Birth weight and later risk of depression in a national birth cohort

Maternal inflammatory and microbial drivers of low birthweight in low- and middle-income countries

BACKGROUND

Low birthweight (LBW) is when an infant is born too soon or too small, and it affects one in seven infants in low- and middle-income countries. LBW has a significant impact on short-term morbidity and mortality, and it impairs long-term health and human capital. Antenatal microbial and inflammatory exposure may contribute to LBW.

METHODS

Ovid-Medline, Embase and Cochrane databases were searched for English-language articles evaluating inflammatory, microbial or infective causes of LBW, small-for-gestational age, intra-uterine growth restriction or prematurity. Inclusion criteria were human studies including published data; conference abstracts and grey literature were excluded. A narrative synthesis of the literature was conducted.

RESULTS

Local infections may drive the underlying causes of LBW: for example, vaginitis and placental infection are associated with a greater risk of prematurity. Distal infection and inflammatory pathways are also associated with LBW, with an association between periodontitis and preterm delivery and environmental enteric dysfunction and reduced intra-uterine growth. Systemic maternal infections such as malaria and HIV are associated with LBW, even when infants are exposed to HIV but not infected. This latter association may be driven by chronic inflammation, co-infections and socio-economic confounders. Antimicrobial prophylaxis against other bacteria in pregnancy has shown minimal impact in most trials, though positive effects on birthweight have been found in some settings with a high infectious disease burden.

CONCLUSION

Maternal inflammatory and infective processes underlie LBW, and provide treatable pathways for interventions. However, an improved understanding of the mechanisms and pathways underlying LBW is needed, given the impact of LBW on life-course.

Human Cord Blood Endothelial Progenitor Cells and Pregnancy Complications (Preeclampsia, Gestational Diabetes Mellitus, and Fetal Growth Restriction)

Hemangioblasts give rise to endothelial progenitor cells (EPCs), which also express the cell surface markers CD133 and c-kit. They may differentiate into the outgrowth endothelial cells (OECs) that control neovascularization in the developing embryo. According to numerous studies, reduced levels of EPCs in circulation have been linked to human cardiovascular disorders. Furthermore, preeclampsia and senescence have been linked to levels of EPCs produced from cord blood. Uncertainties surround how preeclampsia affects the way EPCs function. It is reasonable to speculate that preeclampsia may have an impact on the function of fetal EPCs during the in utero period; however, the present literature suggests that maternal vasculopathies, including preeclampsia, damage fetal circulation. Additionally, the differentiation potential and general activity of EPCs may serve as an indicator of the health of the fetal vascular system as they promote neovascularization and repair during pregnancy. Thus, the purpose of this review is to compare-through the assessment of their quantity, differentiation potency, angiogenic activity, and senescence-the angiogenic function of fetal EPCs obtained from cord blood for normal and pregnancy problems (preeclampsia, gestational diabetes mellitus, and fetal growth restriction). This will shed light on the relationship between the angiogenic function of fetal EPCs and pregnancy complications, which could have an effect on the management of long-term health issues like metabolic and cardiovascular disorders in offspring with abnormal vasculature development.

Developmental Trajectory of Body Weight in Youths at Risk for Major Mood Disorders

Importance

Mood disorders are associated with increased body weight, especially in females, but it remains unknown when the weight increase starts.

Objectives

To examine sex-specific weight trajectories associated with familial mood disorder risk and determine the age at which youth at familial risk for mood disorders begin to diverge in weight from controls.

Design, Setting, and Participants

This community-based, single-center, acceleration cohort study of youth at familial risk for mood disorders and controls with yearly follow-ups (mean [SD], 5 [2.1] years) from January 1, 2014, to December 31, 2022, assessed 394 unaffected female and male offspring (aged 3 to 20 years) of parents with or without a mood disorder. Parents with mood (depressive or bipolar) disorders were recruited through adult mental health services. Parents of control participants were matched on age and socioeconomic factors and recruited through acquaintance referrals or schools.

Exposures

The youth in the familial mood risk group had at least 1 parent with a major mood disorder, whereas control youth did not have a parent with a mood disorder.

Main Outcomes and Measures

Body mass indexes (BMIs) were calculated as weight in kilograms divided by height in meters squared from measured weight and height at annual assessments and then converted to age- and sex-adjusted z scores (zBMIs). Repeated-measure regressions examined the association between zBMI and age in youth at familial risk of mood disorders and controls while accounting for sex. Sensitivity analyses accounted for socioeconomic status, prematurity, and birth weight.

Results

Of 394 participants (mean [SD] age, 11.5 [3.6] years; 203 [51.5%] female), youths at familial risk for mood disorders showed overall no difference in body weight (β = 0.12; 95% CI, 0.01-0.24) from controls. A sex-specific difference was detected, with females at familial risk showing a rapid peripubertal increase in body weight, leading to significantly increased zBMIs at 12 years and older compared with controls (β = 0.57; 95% CI, 0.31-0.82) independent of socioeconomic status, prematurity, or birth weight. Males did not differ from controls at any age.

Conclusions and Relevance

In this cohort study, females with a family history of mood disorders were prone to weight gain starting around puberty and predating mood disorder onset. Early interventions aiming to prevent adverse mental and physical outcomes in this vulnerable group need to start in childhood.

The relationship of life-course patterns of adiposity with type 2 diabetes, depression, and their comorbidity in the Northern Finland Birth Cohort 1966

OBJECTIVES

Type 2 diabetes (T2D) and comorbid depression challenges clinical management particularly in individuals with overweight. We aim to explore the shared etiology, via lifecourse adiposity, between T2D and depression.

METHODS

We used data from birth until 46years from Northern Finland Birth Cohort 1966 (n = 6,372; 53.8% females). We conducted multivariate analyses on three outcomes: T2D (4.2%), depression (19.2%) and as comorbidity (1.8%). We conducted (i) Path analysis to clarify time-dependent body mass index (BMI) related pathways, including BMI polygenic risk scores (PRS); and (ii) Cox regression models to assess whether reduction of overweight between 7years and 31years influence T2D, depression and/or comorbidity. The models were tested for covariation with sex, education, smoking, physical activity, and diet score.

RESULTS

The odd ratios (OR) of T2D in individuals with depression was 1.68 [95% confidence interval (CI): 1.34-2.11], and no change in estimate was observed when adjusted for covariates. T2D and comorbidity showed similar patterns of relationships in the path analyses (P < 0.001). The genetic risk for obesity (PRS BMI) did not show direct effect on T2D or comorbidity in adulthood but indirectly through measures of adiposity in early childhood and mid-adulthood in the path analysis (P < 0.001). Having early-onset of overweight at 7years and 31years showed highest risk of T2D (OR 3.8, 95%CI 2.4-6.1) and comorbidity (OR 5.0, 95%CI 2.7-9.5), with mild-to-moderate attenuation with adjustments. Depression showed no significant associations.

CONCLUSIONS

We found evidence for overweight since childhood as a risk factor for T2D and co-morbidity between T2D and depression, influenced moderately by lifestyle factors in later life. However, no shared early life adiposity related risk factors were observed between T2D and depression when assessed independently in this Finnish setting.

