88) (Table 3). A one SD increase in IF2 was similarly associated with a decrease in standardized gestational age at delivery (β = -.13, 95% CI: -.23, -.04) and an increase in odds of preterm delivery (OR: 1.46, 95% CI: 1.04, 2.05). Neither IF1 nor IF2 was associated with measures of fetal growth. AIC identified that IL-6 was a slightly better fit for length of gestation compared to either composite measure, though all performed similarly. CONCLUSION Independent of known sociodemographic risk factors, an elevated mid-pregnancy inflammatory profile was associated with a nearly 50% increase in odds of preterm delivery. The composite performed similarly to IL-6. These results suggest that maternal low-grade inflammation is a risk factor for preterm delivery, and that mid-pregnancy inflammatory biomarkers may be useful in predicting risk for preterm delivery.
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Affiliation(s)
- Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Madeleine Caplan
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Psychology, Northwestern University, Evanston, Illinois, USA.,Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Kristine Kuchta
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California Irvine, Irvine, California, USA.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Emma K Adam
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA.,School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California Irvine, Irvine, California, USA.,Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Evanston, Illinois, USA.,Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
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26
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Gyllenhammer LE, Entringer S, Buss C, Simhan HN, Grobman WA, Borders AE, Wadhwa PD. Racial differences across pregnancy in maternal pro-inflammatory immune responsivity and its regulation by glucocorticoids. Psychoneuroendocrinology 2021; 131:105333. [PMID: 34174524 PMCID: PMC10174638 DOI: 10.1016/j.psyneuen.2021.105333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 05/05/2021] [Accepted: 06/15/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The distribution of adverse pregnancy, birth and subsequent child developmental and health outcomes in the U.S. is characterized by pronounced racial (particularly Black-white) disparities. In this context, chronic stress exposure represents a variable of considerable importance, and the immune/inflammatory system represents a leading candidate biological pathway of interest. Previous pregnancy studies examining racial disparities in immune processes have largely utilized circulating cytokine levels, and have yielded null or mixed results. Circulating cytokines primarily represent basal secretion and do not necessarily represent functional features of immune responsivity and regulation. Thus, in order to conduct a more in-depth characterization of racial differences in functional immune properties during pregnancy, we utilized an ex vivo stimulation assay, a dynamic measure of immune function at the cellular level, to investigate Black-white racial differences in in mid- and late-gestation in i) pro-inflammatory (IL-6) responsivity of leukocytes to antigen [lipopolysaccharide (LPS)] challenge, and ii) regulation (dampening) of this pro-inflammatory response by glucocorticoids. METHOD 177 women (N = 42 Black (24%), n = 135 white (76%)) with a singleton, intrauterine pregnancy provided 20 mL venous blood in mid- (16.6 ± 2.4 wks) and late (33.3 ± 1.1 wks) pregnancy. Maternal pro-inflammatory responsivity of leukocytes was quantified by assessing the release of the pro-inflammatory cytokine IL-6 in response to LPS stimulation, and regulation of the pro-inflammatory response was quantified by assessing the suppression of the stimulated IL-6 response after co-incubation with progressively increasing levels of dexamethasone [10-7, 10-6, 10-5 M] (i.e., glucocorticoid receptor resistance (GRR)). A priori model covariates included maternal age, parity, SES (socioeconomic status), and pre-pregnancy BMI. RESULTS Maternal pro-inflammatory responsivity (LPS-stimulated IL-6) and GRR increased significantly across mid- and late gestation (adjusted β = 0.157, p = 0.007; β = 0.627, p < 0.001, respectively). Across both time points in pregnancy Black women exhibited significantly higher LPS-stimulated IL-6 release and reduced glucocorticoid regulation of the IL-6 response (i.e., higher GRR) relative to white women, before and after adjusting for covariates (β = 0.381, p = 0.0030; β = 0.391, p = 0.0075, respectively). There was no racial difference in the concentrations of circulating IL-6 (p = 0.9199). CONCLUSION Our findings support the hypothesis postulating significant racial (Black-white) differences in key functional properties of the maternal immune system in pregnancy, which were not apparent using circulating cytokine measures. These data elucidate a potentially important physiological mechanism underlying the transduction of environmental conditions into racial disparities in reproductive and subsequent child health outcomes, and the use of these ex vivo measures should be considered in future studies.
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Affiliation(s)
- Lauren E Gyllenhammer
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, United States; Department of Pediatrics, University of California, School of Medicine, Irvine, CA, United States
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, United States; Department of Pediatrics, University of California, School of Medicine, Irvine, CA, United States; Charité-Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, United States; Department of Pediatrics, University of California, School of Medicine, Irvine, CA, United States; Charité-Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Ann E Borders
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States
| | - Pathik D Wadhwa
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, United States; Department of Pediatrics, University of California, School of Medicine, Irvine, CA, United States; Department of Psychiatry and Human Behavior, University of California, School of Medicine, Irvine, CA, United States; Department of Obstetrics and Gynecology, University of California, School of Medicine, Irvine, CA, United States; Department of Epidemiology, University of California, School of Medicine, Irvine, CA, United States.
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27
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Spallek J, Scholaske L, Duman EA, Razum O, Entringer S. Association of maternal migrant background with inflammation during pregnancy - Results of a birth cohort study in Germany. Brain Behav Immun 2021; 96:271-278. [PMID: 34146669 PMCID: PMC8316562 DOI: 10.1016/j.bbi.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Health disparities in children of immigrants are prevalent from birth and are hypothesized to - in part - emerge as a biological consequence of migration's unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. MATERIAL AND METHODS Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents' (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). RESULTS Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p < .01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p < .10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p < .10), and 2nd generation women with other migrant background (B = 0.43, SE = 0.17, p < .05). DISCUSSION Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context.