Trans- and Multigenerational Maternal Social Isolation Stress Programs the Blood Plasma Metabolome in the F3 Generation

Metabolic risk factors are among the most common causes of noncommunicable diseases, and stress critically contributes to metabolic risk. In particular, social isolation during pregnancy may represent a salient stressor that affects offspring metabolic health, with potentially adverse consequences for future generations. Here, we used proton nuclear magnetic resonance (¹H NMR) spectroscopy to analyze the blood plasma metabolomes of the third filial (F3) generation of rats born to lineages that experienced either transgenerational or multigenerational maternal social isolation stress. We show that maternal social isolation induces distinct and robust metabolic profiles in the blood plasma of adult F3 offspring, which are characterized by critical switches in energy metabolism, such as upregulated formate and creatine phosphate metabolisms and downregulated glucose metabolism. Both trans- and multigenerational stress altered plasma metabolomic profiles in adult offspring when compared to controls. Social isolation stress increasingly affected pathways involved in energy metabolism and protein biosynthesis, particularly in branched-chain amino acid synthesis, the tricarboxylic acid cycle (lactate, citrate), muscle performance (alanine, creatine phosphate), and immunoregulation (serine, threonine). Levels of creatine phosphate, leucine, and isoleucine were associated with changes in anxiety-like behaviours in open field exploration. The findings reveal the metabolic underpinnings of epigenetically heritable diseases and suggest that even remote maternal social stress may become a risk factor for metabolic diseases, such as diabetes, and adverse mental health outcomes. Metabolomic signatures of transgenerational stress may aid in the risk prediction and early diagnosis of non-communicable diseases in precision medicine approaches.

Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: longitudinal analyses from two 20-year birth cohort studies

BACKGROUND

We aimed to identify groups of children presenting distinct perinatal adversity profiles and test the association between profiles and later risk of suicide attempt.

METHODS

Data were from the Québec Longitudinal Study of Child Development (QLSCD, N = 1623), and the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 5734). Exposures to 32 perinatal adversities (e.g. fetal, obstetric, psychosocial, and parental psychopathology) were modeled using latent class analysis, and associations with a self-reported suicide attempt by age 20 were investigated with logistic regression. We investigated to what extent childhood emotional and behavioral problems, victimization, and cognition explained the associations.

RESULTS

In both cohorts, we identified five profiles: No perinatal risk, Poor fetal growth, Socioeconomic adversity, Delivery complications, Parental mental health problems (ALSPAC only). Compared to children with No perinatal risk, children in the Poor fetal growth (pooled estimate QLSCD-ALSPAC, OR 1.89, 95% CI 1.04-3.44), Socioeconomic adversity (pooled-OR 1.42, 95% CI 1.08-1.85), and Parental mental health problems (OR 1.74, 95% CI 1.27-2.40), but not Delivery complications, profiles were more likely to attempt suicide. The proportion of this effect mediated by the putative mediators was larger for the Socioeconomic adversity profile compared to the others.

CONCLUSIONS

Perinatal adversities associated with suicide attempt cluster in distinct profiles. Suicide prevention may begin early in life and requires a multidisciplinary approach targeting a constellation of factors from different domains (psychiatric, obstetric, socioeconomic), rather than a single factor, to effectively reduce suicide vulnerability. The way these factors cluster together also determined the pathways leading to a suicide attempt, which can guide decision-making on personalized suicide prevention strategies.

Early life factors as predictors of age-associated deficit accumulation across 17 years from midlife into old age

BACKGROUND

Early life exposures have been associated with the risk of frailty in old age. We investigated whether early life exposures predict the level and rate of change in a frailty index (FI) from midlife into old age.

METHODS

A linear mixed model analysis was performed using data from three measurement occasions over 17 years in participants from the Helsinki Birth Cohort Study (n=2000) aged 57-84 years. A 41-item FI was calculated on each occasion. Information on birth size, maternal body mass index (BMI), growth in infancy and childhood, childhood socioeconomic status (SES), and early life stress (wartime separation from both parents), was obtained from registers and healthcare records.

RESULTS

At age 57 years the mean FI level was 0.186 and the FI levels increased by 0.34 percent/year from midlife into old age. Larger body size at birth associated with a slower increase in FI levels from midlife into old age. Per 1kg greater birth weight the increase in FI levels per year was -0.087 percentage points slower (95% CI=-0.163, -0.011; p=0.026). Higher maternal BMI was associated with a higher offspring FI level in midlife and a slower increase in FI levels into old age. Larger size, faster growth from infancy to childhood, and low SES in childhood were all associated with a lower FI level in midlife but not with its rate of change.

CONCLUSIONS

Early life factors seem to contribute to disparities in frailty from midlife into old age. Early life factors may identify groups that could benefit from frailty prevention, optimally initiated early in life.

Associations of parental and perinatal factors with subsequent risk of stress-related disorders: a nationwide cohort study with sibling comparison

Little is known about the contribution of pregnancy-related parental and perinatal factors to the development of stress-related disorders. We aimed to investigate whether parental/perinatal adversities entail higher risks of stress-related disorders in the offspring, later in life, by accounting for genetic and early environmental factors. Based on the nationwide Swedish registers, we conducted a population-based cohort study of 3,435,747 singleton births (of which 2,554,235 were full siblings), born 1973-2008 and survived through the age of 5 years. Using both population- and sibling designs, we employed Cox regression to assess the association between parental and perinatal factors with subsequent risk of stress-related disorders. We identified 55,511 individuals diagnosed with stress-related disorders in the population analysis and 37,433 in the sibling analysis. In the population-based analysis we observed increased risks of stress-related disorders among offspring of maternal/paternal age <25, single mothers, parity ≥4, mothers with BMI ≥ 25 or maternal smoking in early pregnancy, gestational diabetes, and offspring born moderately preterm (GA 32-36 weeks), or small-for-gestational-age. These associations were significantly attenuated toward null in the sibling analysis. Cesarean-section was weakly associated with offspring stress-related disorders in population [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.06-1.12] and sibling analyses (HR 1.10, 95% CI 1.02-1.20). Our findings suggest that most of the observed associations between parental and perinatal factors and risk of stress-related disorders in the population analysis are driven by shared familial environment or genetics, and underscore the importance of family designs in epidemiological studies on the etiology of psychiatric disorders.

Cross-sectional investigation and correlation analysis of psychology of college students returning to campus after COVID-19 lockdown lift

OBJECTIVE

To conduct a large cross-sectional survey of the mental health of college students during the recovery period of the COVID-19 epidemic.

METHODS

Symptom Checklist 90 (SCL-90) and COVID-19 questionnaire were used to investigate the overall mental health level and cognition of epidemic situation of college students in seven colleges and universities in Shaanxi Province.

RESULTS

(1) In the recovery period of COVID-19 epidemic, college students still had psychological and somatic symptoms such as obsessive-compulsive disorder, interpersonal sensitivity, anxiety, hostility, and poor appetite or insomnia; (2) female college students, science and engineering college students, freshmen and senior graduates, and some ethnic minority college students were all groups with psychological symptoms; (3) the psychological status of college students was related to their perception of COVID-19 epidemic, and the more knowledge about epidemic prevention and control, the more confident they were in overcoming the epidemic, and the milder the psychological symptoms.

CONCLUSION

College students still have some mental health problems in the recovery period of COVID-19 epidemic, which should be paid attention to by education authorities and colleges and universities.

Depressive symptoms during early adulthood and the development of physical multimorbidity in the UK: an observational cohort study

BACKGROUND

An understanding of whether early-life depression is associated with physical multimorbidity could be instrumental for the development of preventive measures and the integrated management of depression. We therefore aimed to map out the cumulative incidence of physical multimorbidity over adulthood, and to determine the association between the presence of depressive symptoms during early adulthood and the development of physical multimorbidity in middle age.

METHODS

In this observational cohort study, we used pooled data from the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS). Cohort waves were pooled in each decade of adult life available (when cohort members were aged 26 years in the BCS and 23 years in the NCDS [baseline]; 34 years in the BCS and 33 years in the NCDS [age 34 BCS/33 NCDS]; 42 years in the BCS and NCDS [age 42 BCS/NCDS]; and 46 years in the BCS and 50 years in the NCDS [age 46 BCS/50 NCDS]). We included participants who had completed the nine-item Malaise Inventory at baseline, and did not have a history of physical multimorbidity, any physical multimorbidity at baseline, or the presence of depressive symptoms before the development of physical multimorbidity. The presence of depressive symptoms was determined using the nine-item Malaise Inventory (cutoff score ≥4). Physical multimorbidity was defined as having at least two measures of any of the following ten self-reported groups of long-term conditions: asthma or bronchitis; backache; bladder or kidney conditions; cancer; cardiovascular conditions; convulsions or epilepsy; diabetes; hearing conditions; migraine; and stomach, bowel, or gall conditions. Cumulative incidence (with 95% CI) of physical multimorbidity was calculated for each decade considered after baseline, with physical multimorbidity being assessed as both a dichotomous and categorical variable. The association between depressive symptoms and the development of physical multimorbidity was assessed using adjusted relative risk ratios (with 95% CIs).

FINDINGS

Analyses included 15 845 participants, of whom 4001 (25·25%; 95% CI 24·57-25·93) had depressive symptoms at baseline and 11 844 (74·75%; 74·07-75·42) did not. The cumulative incidence of physical multimorbidity (dichotomous) ranged over the study period from 2263 (18·44%; 95% CI 17·75-18·14) of 12 273 participants at age 34 BCS/33 NCDS, to 4496 (42·90%; 41·95-43·85) of 10 481 participants at age 46 BCS/50 NCDS, and was consistently higher in participants with depressive symptoms at baseline. The adjusted relative risk of physical multimorbidity was higher in participants with depressive symptoms than in those without and remained stable over the study period (adjusted relative rate ratio 1·67, 95% CI 1·50-1·87, at age 34 BCS/33 NCDS; 1·63, 1·48-1·79, at age 42 BCS/NCDS; and 1·58, 1·43-1·73, at age 46 BCS/50 NCDS).

INTERPRETATION

The presence of depressive symptoms during early adulthood is associated with an increased risk of the development of physical multimorbidity in middle age. Although further research about the drivers of this relationship is needed, these results could help to enhance the integrated management of individuals with depressive symptoms and the development of preventive strategies to reduce the effect and burden of physical multimorbidity.

FUNDING

UK Medical Research Council and Guy's Charity.

The influence and enlightenment of five public health emergencies on public psychology since new century: A systematic review

BACKGROUND

Since the 21st century, humans have experienced five public health emergencies: the severe acute respiratory syndrome (SARS), type A H1N1 influenza (H1N1), Middle East respiratory syndrome (MERS), Ebola virus disease (EVD), and the new coronavirus pneumonia (COVID-19). They caused a large number of casualties and a wider psychological crisis, which might cause severe consequences such as post-traumatic stress disorder and suicide.

AIMS

To reveal the law of formation of public psychological crisis in public health emergencies, and draw lessons from it. To provide ideas for effectively deal with these psychological crisis problems and fundamentally curbing the occurrence of public health emergencies.

METHOD

Through the method of literature research, 'public health incidents', 'psychological crisis', 'mental health', 'psychological intervention', 'SARS', 'H1N1', 'MERS', 'EVD', and 'COVID-19' were used to search literatures in the databases such as PubMed, Springer, and Sciencedirect, and the literatures were summarized, sorted, and studied.

RESULTS

(1) The public health emergencies caused a universal psychological crisis. The main manifestations were depression, compulsion, despair, etc. The people involved mainly include patients, suspected isolated patients, medical staff, and the general public in the epidemic situation. (2) People's psychological state often experienced stress stage, shock stage, acceptance, and reorganization. Only some susceptible individuals couldn't complete effective psychological reconstruction, resulting in serious psychological disorders. Individual susceptibility is related to genetic factors, adversity, and traumatic stimuli experienced in early life.

CONCLUSION

To reduce these psychological crisis problems, we should establish and improve the psychological crisis intervention or rescue system of public health emergencies, it was still necessary to live in harmony with nature, get rid of the inappropriate habit of preying on wild animals, in order to prevent the cross-species transmission of the virus between wild animals and humans, and to fundamentally avoid the occurrence of major infectious diseases.

Research Review: Developmental origins of depression - a systematic review and meta-analysis

BACKGROUND

Many observational studies have found a direct association between adverse in utero, perinatal and postnatal exposures and offspring's depression. These findings are consistent with the 'developmental origins of disease hypothesis'. But no review has comprehensively summarized the roles of these exposures. This review aims to systematically scrutinize the strength of associations between individual prenatal, perinatal, and postnatal exposures and subsequent depression in offspring.

METHODS

We conducted a systematic review and meta-analysis to synthesize the literature from the EMBASE, HealthStar, PsychoInfo, and Medline databases since their inception to September 1, 2019. English language articles on population-based prospective cohort studies examining the associations between in utero, perinatal, and postnatal exposures and offspring's depression were searched. Random-effects models were used to calculate pooled estimates, and heterogeneity and sensitivity tests were conducted to explore potential confounders in the relationships of depression and early-life factors. Qualitative analysis was also conducted.

RESULTS

Sixty-four prospective cohort studies with 28 exposures studied in the relationships to offspring's depression met inclusion criteria. The meta-analysis found 12 prenatal, perinatal, and postnatal characteristics were associated with an increased risk of depression in offspring: low birth weight, premature birth, small gestational age, maternal education, socioeconomic status, having younger parents (<20 years), having older parents (≥35 years), maternal smoking, paternal smoking, maternal stress, maternal anxiety, and prenatal depression. Heterogeneity and sensitivity tests supported the findings. By and large, study characteristics had no effects on conclusions. Qualitative analyses generally supported the findings of meta-analysis and reported on additional risk factors.

CONCLUSIONS

This review provides a robust and comprehensive overview of the lasting psychopathological effects of in utero, perinatal, and postnatal exposures. The findings highlight the need for clinical and public health interventions focusing on the identified risk factors. Large prospective cohort studies are warranted to investigate the combined effects of multiple co-existing early-life exposures.