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Affiliation(s)
- Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
| | - Laura Scholaske
- German Center for Integration and Migration Research (DeZIM), Berlin, Germany
| | - Elif Aysimi Duman
- Department of Psychology, Bogazici University, Istanbul, Turkey,,Center for Life Sciences and Technologies, Bogazici University, Istanbul, Turkey
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sonja Entringer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, 10117 Berlin, Germany;,Department of Pediatrics, University of California, Irvine, California 92617, USA.,Development, Health and Disease Research Program University of California, Irvine, California 92617, USA
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28
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Friedman C, Dabelea D, Thomas DSK, Peel JL, Adgate JL, Magzamen S, Martenies SE, Allshouse WB, Starling AP. Exposure to ambient air pollution during pregnancy and inflammatory biomarkers in maternal and umbilical cord blood: The Healthy Start study. ENVIRONMENTAL RESEARCH 2021; 197:111165. [PMID: 33857458 PMCID: PMC8216209 DOI: 10.1016/j.envres.2021.111165] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Air pollution exposure during pregnancy has been associated with adverse pregnancy and birth outcomes. Inflammation has been proposed as a potential link. We estimated associations between air pollution exposure during pregnancy and inflammatory biomarkers in maternal and cord blood. We evaluated whether maternal inflammation was associated with infant outcomes. METHODS Among 515 mother-infant dyads in the Healthy Start study (2009-2014), trimester-long, 7- and 30-day average concentrations of particulate matter ≤2.5 μm (PM2.5) and ozone (O3) during pregnancy were estimated, using inverse-distance-weighted interpolation. Inflammatory biomarkers were measured in maternal blood in mid-pregnancy (C-reactive protein [CRP], Interleukin [IL]-6, and tumor necrosis factor-α [TNFα]) and in cord blood at delivery (CRP, IL-6, IL-8, IL-10, monocyte chemoattractant protein-1 [MCP-1], and TNFα). We used linear regression to estimate associations between pollutants and inflammatory biomarkers and maternal inflammatory biomarkers and infant weight and body composition. RESULTS There were positive associations between PM2.5 during certain exposure periods and maternal IL-6 and TNFα. There were negative associations between recent O3 and maternal CRP, IL-6, and TNFα and positive associations between trimester-long O3 exposure and maternal inflammatory biomarkers, though some 95% confidence intervals included the null. Patterns were inconsistent for associations between PM2.5 and O3 and cord blood inflammatory biomarkers. No consistent associations between maternal inflammatory biomarkers and infant outcomes were identified. CONCLUSIONS Air pollution exposure during pregnancy may impact maternal inflammation. Further investigations should examine the health consequences for women and infants of elevated inflammatory biomarkers associated with air pollution exposure during pregnancy.
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Affiliation(s)
- Chloe Friedman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina Charlotte, NC, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Epidemiology, Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Sheena E Martenies
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Steckle V, Shynlova O, Lye S, Bocking A. Low-intensity physical activity may protect pregnant women against spontaneous preterm labour: a prospective case-control study. Appl Physiol Nutr Metab 2021; 46:337-345. [DOI: 10.1139/apnm-2019-0911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The innate immune system plays a significant role in onset of parturition. Maternal antenatal physical activity can influence immune function and timing of labour. We examined physical activity patterns and concentration of 19 cytokines at 16 and 27 weeks gestational age (GA), in peripheral plasma of 28 asymptomatic women who later had spontaneous preterm labour (SPTL, <37 weeks GA) and 52 women who later delivered at term (TL; ≥37 weeks GA). This nested case-control study used data from the Ontario Birth Study cohort. Exercise was assessed using the International Physical Activity Questionnaire, and cytokines were analyzed using Luminex assays. There was no significant difference in exercise patterns between SPTL and TL subjects. Plasma concentration of interleukin (IL)-10 was significantly higher in SPTL women at 16 and 27 weeks, while tumour necrosis factor alpha (TNF-α), IL-8, and monocyte chemoattractant protein (MCP)-1 concentrations were increased at 27 weeks GA (p < 0.05). Concentration of IL-10 was negatively correlated with the amount of reported walking (ρ = −0.264, p = 0.03). Women should be encouraged to partake in low-intensity exercise throughout pregnancy, as it may confer a protective effect against SPTL through IL-10–mediated pathways. Additionally, plasma cytokine analysis at 27 weeks GA may be useful for predicting SPTL in asymptomatic women. Novelty: In women that delivered preterm, plasma levels of anti-inflammatory cytokine IL-10 were significantly elevated at 16 and 27 weeks of gestation. Plasma levels of IL-10 were negatively correlated with the amount of reported walking. Concentration of IL-8, MCP-1 and TNF-α were increased in plasma of asymptomatic women that subsequently deliver preterm.