The effect of antenatal depression on birth weight among newborns in South Gondar zone, Northwest Ethiopia: a population-based prospective cohort study

Background

There is a high prevalence of antenatal depression and low birth weight (LBW) (< 2.5 kg) in Ethiopia. Prior evidence revealed that the association between antenatal depression and LBW in high- and low-income countries is conflicting. The effect of antenatal depression on birth weight is under-researched in Ethiopia. We aimed to examine the independent effect of antenatal depression on newborn birth weight in an urban community in Northwest Ethiopia.

Methods

A total of 970 pregnant women were screened for antenatal depression in their second and third trimester of pregnancy through the use of the Edinburgh Postnatal Depression Scale (EPDS). A logistic regression model was used to adjust confounders and determine associations between antenatal depression and low birth weight. Information was collected on the birth weight of newborns and mother’s socio-demographic, anthropometric, obstetric, clinical, psychosocial, and behavioral factors.

Results

The cumulative incidence of LBW was found to be 27.76%. The cumulative incidence of LBW in those born from depressed pregnant women was 40% as compared to 21% in none depressed. While considering all other variables constant, mothers who had antenatal depression were 2.51 (COR = 2.51 (95 CI: 1.87, 3.37)) more likely to have a child with low birth weight. After adjusting for potential confounders, antenatal depression in the second and third trimester of pregnancy (AOR = 1.92 (95% CI: 1.31, 2.81)) remained significantly associated with LBW. Mid-Upper Arm Circumference (MUAC) ≤21, lack of ANC follow up, and preterm births were also associated with LBW.

Conclusion

This study showed that antenatal depression during the second and third trimester of pregnancy is associated with LBW of newborns and replicates results found in high-income countries. Linking early screening, detection, and treatment of antenatal depression into routine antenatal care could be essential to improve pregnancy outcomes.

Early predictors of mental health in mid-adulthood

AIM

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood.

METHODS

In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ² and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience.

RESULTS

Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001).

CONCLUSIONS

The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Obstetric complications and subsequent risk of mood disorders for offspring in adulthood: a comprehensive overview

Background: A number of studies reported obstetric complications (OCs) to be a risk factor for the development of psychiatric conditions in the adulthood, including mood disorders.Aim: The aim of this study was to review the literature about the link between OCs during the perinatal period (items of Lewis-Murray scale) and the future risk of developing a mood disorder in adulthood, such as the major depressive disorder (MDD) or the bipolar disorder (BD).Methods: A research in the main database sources has been conducted to obtain an overview of the association mentioned above.Results: Few studies have investigated the role of OCs in the development of mood disorders in adulthood. The most robust evidence is that low birth weight (LBW) and preterm birth may be risk factors for the development of MDD in the future, even if some of the available data come from studies with small sample sizes or a retrospective design.Conclusion: OCs may confer a risk of developing mood disorders in adulthood. Future research should confirm these preliminary findings and clarify if other obstetric or neonatal complications (e.g. cyanosis or newborn epileptic seizures) may have a role in the future onset of mood disorders.

Sex-dependent associations of low birth weight and suicidal ideation in adulthood: a community-based cohort study

Low birth weight (LBW; < 2,500 g) has been identified as a risk factor for adverse mental health outcomes over the life span. However, little is known about the association of LBW and suicidal ideation in middle and late adulthood. We investigated N = 8,278 participants of a representative community cohort: 3,849 men (46.5%) and 4,429 women (53.5%) (35-74 years of age). We assessed standardized measures of mental distress, sociodemographics, health behavior, and somatic factors (based on an extensive medical assessment). Controlling for these confounders, we examined the relationship of birth weight and suicidal ideation in logistic regression models. As men and women differ with regard to their susceptibility to suicidal ideation and behavior, we tested sex-dependent effects. LBW was reported by 458 participants (5.5%). In men, LBW was associated with a higher likelihood of reporting suicidal ideation (OR 2.92, 95% CI 1.58-5.12). In women, there was no such relationship. The findings underscore the interrelatedness of the physical and psychological domain, the role of early adversity in suicidal ideation, and they identify a vulnerable group whose numbers are expected to grow. They also indicate other risk factors for suicidal ideation in the community (mental distress, lack of social support, and health risk behavior).

Common mental disorders prevalence in adolescents: A systematic review and meta-analyses

An increasing number of original studies suggest the relevance of assessing mental health; however, there has been a lack of knowledge about the magnitude of Common Mental Disorders (CMD) in adolescents worldwide. This study aimed to estimate the prevalence of CMD in adolescents, from the General Health Questionnaire (GHQ-12). Only studies composed by adolescents (10 to 19 years old) that evaluated the CMD prevalence according to the GHQ-12 were considered. The studies were searched in Medline, Embase, Scopus, Web of Science, Lilacs, Adolec, Google Scholar, PsycINFO and Proquest. In addition, the reference lists of relevant reports were screened to identify potentially eligible articles. Studies were selected by independent reviewers, who also extracted data and assessed risk of bias. Meta-analyses were performed to summarize the prevalence of CMD and estimate heterogeneity across studies. A total of 43 studies were included. Among studies that adopted the cut-off point of 3, the prevalence of CMD was 31.0% (CI 95% 28.0-34.0; I2 = 97.5%) and was more prevalent among girls. In studies that used the cut-off point of 4, the prevalence of CMD was 25.0% (CI 95% 19.0-32.0; I2 = 99.8%). Global prevalence of CMD in adolescents was 25.0% and 31.0%, using the GHQ cut-off point of 4 and 3, respectively. These results point to the need to include mental health as an important component of health in adolescence and to the need to include CMD screening as a first step in the prevention and control of mental disorders.

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA).

Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA.

Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 – 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 – 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 – 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA.

Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

Body mass index trajectories in childhood and adolescence - Risk for non-affective psychosis

BACKGROUND

Underweight in early adulthood increases risk for schizophrenia, but the effect of early childhood underweight on psychosis risk is not well known.

METHODS

We studied whether underweight or overweight in childhood and adolescence increases risk for non-affective psychosis or other psychiatric disorders in a population-based cohort study 'Cardiovascular Risk in Young Finns'. Body mass index (BMI) trajectories were recorded in the years 1980, 1983 and 1986 (in 3-18 years of age), before the first hospitalization due to a psychiatric disorder. BMI was categorized as underweight, normal weight or overweight, using the BMI classification for children and adolescents. We formed DSM-IV based diagnostic groups of non-affective psychosis (n = 69, including a schizophrenia subgroup, n = 41) and affective disorders (i.e. mood and anxiety disorders, n = 112) based on the Care Register for Health Care. Groups were compared with subjects with no psychiatric diagnoses (n = 3310). Sex, age, low birthweight and mother's mental disorders were included in the analyses.

RESULTS

Underweight, but not overweight, independently predicted later development of non-affective psychosis. The risk of psychosis was over two-fold (relative risk (RR) [95% CI] 2.31 [1.2-4.4]) and of schizophrenia nearly 2.5-fold (RR 2.44 [1.03-5.8]) after underweight in childhood/adolescence. Underweight or overweight in childhood and adolescence was not associated with mood or anxiety disorders.

CONCLUSIONS

These results support the hypothesis of non-affective psychosis as a neurodevelopmental disorder with somatic manifestations throughout childhood and adolescence.

Sequential risk of depression in children born prematurely: A nationwide population- based analysis

BACKGROUND

Whether children born prematurely are at a high risk of depression is still unknown. The present study examined the risk of depression in children who were born prematurely, by analyzing a national cohort in Taiwan.

METHODS

All premature births between January 1, 2000, and December 31, 2010, by using the Taiwan National Health Insurance Research Database. A total of 21,478 preterm children and 85,903 full-term children were enrolled in this study. Sex, level of urbanization of residential area, and parental occupation were considered. We included participants who received a diagnosis of depression in more than two clinical visits or were hospitalized due to depression.

RESULTS

Preterm children had a 2.75-fold higher risk of depression than full-term children (95% confidence interval [CI] = 1.58-4.79, p < 0.001). Sex was not likely to be associated with depression in this study (p = 0.95). The lowest level of urbanization significantly contributed to the risk of depression in preterm children (adjusted hazard ratio = 6.8, 95% CI = 1.63-28.46, p < 0.01). Regarding parental occupation, preterm children whose parents had blue-collar and other occupations had a 3.4- and 6.06-fold higher risk of depression, respectively, compared with other children (blue-collar occupations: 95% CI = 1.04-11.15, p < 0.05; other occupations: 95% CI = 1.71-21.49, p < 0.01).

CONCLUSIONS

Preterm children had a 2.7-fold higher risk of depression than children born full-term. Early identification, timely psychiatric care, intervention strategies, and support for their families may reduce the complications of mental illness in preterm children.

Fetal Origins of Mental Disorders? An Answer Based on Mendelian Randomization

The Barker hypothesis states that low birth weight (BW) is associated with higher risk of adult onset diseases, including mental disorders like schizophrenia, major depressive disorder (MDD), and attention deficit hyperactivity disorder (ADHD). The main criticism of this hypothesis is that evidence for it comes from observational studies. Specifically, observational evidence does not suffice for inferring causality, because the associations might reflect the effects of confounders. Mendelian randomization (MR) - a novel method that tests causality on the basis of genetic data - creates the unprecedented opportunity to probe the causality in the association between BW and mental disorders in observation studies. We used MR and summary statistics from recent large genome-wide association studies to test whether the association between BW and MDD, schizophrenia and ADHD is causal. We employed the inverse variance weighted (IVW) method in conjunction with several other approaches that are robust to possible assumption violations. MR-Egger was used to rule out horizontal pleiotropy. IVW showed that the association between BW and MDD, schizophrenia and ADHD is not causal (all p > .05). The results of all the other MR methods were similar and highly consistent. MR-Egger provided no evidence for pleiotropic effects biasing the estimates of the effects of BW on MDD (intercept = -0.004, SE = 0.005, p = .372), schizophrenia (intercept = 0.003, SE = 0.01, p = .769), or ADHD (intercept = 0.009, SE = 0.01, p = .357). Based on the current evidence, we refute the Barker hypothesis concerning the fetal origins of adult mental disorders. The discrepancy between our results and the results from observational studies may be explained by the effects of confounders in the observational studies, or by the existence of a small causal effect not detected in our study due to weak instruments. Our power analyses suggested that the upper bound for a potential causal effect of BW on mental disorders would likely not exceed an odds ratio of 1.2.

Birth size is not associated with depressive symptoms from adolescence to middle-age: results from the Northern Swedish Cohort study

Low birth weight has been shown to be related to increased risk of depression later in life - but the evidence is not conclusive. We examined the association of size at birth with repeatedly measured depressive symptoms in 947 individuals from the Northern Swedish Cohort, a community-based age-homogeneous cohort born in 1965, and followed with questionnaires between ages 16 and 43 (participation rate above 90% in all the surveys). Information on birth size was retrieved from archived birth records. Length of gestation was known for a subsample of 512 individuals (54%). We studied the association of birth weight and ponderal index with self-reported depressive symptoms at ages 16, 21, 30 and 43; with the life-course average of depressive symptoms score and with longitudinal trajectories of depressive symptoms retrieved by latent class growth analysis. Socioeconomic background, mental illness or alcohol problems of a parent, exposure to social adversities in adolescence and prematurity were accounted for in the analyses. We did not find any relationship between weight or ponderal index at birth and our measure of depressive symptoms between ages 16 and 43 in a series of different analyses. Adjustment for length of gestation did not alter the results. We conclude that size at birth is not associated with later-life depressive symptoms score in this cohort born in the mid-1960s in Sweden. The time and context need to be taken into consideration in future studies.

Neurobiology of depression: A neurodevelopmental approach

OBJECTIVES

The main aims of this paper are to review and evaluate the neurobiology of the depressive syndrome from a neurodevelopmental perspective.

METHODS

An English language literature search was performed using PubMed.

RESULTS

Depression is a complex syndrome that involves anatomical and functional changes that have an early origin in brain development. In subjects with genetic risk for depression, early stress factors are able to mediate not only the genetic risk but also gene expression. There is evidence that endocrine and immune interactions have an important impact on monoamine function and that the altered monoamine signalling observed in the depressive syndrome has a neuro-endocrino-immunological origin early in the development.

CONCLUSIONS

Neurodevelopment is a key aspect to understand the whole neurobiology of depression.

Social dominance predicts hippocampal glucocorticoid receptor recruitment and resilience to prenatal adversity

The developing fetus is highly sensitive to prenatal stress, which may alter Hypothalamic-Pituitary-Adrenal (HPA) axis programming and increase the risk of behavioral disorders. There is high variability among the human population, wherein many offspring of stressed pregnancies display resilience to adversity, while the remainder displays vulnerability. In order to identify biological substrates mediating between resilience or vulnerability to prenatal adversity, we exposed stress-resistant Dominant (Dom) and stress-sensitive Submissive (Sub) mice to mild prenatal restraint stress (PRS, 45 min on gestational days (GD) 15, 16 and 17). We hypothesized that PRS would differentially alter prenatal programming of limbic regions regulating the HPA axis and affect among Dom and Sub offspring. Indeed, PRS increased Sub offspring’s serum corticosterone, and exaggerated their anxiety- and depressive-like behavior, while Dom offspring remained resilient to the hormonal and behavioral consequences of PRS. Moreover, PRS exposure markedly facilitated glucocorticoid receptor (GR) recruitment to the hippocampus among Dom mice in response to restraint stress, which may be responsible for their resilience to stressful challenge. These findings suggest proclivity to adaptive or maladaptive prenatal programming of hippocampal GR recruitment to be inheritable and predictable by social dominance or submissiveness.

Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences

Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of "high-risk" individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their "low-risk" counterparts.