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Affiliation(s)
- Valerie Steckle
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada
| | - Oksana Shynlova
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada
| | - Stephen Lye
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada
| | - Alan Bocking
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada
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30
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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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Volk HE, Park B, Hollingue C, Jones KL, Ashwood P, Windham GC, Lurman F, Alexeeff SE, Kharrazi M, Pearl M, Van de Water J, Croen LA. Maternal immune response and air pollution exposure during pregnancy: insights from the Early Markers for Autism (EMA) study. J Neurodev Disord 2020; 12:42. [PMID: 33327930 PMCID: PMC7745402 DOI: 10.1186/s11689-020-09343-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perinatal exposure to air pollution and immune system dysregulation are two factors consistently associated with autism spectrum disorders (ASD) and other neurodevelopmental outcomes. However, little is known about how air pollution may influence maternal immune function during pregnancy. OBJECTIVES To assess the relationship between mid-gestational circulating levels of maternal cytokines/chemokines and previous month air pollution exposure across neurodevelopmental groups, and to assess whether cytokines/chemokines mediate the relationship between air pollution exposures and risk of ASD and/or intellectual disability (ID) in the Early Markers for Autism (EMA) study. METHODS EMA is a population-based, nested case-control study which linked archived maternal serum samples collected during weeks 15-19 of gestation for routine prenatal screening, birth records, and Department of Developmental Services (DDS) records. Children receiving DDS services for ASD without intellectual disability (ASD without ID; n = 199), ASD with ID (ASD with ID; n = 180), ID without ASD (ID; n = 164), and children from the general population (GP; n = 414) with no DDS services were included in this analysis. Serum samples were quantified for 22 cytokines/chemokines using Luminex multiplex analysis technology. Air pollution exposure for the month prior to maternal serum collection was assigned based on the Environmental Protection Agency's Air Quality System data using the maternal residential address reported during the prenatal screening visit. RESULTS Previous month air pollution exposure and mid-gestational maternal cytokine and chemokine levels were significantly correlated, though weak in magnitude (ranging from - 0.16 to 0.13). Ten pairs of mid-pregnancy immune markers and previous month air pollutants were significantly associated within one of the child neurodevelopmental groups, adjusted for covariates (p < 0.001). Mid-pregnancy air pollution was not associated with any neurodevelopmental outcome. IL-6 remained associated with ASD with ID even after adjusting for air pollution exposure. CONCLUSION This study suggests that maternal immune activation is associated with risk for neurodevelopmental disorders. Furthermore, that prenatal air pollution exposure is associated with small, but perhaps biologically relevant, effects on maternal immune system function during pregnancy. Additional studies are needed to better evaluate how prenatal exposure to air pollution affects the trajectory of maternal immune activation during pregnancy, if windows of heightened susceptibility can be identified, and how these factors influence neurodevelopment of the offspring.
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Affiliation(s)
- Heather E Volk
- Department of Mental Health, Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center, 624 N. Broadway, HH833, Baltimore, MD, 21205, USA.
| | - Bo Park
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Calliope Hollingue
- Department of Mental Health, Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, Kennedy Krieger Institute Intellectual and Developmental Disabilities Research Center, 624 N. Broadway, HH833, Baltimore, MD, 21205, USA
| | - Karen L Jones
- UC Davis MIND Institute, University of California Davis, Davis, CA, USA
| | - Paul Ashwood
- UC Davis MIND Institute, University of California Davis, Davis, CA, USA
| | - Gayle C Windham
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
| | | | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Martin Kharrazi
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
| | - Michelle Pearl
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
| | - Judy Van de Water
- UC Davis MIND Institute, University of California Davis, Davis, CA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
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Ghassabian A, Hornig M, Chen Z, Yeung E, Buka SL, Yu J, Ma G, Goldstein JM, Gilman SE. Gestational Cytokines and the Developmental Expression of Obesity in Childhood. Obesity (Silver Spring) 2020; 28:2192-2200. [PMID: 32985128 PMCID: PMC7644634 DOI: 10.1002/oby.22967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study examined the extent to which maternal immune activity during pregnancy is associated with childhood adiposity, and if so, whether associations at birth differ from those in infancy and childhood. Sex-specific associations were also examined. METHODS Participants were 1,366 singleton pregnancies from the Collaborative Perinatal Project (1959-1966). Interleukin-1β (IL-1β), IL-6, TNF-α, IL-8, and IL-10 in maternal sera were assayed repeatedly during pregnancy. Children's BMI was calculated repeatedly from birth through age 8 and derived age- and sex-normalized BMI z scores (BMIz). Linear mixed models were used to estimate the cumulative concentration of each cytokine in the second and third trimesters and then related this concentration to child BMIz. RESULTS Children exposed to higher IL-1β, IL-6, IL-8, and IL-10 concentrations had lower BMIz at birth but higher BMIz during childhood. Higher concentrations of IL-8 and IL-1β were also associated with higher BMIz during infancy (B per log increase in IL-8 = 0.04; 95% CI: 0.02 to 0.07; B per log increase in IL-1β = 0.03; 95% CI: 0.001 to 0.06). The associations between TNF-α and BMIz were in opposing directions in boys (B = -0.13; 95% CI: -0.31 to 0.04) and girls (B = 0.14; 95% CI: 0.02 to 0.26) during childhood. CONCLUSIONS Maternal prenatal inflammation contributes to the age- and sex-specific programming of obesity risk in childhood.
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Affiliation(s)
- Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University School of Medicine, New York, NY, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Edwina Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Gina Ma
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jill M Goldstein
- Departments of Psychiatry and Medicine, Harvard Medical School, and Department of Psychiatry and Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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The Pelvic Girdle Pain deadlock: 2. Topics that, so far, have remained out of focus. Musculoskelet Sci Pract 2020; 48:102166. [PMID: 32560869 DOI: 10.1016/j.msksp.2020.102166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In our preceding paper, we concluded that Pelvic Girdle Pain (PGP) should be taken seriously. Still, we do not know its causes. Literature reviews on treatment fail to reveal a consistent pattern, and there are patients who do not respond well to treatment. We designated the lack of progress in research and in the clinic as 'deadlock', and proposed a 'deconstruction' of PGP, that is to say, taking PGP apart into its relevant dimensions. PURPOSE We examine the proposition that PGP may emerge as local inflammation. Inflammation would be a new dimension to be taken into account, between biomechanics and psychology. To explore the consequences of this idea, we present four different topics that, so far, have remained out of focus. One: The importance of microtrauma. Two: Ways to counteract chronification. Three: The importance of sickness behaviour when systemic inflammation turns into neuroinflammation of the brain. And Four: The mainly emotional and cognitive nature of chronic pain, and how aberrant neuroinflammation may render chronic pain intractable. For intractable pain, sleep and stress management are promising treatment options. IMPLICATIONS The authors hope that the present paper helps to stimulate the flexible creativity that is required to deal with the biological and psychological impact of PGP. Measuring inflammatory mediators in PGP should be a research priority. It should be understood that the boundaries between biology and psychology are becoming blurred. Clinicians must frequently monitor pain, disability, and mood, and be ready to switch treatment whenever the patient does not improve.