The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: a systematic review

To understand the full extent of the impact of a trial, it is important to consider the long-term consequences of outcomes beyond the trial follow-up period, especially for early year's interventions. A systematic review of the literature associated with the long-term consequences of four key outcomes from the Building Blocks trial, specifically, low birth weight, smoking during pregnancy, interval to subsequent pregnancy and A&E attendance or inpatient admission was conducted. These factors were guided by the funders, the Department of Health, as being of particular interest in the UK context. Relevant studies were identified from a number of sources including large databases, reference checking and citation searching. The search yielded 3665 papers, 43 of which were considered appropriate for inclusion. Of these, 29 were relating to smoking during pregnancy, 13 to low birth weight, 0 to A&E attendances during early childhood and 1 to short (< 2 years) interval to subsequent pregnancy. Consistent associations were found between maternal smoking during pregnancy and the effects this has on children's health, educational attainment and likelihood of engaging in problem behaviour and criminal activity in later life. Low birth weight was also found to impact on children's long-term health and cognitive development. Subsequent pregnancies within two years of the previous birth were linked with increased likelihood of pre-term birth and neonatal death. Only minimal evidence was identified regarding the consequences of a short interval to second pregnancy and of child A&E and outpatient attendances. Given that these outcomes have been identified by the UK Department of Health as of particular interest for UK benefit, investment of research in these areas is recommended to establish a clearer picture of both short and long-term consequences.

Role of Placental VDR Expression and Function in Common Late Pregnancy Disorders

Vitamin D, besides its classical role in bone metabolism, plays a distinct role in multiple pathways of the feto-maternal unit. Calcitriol is the major active ligand of the nuclear vitamin D receptor (VDR). The vitamin D receptor (VDR) is expressed in different uteroplacental parts and exerts a variety of functions in physiologic pregnancy. It regulates decidualisation and implantation, influences hormone secretion and placental immune modulations. This review highlights the role of the vitamin D receptor in physiologic and disturbed pregnancy, as preeclampsia, fetal growth restriction, gestational diabetes and preterm birth. We discuss the existing literature regarding common VDR polymorphisms in these pregnancy disorders.

Effects of maternal stress during pregnancy on learning and memory via hippocampal BDNF, Arc (Arg3.1) expression in offspring

The intrauterine environment has a significant long-term impact on individual's life, this study was designed to investigate the effect of stress during pregnancy on offspring's learning and memory abilities and analyze its mechanisms from the expression of BDNF and Arc in the hippocampus of the offspring. A rat model of maternal chronic stress during pregnancy was mating from 3rd day during been subjecting to chronic unpredictable mild stress (CUMS). The body weights and behavioral changes were recorded, and plasma corticosterone levels were determined by radioimmunoassay. The learning and memory abilities of the offspring were measured by Morris water maze testing from PND 42. The expression of hippocampal BDNF and Arc mRNA and protein were respectively measured using RT-PCR and Western blotting. Results indicated that an elevation was observed in the plasma corticosterone level of rat model of maternal chronic stress during pregnancy, a reduction in the crossing and rearing movement times and the preference for sucrose. The body weight of maternal stress's offspring was lower than the control group, and the plasma corticosterone level was increased. Chronic stress during pregnancy had a significant impact on the spatial learning and memory of the offspring. The expression of BDNF mRNA and protein, Arc protein in offspring of maternal stress during pregnancy was attenuated and some relationships existed between these parameters. Collectively, these findings disclose that long-time maternal stress during pregnancy could destroy spatial learning and memory abilities of the offspring, the mechanism of which is related to been improving maternal plasma corticosterone and reduced hippocampal BDNF, Arc of offspring rats.

Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology

Very preterm birth (VPT; < 32 weeks of gestation) has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset. Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity. However, the etiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies. Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological, and psychosocial factors.

Impact of Early Environment on Children's Mental Health: Lessons From DNA Methylation Studies With Monozygotic Twins

Over the past decade, epigenetic analyses have made important contributions to our understanding of healthy development and a wide variety of adverse conditions such as cancer and psychopathology. There is increasing evidence that DNA methylation is a mechanism by which environmental factors influence gene transcription and, ultimately, phenotype. However, differentiating the effects of the environment from those of genetics on DNA methylation profiles remains a significant challenge. Monozygotic (MZ) twin study designs are unique in their ability to control for genetic differences because each pair of MZ twins shares essentially the same genetic sequence with the exception of a small number of de novo mutations and copy number variations. Thus, differences within twin pairs in gene expression and phenotype, including behavior, can be attributed in the majority of cases to environmental effects rather than genetic influence. In this article, we review the literature showing how MZ twin designs can be used to study basic epigenetic principles, contributing to understanding the role of early in utero and postnatal environmental factors on the development of psychopathology. We also highlight the importance of initiating longitudinal and experimental studies with MZ twins during pregnancy. This approach is especially important to identify: (1) critical time periods during which the early environment can impact brain and mental health development, and (2) the specific mechanisms through which early environmental effects may be mediated. These studies may inform the optimum timing and design for early preventive interventions aimed at reducing risk for psychopathology.

Behavioral epigenetics and the developmental origins of child mental health disorders

Advances in understanding the molecular basis of behavior through epigenetic mechanisms could help explain the developmental origins of child mental health disorders. However, the application of epigenetic principles to the study of human behavior is a relatively new endeavor. In this paper we discuss the 'Developmental Origins of Health and Disease' including the role of fetal programming. We then review epigenetic principles related to fetal programming and the recent application of epigenetics to behavior. We focus on the neuroendocrine system and develop a simple heuristic stress-related model to illustrate how epigenetic changes in placental genes could predispose the infant to neurobehavioral profiles that interact with postnatal environmental factors potentially leading to mental health disorders. We then discuss from an 'Evo-Devo' perspective how some of these behaviors could also be adaptive. We suggest how elucidation of these mechanisms can help to better define risk and protective factors and populations at risk.

Thyroid Function in Pregnancy: What Is Normal?

BACKGROUND

Gestational thyroid dysfunction is common and associated with maternal and child morbidity and mortality. During pregnancy, profound changes in thyroid physiology occur, resulting in different thyroid-stimulating hormone (TSH) and free thyroxine (FT4) reference intervals compared to the nonpregnant state. Therefore, international guidelines recommend calculating trimester- and assay-specific reference intervals per center. If these reference intervals are unavailable, TSH reference intervals of 0.1–2.5 mU/L for the first trimester and 0.2–3.0 mU/L for the second trimester are recommended. In daily practice, most institutions do not calculate institution-specific reference intervals but rely on these fixed reference intervals for the diagnosis and treatment of thyroid disorders during pregnancy. However, the calculated reference intervals for several additional pregnancy cohorts have been published in the last few years and show substantial variation.

CONTENT

We provide a detailed overview of the available studies on thyroid function reference intervals during pregnancy, different factors that contribute to these reference intervals, and the maternal and child complications associated with only minor variations in thyroid function.

SUMMARY

There are large differences in thyroid function reference intervals between different populations of pregnant women. These differences can be explained by variations in assays as well as population-specific factors, such as ethnicity and body mass index. The importance of using correct reference intervals is underlined by the fact that even small subclinical variations in thyroid function have been associated with detrimental pregnancy outcomes, including low birth weight and pregnancy loss. It is therefore crucial that institutions do not rely on fixed universal cutoff concentrations, but calculate their own pregnancy-specific reference intervals.

Placental vitamin D receptor expression is decreased in human idiopathic fetal growth restriction

Fetal growth restriction (FGR) affects up to 5 % of pregnancies worldwide, and trophoblast function plays a significant role on the outcome. An epidemiological study has linked vitamin D deficiency to adverse perinatal outcomes, which include decreased birth weight. The placenta as an important source of vitamin D regulates its metabolism through the vitamin D receptor (VDR), but the mechanism by which VDR regulates trophoblast function is poorly understood. Our study aimed at determining placental VDR expression in FGR and gestation-matched control (GMC) pregnancies and identifying the actions of VDR in trophoblast differentiation and apoptosis. Placentae were collected from a well-defined cohort of idiopathic FGR and GMC pregnancies. VDR mRNA and protein expressions were determined by PCR, immunohistochemistry and immunoblotting, while functional consequences of VDR inactivation in vitro were determined on BeWo cells by determining changes in differentiation, attachment and apoptosis. Significant decreases in VDR mRNA expression (p = 0.0005) and protein expression (p = 0.0003) were observed in the FGR samples, while VDR inactivation, which showed markers for differentiation, cell attachment and apoptosis, was significantly increased. Thus, decreased placental VDR may contribute to uncontrolled premature differentiation and apoptosis of trophoblasts that are characteristics of idiopathic FGR pregnancies.

KEY MESSAGE

Fetal growth restriction (FGR) affects up to 5 % of all pregnancies worldwide. FGR is the second highest cause of perinatal mortality and morbidity. The placenta plays a pivotal role in vitamin D metabolism during pregnancy. Vitamin D deficiency is associated with adverse pregnancy outcomes. Placental vitamin D receptor expression is decreased in FGR.

Epidemiology of child psychopathology: major milestones

Child psychiatric epidemiology has developed rapidly from descriptive, cross-sectional studies in the 1960s to the current large-scale prospective cohorts that unravel aetiological mechanisms. The objective of the study was to give an overview of epidemiological studies that have influenced child psychiatry. A chronological overview of selected major milestone studies was obtained to demonstrate the development of child psychiatric epidemiology, with a more in-depth discussion of findings and methodological issues exemplified in one cohort, the Generation R Study. Epidemiological studies have been successful in describing the frequency and course of child psychiatric problems. The high expectations that biological factors can be used to better explain, diagnose or predict child psychiatric problems have not been met. More ambitious large-scale child psychiatric cohort studies are needed, carefully applying genetics, neuroscience or other molecular research to better understand how the brain produces maladaptive behaviour. Progress will only be attained if the basic sciences are systematically integrated in cohorts with rigorous epidemiological designs rather than hurriedly inserted in child psychiatric studies.

Maternal stress during pregnancy is associated with moderate to severe depression in 11-year-old children

AIM

Maternal stress during pregnancy has been associated with negative outcomes in children. We examined the risk factors for symptoms of depression in 11-year-old children, including the interaction between birthweight and other variables.

METHODS

We collected maternal, obstetric and demographic information from birth through to the age of 11. Approximately, half of the 609 children were born small-for-gestational-age (SGA). Information collected at 3.5 and 7 years of age included intelligence testing and parent-reported behavioural and emotional development. At 11 years of age, the children completed the Center for Epidemiological Studies Depression Scale for Children. Multivariable logistic regression analysis examined the relationship between self-reported symptoms of moderate to severe depression at the age of 11 and explanatory variables.

RESULTS

Symptoms of moderate to severe depression were related to increasing maternal stress during pregnancy, young maternal age, lower intelligence test scores at 7-years-old and being bullied at school in the previous 6 months. There was also a significant interaction between maternal stress in pregnancy and symptoms of depression in 11-year-old children born SGA.

CONCLUSION

Increasing maternal stress during pregnancy was associated with increased risk of symptoms of moderate to severe depression in 11-year-old children, especially those who were born SGA.

Low birth weight, preterm birth and small for gestational age association with adult depression: systematic review and meta-analysis

BACKGROUND

There is no consensus on the effects that low birth weight, premature birth and intrauterine growth have on later depression.

AIMS

To review systematically the evidence on the relationship of low birth weight, smallness for gestational age (SGA) and premature birth with adult depression.

METHOD

We searched the literature for original studies assessing the effect of low birth weight, premature birth and SGA on adult depression. Separate meta-analyses were carried out for each exposure using random and fixed effects models. We evaluated the contribution of methodological covariates to heterogeneity using meta-regression.

RESULTS

We identified 14 studies evaluating low birth weight, 9 premature birth and 4 SGA. Low birth weight increased the odds of depression (OR = 1.39, 95% CI 1.21-1.60). Premature birth and SGA were not associated with depression, but publication bias might have underestimated the effect of the former and only four studies evaluated SGA.

CONCLUSIONS

Low birth weight was associated with depression. Future studies evaluating premature birth and SGA are needed.

Early development, stress and depression across the life course: pathways to depression in a national British birth cohort

BACKGROUND

The aetiology of depression is multifactorial, with biological, cognitive and environmental factors across the life course influencing risk of a depressive episode. There is inconsistent evidence linking early life development and later depression. The aim of this study was to investigate relationships between low birthweight (LBW), infant neurodevelopment, and acute and chronic stress as components in pathways to depression in adulthood.

METHOD

The sample included 4627 members of the National Survey of Health and Development (NSHD; the 1946 British birth cohort). Weight at birth, age of developmental milestones, economic deprivation in early childhood, acute stressors in childhood and adulthood, and socio-economic status (SES) in adulthood were assessed for their direct and indirect effects on adolescent (ages 13 and 15 years) and adult (ages 36, 43 and 53 years) measures of depressive symptoms in a structural equation modelling (SEM) framework. A structural equation model developed to incorporate all variables exhibited excellent model fit according to several indices.

RESULTS

The path of prediction from birthweight to age of developmental milestones to adolescent depression/anxiety to adult depression/anxiety was significant (p < 0.001). Notably, direct paths from birthweight (p = 0.25) and age of developmental milestones (p = 0.23) to adult depression were not significant. Childhood deprivation and stressors had important direct and indirect effects on depression. Stressors in adulthood were strongly associated with adult depression.

CONCLUSIONS

Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.

Risk factors for migraine and tension-type headache in 11 year old children

BACKGROUND

Though migraine and tension type headache are both commonly diagnosed in childhood, little is known about their determinants when diagnosed prior to puberty onset. Our aim was to determine psychosocial- and health-related risk factors of migraine and tension-type headache in 11 year old children.

METHODS

871 New Zealand European children were enrolled in a longitudinal study at birth and data were collected at birth, 1, 3.5, 7, and 11 years of age. Primary headache was determined at age 11 years based on the International Headache Society. Perinatal factors assessed were small for gestational age status, sex, maternal smoking during pregnancy, maternal perceived stress, and maternal school leaving age. Childhood factors assessed were sleep duration, percent body fat, television watching, parent and self-reported total problem behaviour, being bullied, and depression.