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Stephens JE, Kessler CL, Buss C, Miller GE, Grobman WA, Keenan-Devlin L, Borders AE, Adam EK. Early and current life adversity: Past and present influences on maternal diurnal cortisol rhythms during pregnancy. Dev Psychobiol 2020; 63:305-319. [PMID: 32572946 DOI: 10.1002/dev.22000] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/13/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
Stress during pregnancy affects maternal health and well-being, as well as the health and well-being of the next generation, in part through the hypothalamic-pituitary-adrenal (HPA) axis. Although most studies have focused solely on proximal experiences (i.e., during the pregnancy) as sources of prenatal stress, there has been a recent surge in studies that examine maternal early life adversity as a source of stress system dysregulation during pregnancy. The current study of 178 pregnant women examined the association of economic and life stress experienced during two time periods (i.e., childhood and pregnancy) with maternal HPA axis activity during the third trimester of pregnancy. Findings indicated that a current annual income of less than $15,000 and greater childhood disadvantage were associated with a flatter diurnal cortisol slope. Childhood maltreatment, particularly sexual abuse, was associated with a higher cortisol awakening response (CAR), even when controlling for recent adversity. We found some evidence that past adversity moderates the relationship between current adversity and diurnal cortisol, specifically for economic adversity and waking cortisol. Overall, our findings indicate that early life stressors play an important and underappreciated role in shaping stress biology during pregnancy.
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Affiliation(s)
- Jacquelyn E Stephens
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Courtenay L Kessler
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Claudia Buss
- University of California Irvine, Irvine, CA, USA.,Charité University Medicine Berlin, Berlin, Germany
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - William A Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Ann E Borders
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,NorthShore University HealthSystem, Evanston, IL, USA
| | - Emma K Adam
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA.,Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Ross KM, Carroll J, Horvath S, Hobel CJ, Coussons-Read ME, Schetter CD. Immune epigenetic age in pregnancy and 1 year after birth: Associations with weight change. Am J Reprod Immunol 2020; 83:e13229. [PMID: 32061136 PMCID: PMC8401279 DOI: 10.1111/aji.13229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
PROBLEM Epigenetic age indices are markers of biological aging determined from DNA methylation patterns. Accelerated epigenetic age predicts morbidity and mortality. Women tend to demonstrate slower blood epigenetic aging compared to men, possibly due to female-specific hormones and reproductive milestones. Pregnancy and the post-partum period are critical reproductive periods that have not been studied yet with respect to epigenetic aging. The purpose of this paper was to examine whether pregnancy itself and an important pregnancy-related variable, changes in body mass index (BMI) between pregnancy and the post-partum period, are associated with epigenetic aging. METHOD OF STUDY A pilot sample of 35 women was recruited as part of the Healthy Babies Before Birth (HB3) project. Whole blood samples were collected at mid-pregnancy and 1 year post-partum. DNA methylation at both time points was assayed using Infinium 450K and EPIC chips. Epigenetic age indices were calculated using an online calculator. RESULTS Paired-sample t-tests were used to test differences in epigenetic age indices from pregnancy to 1 year after birth. Over this critical time span, women became younger with respect to phenotypic epigenetic age, GrimAge, DNAm PAI-1, and epigenetic age indices linked to aging-related shifts in immune cell populations, known as extrinsic epigenetic age. Post-partum BMI retention, but not prenatal BMI increases, predicted accelerated epigenetic aging. CONCLUSION Women appear to become younger from pregnancy to the post-partum period based on specific epigenetic age indices. Further, BMI at 1 year after birth that reflects weight retention predicted greater epigenetic aging during this period.
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Affiliation(s)
- Kharah M. Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Judith Carroll
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California – Los Angeles, Los Angeles, CA, USA
| | - Steve Horvath
- Department of Biostatistics, University of California – Los Angeles, Los Angeles, CA, USA
| | - Calvin J. Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mary E. Coussons-Read
- Psychology Department, University of Colorado – Colorado Springs, Colorado Springs, CO, USA
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Sun B, Parks WT, Simhan HN, Bertolet M, Catov JM. Early pregnancy immune profile and preterm birth classified according to uteroplacental lesions. Placenta 2019; 89:99-106. [PMID: 32056560 DOI: 10.1016/j.placenta.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Preterm birth is a heterogeneous phenotype, with placental abnormalities underlying many cases. The etiology of preterm births that occur in the absence of placental abnormalities, however, remain enigmatic and we considered that early pregnancy biomarkers may provide clues. METHODS Women from a hospital-based cohort (2008-2012, n = 397) were randomly selected within 6 strata of term and preterm birth with and without placental decidual vasculopathy (arteriopathy), intrauterine inflammation/infection (acute chorioamnionitis), or no lesions. Lipids and inflammatory markers were analyzed in first trimester samples (12.5 ± 0.6 weeks) and related to outcome groups (referent, term births with no lesions). Factor analysis then clustered analytes and related these to preterm birth groups, adjusted for covariates and stratified by pre-pregnancy obesity. RESULTS Three biomarker patterns were identified. Immune activation cytokines (33% of the variance) were associated with preterm birth with no lesions (aOR 1.5, 95%CI 1.1-2.1), particularly among obese women. In contrast, inflammatory chemokines (9% of variance) were associated with term and preterm vasculopathy among non-obese women (aOR 2.6 [1.3, 4.7] and 2.0 [1.1, 3.0], respectively). DISCUSSION The early pregnancy maternal immune profile is related to preterm births classified according to placental lesions, and these associations vary according to obesity status.
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Affiliation(s)
- Baiyang Sun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
| | - Hyagriv N Simhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & RS, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Marnie Bertolet
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Janet M Catov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & RS, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA.
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Ross KM, Carroll JE, Dunkel Schetter C, Hobel C, Cole SW. Pro-inflammatory immune cell gene expression during the third trimester of pregnancy is associated with shorter gestational length and lower birthweight. Am J Reprod Immunol 2019; 82:e13190. [PMID: 31529581 DOI: 10.1111/aji.13190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
PROBLEM Altered maternal immune function predicts risk for shorter gestation and low birthweight. Few studies examine associations between prenatal immune cell gene expression and gestational length or birthweight. No studies examine which cell types drive associations. The purpose of this study is to explore associations between peripheral blood immune cell gene expression and gestational length and birthweight, using transcript origin analysis. METHOD OF STUDY Eighty-nine women were drawn from the Community Child Health Network cohort. Third trimester maternal dried blood spots were used for genome-wide transcriptional (mRNA) profiling. Gestational length and birthweight were obtained from medical charts. Covariates were age, race/ethnicity, pre-pregnancy body mass index, smoking, gestational age at blood sampling, and pregnancy infections. Associations between gene expression profiles and gestational length and birthweight were tested using general linear models. The Transcription Element Listening System (TELiS) bioinformatics analysis quantified upstream transcription factor activity. Transcript origin analysis identified leukocyte subsets mediating observed effects. RESULTS Shorter gestation was predicted by increased NF-kB (TFBM ratio = -0.582 ± 0.172, P < .001) and monocyte activity (diagnosticity score = 0.172 ± 0.054, P < .001). Longer gestation was associated with increased dendritic cell activity (diagnosticity score = 0.194 ± 0.039, P < .001). Increased AP-1 activity predicted lower birthweight (TFBM ratio = -0.240 ± 0.111, P = .031). Dendritic cells and CD4+ and CD8+ T cells predicted birthweight-related gene expression differences (diagnosticity score P's < 0.021). CONCLUSION Higher third trimester pro-inflammatory gene expression predicted shorter gestation and lower birthweight. Variations in monocyte and dendritic cell biology contributed to both effects, and T-cell biology contributed to higher birthweight. These analyses clarify the role of myeloid/lymphoid lineage immune regulation in pregnancy outcomes.
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Affiliation(s)
- Kharah M Ross
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, California
| | | | - Calvin Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steve W Cole
- Department of Medicine and Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, Los Angeles, California
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Maternal pro-inflammatory state during pregnancy and newborn leukocyte telomere length: A prospective investigation. Brain Behav Immun 2019; 80:419-426. [PMID: 30974172 PMCID: PMC7954441 DOI: 10.1016/j.bbi.2019.04.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/14/2019] [Accepted: 04/06/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Telomere biology plays a fundamental role in maintaining the integrity of the genome and cell, and shortened telomeres have been linked to several age-related diseases. The initial (newborn) telomere length (TL) represents a critically important feature of the telomere biology system. Exposure to a variety of adverse prenatal conditions such as maternal stress, suboptimal diet, obesity, and obstetric complications, is associated with shorter offspring TL at birth and in adult life. Many, if not all, of these exposures are believed to have an inflammatory component. In this context, stress-related immunological processes during pregnancy may constitute a potential additional biological pathway because they can affect telomere length and telomerase activity via transcriptions factors such as cyclic adenosine monophosphate-dependent transcription factor (ATF7) and nuclear factor-kappa B (NF-κB). Thus, in the present study we examined the hypothesis that maternal pro-inflammatory state across pregnancy, operationalized as the balance between tumor necrosis factor (TNF)-α, a major pro-inflammatory cytokine, and interleukin-10 (IL-10), the major anti-inflammatory cytokine, is associated with newborn leukocyte telomere length (LTL) at birth. METHODS AND MATERIALS Participants were healthy women (N = 112) recruited in early pregnancy. Concentrations of TNF- α and IL-10 were quantified in early, mid and late pregnancy from maternal blood samples. Telomere length was assessed in newborn blood samples soon after birth. RESULTS After adjusting for maternal age, maternal pre-pregnancy BMI, birth weight percentile, and infant sex, a higher mean TNF-α/IL-10 ratio across pregnancy was significantly associated with shorter newborn TL (β = -.205, p = .030). Newborn TL was, on average, 10% shorter in offspring of women in the upper compared to lower quartile of the TNF-α/IL-10 ratio during pregnancy. DISCUSSION These findings provide new evidence in humans for a potential "programming" mechanism linking maternal systemic pro-inflammatory processes during pregnancy with the initial (newborn) setting of her offspring's telomere system.
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Ross KM, Thomas JC, Letourneau NL, Campbell TS, Giesbrecht GF. Partner social support during pregnancy and the postpartum period and inflammation in 3-month-old infants. Biol Psychol 2019; 144:11-19. [PMID: 30885739 DOI: 10.1016/j.biopsycho.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 12/31/2022]
Abstract
Prenatal social stress "programs" offspring immune activity in animal models, but how the prenatal social environment affects human offspring inflammation is not known. Here, we test associations between prenatal partner support quality, i.e. positive/helpful support, negative/upsetting support, and their interaction, and infant inflammatory markers. A sample of 113 women from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort were followed from early pregnancy to 3-months postpartum. Partner support quality was measured during pregnancy and the postpartum period. Three-month-old infant blood samples were assayed for inflammatory markers, i.e., adaptive immune markers IFNγ, IL12p70 and IL10. The prenatal positive-by-negative partner support interaction predicted infant IFNγ, IL12p70, and IL10, p's<.035, independent of covariates and postpartum partner support. When negative partner support was high, high positive support predicted higher infant IFNγ, IL12p70, and IL10. As such, partner support during pregnancy that is both highly negative/upsetting and also highly positive/helpful predicted adaptive immunity markers in infants at 3 months of age.