RESULTS

Prevalence of migraine and tension-type headache was 10.5% and 18.6%, respectively. Both migraine and TTH were significantly associated with self-reported problem behaviour in univariable logistic regression analyses. Additionally, migraine was associated with reduced sleep duration, and both sleep and behaviour problems remained significant after multivariable analyses. TTH was also significantly associated with antenatal maternal smoking, higher body fat, and being bullied. For TTH, problem behaviour measured at ages 3.5 and 11 years both remained significant after multivariable analysis. Being born small for gestational age was not associated with either headache group.

CONCLUSIONS

Although they share some commonality, migraine and tension-type headache are separate entities in childhood with different developmental characteristics. The association between primary headache and problem behaviour requires further investigation.

Life course adiposity and adolescent depressive symptoms among Hong Kong adolescents

PURPOSE

Depression is a public health issue, which often emerges in adolescence. Adiposity may be a factor in this emergence; however, in Western settings, both adiposity and depression tend to be socially patterned, making it unclear whether any association is biologically based or contextually specific.

METHODS

Multivariable analysis was used to assess the adjusted association of birth weight and life course body mass index (BMI) z score (at 3 and 9 months and 3, 7, 9, 11, and 12 years of age) and changes in BMI z score with adolescent depressive symptoms score at ∼14 years of age, assessed from Patient Health Questionnaire-9 (PHQ-9) in a population-representative Chinese study, Hong Kong's "Children of 1997" birth cohort, which has little social patterning of birth weight or BMI. We also assessed whether associations varied with sex.

RESULTS

PHQ-9 was available for 5,797 term births (73% follow-up). Birth weight z score, BMI z scores at 3 and 9 months and at 3, 7, 9, 11, and 12 years of age, and successive BMI z score changes had little association with PHQ-9 at ∼14 years of age, adjusted for socioeconomic position, parental depressive symptoms, and survey mode.

CONCLUSIONS

In a developed non-Western setting, life course adiposity does not appear to be a factor in the development of depressive symptoms in adolescence, suggesting that observed associations to date may be contextually specific rather than biologically based.

Sex-specific impact of maternal-fetal risk factors on depression and cardiovascular risk 40 years later

Major depressive disorder (MDD) and cardiovascular disease (CVD) represent leading causes of morbidity and mortality worldwide. We tested the hypothesis that growth restriction and preeclampsia (referred to as fetal risk) are significant predictors of these conditions, with women at higher risk in adulthood. Adult offspring exposed to fetal risk factors and their discordant siblings were from two prenatal cohorts, whose mothers were followed through pregnancy and whom we recruited as adults 40 years later (n = 538; 250 males and 288 females). Subjects were psychiatrically diagnosed and underwent a stress challenge during which parasympathetic regulation was assessed by electrocardiogram, operationalized as high-frequency R-R interval variability (HF-RRV). Linear mixed models and generalized estimating equations were used to examine the relationship of fetal risk on HF-RRV, MDD and comorbidity of low HF-RRV (lowest 25th percentile) and MDD, including interactions with sex and socioeconomic status (SES). Fetal risk was significantly associated with low HF-RRV response (F = 3.64, P = 0.05), particularly among low SES (interaction: F = 4.31, P < 0.04). When stratified by MDD, the fetal risk impact was three times greater among MDD compared with non-MDD subjects (effect size: 0.21 v. 0.06). Females had a significantly higher risk for the comorbidity of MDD and low HF-RRV than males (relative risk (RR) = 1.36, 95% CI: 1.07-1.73), an association only seen among those exposed to fetal risk (RR = 1.38, 95% CI: 1.04-1.83). Findings suggest that these are shared fetal antecedents to the comorbidity of MDD and CVD risk 40 years later, an association stronger in females than in males.

A conceptual framework for the developmental origins of health and disease

In the last decades, the developmental origins of health and disease (DOHaD) have emerged as a vigorous field combining experimental, clinical, epidemiological and public health research. Its goal is to understand how events in early life shape later morbidity risk, especially of non-communicable chronic diseases. As these diseases become the major cause of morbidity and mortality worldwide, research arising from DOHaD is likely to gain significance to public health and economic development. But action may be hindered by the lack of a firm mechanistic explanation and of a conceptual basis, especially regarding the evolutionary significance of the DOHaD phenomenon. In this article, we provide a succinct historical review of the research into the relationship between development and later disease, consider the evolutionary and developmental significance and discuss the underlying mechanisms of the DOHaD phenomenon. DOHaD should be viewed as a part of a broader biological mechanism of plasticity by which organisms, in response to cues such as nutrition or hormones, adapt their phenotype to environment. These responses may be divided into those for immediate benefit and those aimed at prediction of a future environment: disease occurs in the mismatch between predicted and realized future. The likely mechanisms that enable plasticity involve epigenetic processes, affecting the expression of genes associated with regulatory pathways. There is now evidence that epigenetic marks may be inherited and so contribute to non-genomic heritable disease risk. We end by discussing the global significance of the DOHaD phenomenon and its potential applications for public health purposes.

Growth restriction alters adult spatial memory and sensorimotor gating in a sex-specific manner

In Western society, impaired uteroplacental blood flow is the major cause of human intrauterine growth restriction. Infants born small and who experience late childhood accelerated growth have an increased risk of developing adult diseases. Recent studies also suggest a link between birth weight and altered adult behavior, particularly relating to motor function, learning and memory, depression and schizophrenia. The aim of this study was to determine the relative influence of prenatal and postnatal growth restriction on adult behavioral outcomes in male and female rats. Uteroplacental insufficiency was induced in Wistar Kyoto rats by bilateral uterine vessel ligation on day 18 of gestation producing growth-restricted offspring (Restricted group). The Control group had sham surgery. Another group underwent sham surgery, with a reduction in litter size to five at birth equivalent to the Restricted litter size (Reduced Litter group). At 6 months of age, a series of behavioral tests were conducted in male and female offspring. Growth restriction did not impair motor function. In fact, Restricted and Reduced Litter males showed enhanced motor performance compared with Controls (P < 0.05). Spatial memory was greater in Restricted females only (P < 0.05). The Porsolts test was unremarkable, however, males exhibited more depressive-like behavior than females (P < 0.05). A reduction in sensorimotor gating function was identified in Reduced Litter males and females (P < 0.05). We have demonstrated that growth restriction and/or a poor lactational environment can affect adult rat behavior, particularly balance and coordination, memory and learning, and sensorimotor gating function, in a sex-specific manner.

[Prenatal sex-specific programming and chronic diseases or Finis Ab Orígine Pendet]

An increasing incidence of chronic immune diseases such as allergies, multiple sclerosis, and type 2 diabetes, as well as obesity and cardiovascular and psychiatric disorders has been reported over the last five decades. Since the human genome has not altered significantly over this period of time, gene-environment interactions are suspected to be responsible for these increased disease incidences. In this context, the prenatal period is believed to significantly contribute to altered disease susceptibilities, which could be associated with environmental factors to which pregnant women were exposed to. This observation has led to a concept entitled 'developmental origin of health and disease', a topic that is enjoying much attention in clinical and basic science research. The aim of these research endeavors is to postulate guidelines for primary disease prevention. Whilst the emerging insights from this field of research provide significant pieces of the puzzle, one area is still largely neglected: the clear identification of a sex-specific programming effect. Thus it is essential that such an approach becomes fully integrated in future research goals.