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Affiliation(s)
- Kharah M Ross
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Jenna C Thomas
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Ross KM, Cole SW, Carroll JE, Schetter CD. Elevated pro-inflammatory gene expression in the third trimester of pregnancy in mothers who experienced stressful life events. Brain Behav Immun 2019; 76:97-103. [PMID: 30447280 PMCID: PMC6348125 DOI: 10.1016/j.bbi.2018.11.009] [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: 06/26/2018] [Revised: 09/25/2018] [Accepted: 11/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stress exposure is associated with risk for adverse pregnancy outcomes, potentially in part through dysregulated immune and inflammatory activity. Evidence suggests that stress during pregnancy is associated with inflammation during pregnancy, consistent with risk for preterm birth. However, research has not tested whether complementary changes are reflected in immune cell gene expression, or upstream regulation of inflammation. The purpose of this study was to test associations between preconception and prenatal stress exposure and third trimester immune cell gene expression, focusing specifically on sets of genes previously linked to stress in non-pregnant samples: Pro-inflammatory genes, and antiviral and antibody genes. METHODS A sample of 116 low-income, diverse women was recruited from 5 U.S. sites by the Community Child and Health Network at the birth of a child. This study is of the subgroup of women who became pregnant again over the two-year follow-up period, and provided information on stressful life events that occurred both preconception and during the third trimester of the subsequent pregnancy. Dried blood spots (DBS) were collected in the third trimester of pregnancy, and used for gene expression analysis. RESULTS Women with more prenatal stressful life events had higher expression of pro-inflammatory genes when compared to those with fewer life events, and the effect was driven by increased activation of pro-inflammatory transcription factors, NF-κB and AP-1. Preconception stressful life event exposure was not associated with gene expression profiles. When entered into models simultaneously, only prenatal stressful life events were associated with up-regulation of pro-inflammatory genes. No differences between high or low stress groups emerged for antiviral or antibody genes. CONCLUSIONS Prenatal stress exposure was associated with up-regulated pro-inflammatory gene expression during pregnancy, and increased activity of NF-κB and AP-1. In contrast, stress occurring preconception was not associated with gene expression. These results are consistent with the hypothesis that stress-induced activation of pro-inflammatory transcriptional pathways in pregnancy, but not earlier, may increase risk for inflammation-driven adverse pregnancy outcomes.
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Affiliation(s)
- Kharah M. Ross
- Department of Psychology, University of California – Los Angeles, Los Angeles, CA.,Department of Psychology, University of California – Los Angeles, 1285 Franz Hall, 502 Portola Plaza, Los Angeles, CA 90095-1563, USA,
| | - Steve W. Cole
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences - University of California – Los Angeles, Los Angeles, CA
| | - Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences - University of California – Los Angeles, Los Angeles, CA
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Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia. J Perinatol 2019; 39:314-320. [PMID: 30518800 PMCID: PMC6760589 DOI: 10.1038/s41372-018-0275-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Inflammatory and metabolic pathways are implicated in preterm birth and preeclampsia. However, studies rarely compare second trimester inflammatory and metabolic markers between women who deliver preterm with and without preeclampsia. STUDY DESIGN A sample of 129 women (43 with preeclampsia) with preterm delivery was obtained from an existing population-based birth cohort. Banked second trimester serum samples were assayed for 267 inflammatory and metabolic markers. Backwards-stepwise logistic regression models were used to calculate odds ratios. RESULTS Higher 5-α-pregnan-3β,20α-diol disulfate, and lower 1-linoleoylglycerophosphoethanolamine and octadecanedioate, predicted increased odds of preeclampsia. CONCLUSIONS Among women with preterm births, those who developed preeclampsia differed with respect metabolic markers. These findings point to potential etiologic underpinnings for preeclampsia as a precursor to preterm birth.
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Miller ES, Grobman WA, Culhane J, Adam E, Buss C, Entringer S, Miller G, Wadhwa PD, Keenan-Devlin L, Borders A. Antenatal depression, psychotropic medication use, and inflammation among pregnant women. Arch Womens Ment Health 2018; 21:785-790. [PMID: 29862416 PMCID: PMC6240365 DOI: 10.1007/s00737-018-0855-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
Abstract
To evaluate the association between psychotropic medication and inflammatory biomarkers in women with antenatal depressive symptoms (ADS). In this cross-sectional secondary analysis of a prospective multicenter observational study, 723 pregnant women underwent a depression screen using the Center for Epidemiologic Studies Depression Scale (CES-D) between 12 and 21 weeks gestation. Self-reported use of medications for depression and/or anxiety was corroborated with the medical record to document exposure to pharmacotherapy. Serum was collected and inflammatory biomarkers (IFNγ, IL13, IL6, IL8, TNFα, CRP) were measured concomitantly. Women were included if they fell into one of three categories: ADS responsive to treatment (CES-D < 16 with medication), ADS not responsive to medication (CES-D ≥ 23 despite medication), and untreated ADS (CES-D ≥ 23 with no medication). Levels of inflammatory biomarkers were compared among groups and multivariable regressions performed. Of the 85 women studied, 16 (19%) had ADS responsive to treatment, 12 (14%) had ADS not responsive to medication, and 57 (67%) had untreated ADS. TNFα concentrations significantly differed (P = 0.016) across the cohorts. Post hoc bivariate analyses demonstrated that women with ADS responsive to treatment had lower serum TNFα than non-responders (p = 0.02) and women with untreated ADS (p = 0.01). There were no differences in IFNγ, IL13, IL6, IL8, or CRP among the groups. Regressions demonstrated that, compared to women with ADS responsive to treatment, non-responders or women with untreated ADS had higher TNFα levels (β = 0.27, 95% CI 0.02-0.52 and β = 0.23, 95% CI 0.02-0.44, respectively). Pregnant women on pharmacotherapy who respond to treatment for ADS have lower TNFα compared to women not responsive to medication or women with untreated ADS. These data suggest the possibility that either the therapeutic response in the context of pharmacotherapy is accompanied by modulation of the immune system or that pre-existing higher levels of TNFα may be associated with a poorer response to traditional pharmacotherapy.
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Affiliation(s)
- Emily S. Miller
- Northwestern University Feinberg School of Medicine, Chicago IL
| | | | - Jennifer Culhane
- Children’s Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine, Philadelphia PA
| | - Emma Adam
- Northwestern University Institute for Policy Research & School of Education and Social Policy, Chicago IL
| | - Claudia Buss
- University of California, Irvine, CA, & Charité, Universitätsmedizin Berlin, Germany
| | - Sonja Entringer
- University of California, Irvine, CA, & Charité, Universitätsmedizin Berlin, Germany
| | - Gregory Miller
- Northwestern University, Institute for Policy Research, Evanston IL
| | | | - Lauren Keenan-Devlin
- Northwestern University Center for Healthcare Studies, & NorthShore University Health System, University of Chicago Pritzker School of Medicine, Chicago IL
| | - Ann Borders
- Northwestern University Feinberg School of Medicine, Chicago IL,Northwestern University Center for Healthcare Studies, & NorthShore University Health System, University of Chicago Pritzker School of Medicine, Chicago IL
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43
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Prenatal inflammation and risk for schizophrenia: A role for immune proteins in neurodevelopment. Dev Psychopathol 2018; 30:1157-1178. [DOI: 10.1017/s0954579418000317] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractPrenatal inflammation is an established risk factor for schizophrenia. However, the specific inflammatory pathways that mediate this association remain unclear. Potential candidate systems include inflammatory markers produced by microglia, such as cytokines and complement. Accumulating evidence suggests that these markers play a role in typical neurodevelopmental processes, such as synapse formation and interneuron migration. Rodent models demonstrate that altered marker levels during the prenatal period can cause lasting deficits in these systems, leading to cognitive deficits that resemble schizophrenia. This review assesses the potential role of prenatal cytokine and complement elevations on the etiology of schizophrenia. The current neurobiological understanding of the development of schizophrenia is reviewed to identify candidate cellular mechanisms that may be influenced by prenatal inflammation. We discuss the functions that cytokines and complement may play in prenatal neurodevelopment, review evidence that links exposure to these factors with risk for schizophrenia, and consider how these markers may interact with genetic vulnerabilities to influence the neurodevelopment of schizophrenia. We consider how prenatal inflammatory exposure may influence childhood and adolescent developmental risk trajectories for schizophrenia. Finally, we identify areas of further research needed to support the development of anti-inflammatory treatments to prevent the development of schizophrenia in at-risk neonates.
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Vistnes M, Tapia G, Mårild K, Midttun Ø, Ueland PM, Viken MK, Magnus P, Berg JP, Gillespie KM, Skrivarhaug T, Njølstad PR, Joner G, Størdal K, Stene LC. Plasma immunological markers in pregnancy and cord blood: A possible link between macrophage chemo-attractants and risk of childhood type 1 diabetes. Am J Reprod Immunol 2017; 79. [PMID: 29266506 DOI: 10.1111/aji.12802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022] Open
Abstract
PROBLEM Previous studies have suggested that immune perturbations during pregnancy can affect offspring type 1 diabetes (T1D) risk. We aimed to identify immunological markers that could predict offspring T1D or that were linked to T1D risk factors. METHOD OF STUDY We quantified selected circulating immunological markers in mid-pregnancy (interleukin [IL]-1β, IL-1ra, IL-2Rα, IL-2, -4, -5, -6, -10, -12p70, 13, -17A, GM-CSF, IFN-γ, CXCL10, CCL 2, CCL3, CCL4, TNF) and cord blood plasma (neopterin and kynurenine/tryptophan ratio) in a case-control study with 175 mother/child T1D cases (median age 5.8, range 0.7-13.0 years) and 552 controls. RESULTS Pre-pregnancy obesity was positively associated with CCL4, CXCL10, kynurenine/tryptophan ratio and neopterin (P < .01). The established T1D SNPs rs1159465 (near IL2RA) and rs75352297 (near CCR2 and CCR3) were positively associated with IL-2Rα and CCL4, respectively (P < .01). There was a borderline association of CCL4 and offspring T1D risk, independent of maternal obesity and genotype. When grouping the immunological markers, there was a borderline association (P = .05) with M1 phenotype and no association between M2-, Th1-, Th2- or Th17 phenotypes and offspring T1D risk. CONCLUSION Increased mid-pregnancy CCL4 levels showed borderline associations with increased offspring T1D risk, which may indicate a link between environmental factors in pregnancy and offspring T1D risk.
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Affiliation(s)
- Maria Vistnes
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - German Tapia
- Norwegian Institute of Public Health, Oslo, Norway
| | - Karl Mårild
- Norwegian Institute of Public Health, Oslo, Norway.,Barbara Davis Center, University of Colorado, Aurora, CO, USA
| | | | - Per M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Marte K Viken
- Department of Immunology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jens P Berg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kathleen M Gillespie
- Diabetes and Metabolism, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Torild Skrivarhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål R Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Joner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Ketil Størdal
- Norwegian Institute of Public Health, Oslo, Norway.,Pediatric Department, Østfold Hospital Trust, Grålum, Norway
| | - Lars C Stene
- Norwegian Institute of Public Health, Oslo, Norway
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Jennewein MF, Abu-Raya B, Jiang Y, Alter G, Marchant A. Transfer of maternal immunity and programming of the newborn immune system. Semin Immunopathol 2017; 39:605-613. [PMID: 28971246 DOI: 10.1007/s00281-017-0653-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022]
Abstract
As placental mammals, the pregnant women and the fetus have intense and prolonged interactions during gestation. There is increasing evidence that multiple molecular as well as cellular components originating in pregnant women are transferred to the fetus. The transfer of maternal antibodies has long been recognized as a central component of newborn immunity against pathogens. More recent studies indicate that inflammatory mediators, micronutrients, microbial products and maternal cells are transferred in utero and influence the fetal immune system. Together, these multiple signals are likely to form a complex network of interactions that program the neonatal immune system and tune its homeostatic regulation. Maternal disorders, in particular infectious diseases, modify these signals and may thereby alter immunity in early life. Understanding maternal programming of the newborn immune system could provide a basis for interventions promoting child health.
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Affiliation(s)
| | - Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital, Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Yiwei Jiang
- Institute for Medical Immunology, Université Libre de Bruxelles, Rue Adrienne Bolland 8, 6041 Gosselies, Charleroi, Belgium
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, 02139, USA
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Rue Adrienne Bolland 8, 6041 Gosselies, Charleroi, Belgium.
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Miller GE, Culhane J, Grobman W, Simhan H, Williamson D, Adam EK, Buss C, Entringer S, Kim KY, Garcia-Espana JF, Keenan-Devlin L, McDade TW, Wadhwa PD, Borders A. Mothers' childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways. Brain Behav Immun 2017; 65:11-19. [PMID: 28450221 PMCID: PMC5537016 DOI: 10.1016/j.bbi.2017.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/28/2017] [Accepted: 04/23/2017] [Indexed: 12/23/2022] Open
Abstract
Research suggests the health consequences of economic hardship can be transmitted across generations. Some of these disparities are thought to be passed to offspring during gestation. But this hypothesis has not been tested in contemporary American samples, and the mechanisms of transmission have not been characterized. Accordingly, this study had two goals: first, to determine if women exposed to economic hardship during childhood showed higher rates of adverse birth outcomes; and second, to evaluate the contribution of inflammation, psychosocial, lifestyle, and obstetric characteristics to this phenomenon. This prospective study enrolled 744 women with singleton pregnancies (59.1% White; 16.3% Black; 18.7% Latina; 5.9% Other). Childhood economic hardship was measured by self-report. Birth outcomes included length of gestation and incidence of preterm birth; birth weight percentile and small for gestational age; length of hospital stay and admission to Special Care Nursery. Analyses revealed that mothers' childhood economic hardship was independently associated with multiple adverse birth outcomes, even following adjustment for demographics, maternal education, and obstetrical confounders. Women raised in economically disadvantaged conditions had shorter gestation length and higher preterm delivery rates. Their babies had lower birth weights, were more likely to be small for gestational age, stayed in the hospital longer, and had more Special Care Nursery admissions. Mediation analyses suggested these associations arose through multiple pathways, and highlighted roles for inflammation, education, adiposity, and obstetric complications. Collectively, these findings suggest that childhood economic hardship predisposes women to adverse birth outcomes, and highlights likely behavioral and biological mechanisms.
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Affiliation(s)
- Gregory E. Miller
- Department of Psychology, Northwestern University,Institute for Policy Research, Northwestern University
| | - Jennifer Culhane
- Children’s Hospital of Philadelphia, Division of Adolescent Medicine,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - William Grobman
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine
| | - Hyagriv Simhan
- Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine,Division of Obstetrical Services, Magee Women’s Hospital
| | | | - Emma K. Adam
- Institute for Policy Research, Northwestern University,School of Education and Social Policy, Northwestern University
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine,Institute of Medical Psychology, Charite University of Medicine, Berlin, Germany
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine,Institute of Medical Psychology, Charite University of Medicine, Berlin, Germany
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine
| | - Thomas W. McDade
- Institute for Policy Research, Northwestern University,Department of Anthropology, Northwestern University
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine
| | - Ann Borders
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine,Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
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Close relationship qualities and maternal peripheral inflammation during pregnancy. Psychoneuroendocrinology 2017; 77:252-260. [PMID: 28129559 DOI: 10.1016/j.psyneuen.2017.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/16/2016] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Close relationships are associated with pregnancy outcomes, but little is known about the mechanisms involved. This paper examines whether quality of women's close relationships, specifically with romantic partner (RP) and closest friend or family member (CF), is associated with inflammatory biomarkers during the third trimester of pregnancy. METHODS 90 pregnant women were assessed during the second and third trimester. At both visits they completed self-reports describing the positive and negative aspects of their RP and CF relationships. Peripheral blood was collected during these visits, and used to measure systemic levels of cytokines, including IFNγ, IL10, IL6, IL8 and IL13. An index of inflammatory regulation, as reflected by the ratio of IL6:IL10, was also computed. RESULTS Positive (e.g. support, intimacy) and negative (e.g. conflict) aspects of the RP relationship interacted to predict third trimester cytokine values. Specifically, RP relationships relatively low in both positive and negative aspects were associated with lower third trimester anti-inflammatory (IL10, IL13) and anti-viral (IFNγ) cytokines, and a higher IL6:IL10 ratio, controlling for second trimester levels. These associations were independent of demographics, gestational age, weeks between assessment, parity, pre-pregnancy body mass index, maternal stress, distress, depressed mood and RP cohabitation. CF relationship aspects were not associated with inflammatory markers. CONCLUSIONS RP relationships relatively low in both positive, e.g. support and intimacy, and negative, e.g. conflict, aspects were associated with a less anti- and more pro-inflammatory cytokine profile during the third trimester. These findings have implications for understanding the associations amongst close relationships, inflammation, and potentially pregnancy outcomes.
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