Maternal depression and atopic dermatitis in children linked
January 21, 2020
Science Daily/George Washington University
A recent study suggests that maternal depression in the postpartum period, and even beyond, is associated with the development of atopic dermatitis throughout childhood and adolescence.
Maternal depression in the postpartum period, and even beyond, is associated with the development of atopic dermatitis (AD) throughout childhood and adolescence, according to a recent study published in the journal Dermatitis.
AD is a chronic, inflammatory skin disease typically characterized by itch, pain, and sleep disturbance. It has also been strongly linked to a number of mental health disorders, such as depression, anxiety, and suicidal ideation.
The study, led by Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at the George Washington University School of Medicine and Health Sciences, examined the association of maternal depression in the postpartum period, and maternal and paternal depression in later childhood with AD in U.S. children and adolescents.
Silverberg conducted the data acquisition, analysis, and interpretation at Northwestern University Feinberg School of Medicine, in collaboration with first author Costner McKenzie, a medical student at Northwestern.
"We know that emotional factors can exacerbate AD flares and influence the course of the disease," said Silverberg, the senior author of the study. "Previous studies have shown that family environment and other environmental factors can have an impact on AD."
The researchers analyzed data from the Fragile Families and Child Wellbeing Study. They found that postpartum depression was associated with higher odds of AD developing later in childhood, more persistent AD, and increased sleep disturbance among children with AD.
"Our results further suggest that postpartum depression is associated with AD even in older children and adolescents, with more persistent disease and greater sleep disturbance," Silverberg said. "This could potentially suggest more severe AD."
Continued research is needed, according to the researchers, to confirm the associations found, determine underlying mechanisms, and identify appropriate interventions. The authors of the study suggest that pediatricians should consider screening and early intervention for postpartum depression to identify infants at higher risk for AD.
Children born to mothers with depression in the postpartum period and beyond may warrant increased screening for AD and atopic disease, as well as use of gentle skin care and other strategies to mitigate AD.
https://www.sciencedaily.com/releases/2020/01/200121133312.htm
New way to think about brain's link to postpartum depression
Research in animals shows brain's immune system is activated by stress during pregnancy
October 21, 2019
Science Daily/Ohio State University
Chronic stress during pregnancy triggers an immune response in the brain that has potential to alter brain functions in ways that could contribute to postpartum depression, new research in animals suggests.
The study is the first to show evidence of this gestational stress response in the brain, which is unexpected because the immune system in both the body and the brain is suppressed during a normal pregnancy.
The Ohio State University researchers who made the discovery have been studying the brain biology behind postpartum depression for several years, creating depressive symptoms in pregnant rats by exposing them to chronic stress. Chronic stress during pregnancy is a common predictor of postpartum depression, which is characterized by extreme sadness, anxiety and exhaustion that can interfere with a mother's ability to care for herself or her baby.
Stress is known to lead to inflammation, which prompts an immune response to protect against inflammation's harmful effects. Based on what they already know about compromised brain signaling in rats stressed during pregnancy, the scientists suspect the immune cells in the brain responding to stress may be involved. If that's the case, the immune changes may create circumstances in the brain that increase susceptibility to depression.
In unstressed pregnant rats, the normal suppression of the immune system in the body and the brain remained intact throughout pregnancy. In contrast, stressed rats showed evidence of neuroinflammation. The study also showed that the stressed rats' immune response in the rest of their bodies was not active.
"That suggests there's this disconnect between what's happening in the body and what's happening in the brain," said Benedetta Leuner, associate professor of psychology at Ohio State and lead author of the study. She speculated that the signaling changes her lab has seen before in the brain and this immune response are happening in parallel, and may be directly related.
Leuner presented the findings Saturday (Oct. 19, 2019) at the Society for Neuroscience meeting in Chicago.
In this work, rats are exposed to unpredictable and varied stressful events throughout their pregnancies, a practice that adds a component of psychological stress but does not harm the health of the mother or her offspring.
In the stressed animals, the researchers found numerous pro-inflammatory compounds that indicated there was an increase in the number and activity levels of the primary immune cells in the brain called microglia. Their findings also suggested the microglia were affecting brain cells in the process.
Leuner's lab previously determined in rats that chronic stress during pregnancy prevented motherhood-related increases in dendritic spines, which are hair-like growths on brain cells that are used to exchange information with other neurons. These same rats behaved in ways similar to what is seen in human moms with postpartum depression: They had less physical interaction with their babies and showed depressive-like symptoms.
Leuner and colleagues now plan to see whether the brain immune cells activated during gestational stress are responsible for the dendritic spine elimination. They suspect that microglia might be clearing away synaptic material on dendrites.
Leuner has partnered on this research with Kathryn Lenz, assistant professor of psychology at Ohio State, whose work explores the role of the immune system in brain development.
Though pregnancy was known to suppress the body's immune system, Lenz and Leuner showed in a previous study that the same suppression of the immune system happens in the brain during pregnancy -- the number of microglia in the brain decreases.
"By layering gestational stress onto a normal pregnancy, we're finding this normal immunosuppression that should happen during pregnancy doesn't occur, and in fact there's evidence of inflammatory signaling in the brain that could be bad for dendritic spines and synapses," Lenz said. "But we've also found changes in the microglia's appetite. Every characteristic we've looked at in these cells has changed as a result of this stress."
The researchers are now trying to visualize microglia while they're performing their cleanup to see if they are eating synaptic material. They are also manipulating inflammatory changes in the brain to see if that reverses postpartum depression-like behavior in rats.
"We've seen the depressive-like symptoms and neural changes in terms of dendritic spines and synapses, and now we have neuroimmune changes suggesting that those microglia could be contributing to the neural changes -- which we think ultimately underlie the behaviors," Leuner said.
The research was supported by the National Institutes of Health
https://www.sciencedaily.com/releases/2019/10/191021151538.htm
Mothers of fussy babies at higher risk of depressive symptoms
March 25, 2019
Science Daily/Michigan Medicine - University of Michigan
As FDA approval of the first postpartum depression drug hits the news, study looks at how infant fussiness and a baby's level of prematurity may influence the severity of maternal depressive symptoms.
It's no secret that fussy newborns can be especially challenging for parents already facing physical and mental exhaustion from caring for a new baby.
But now science backs up the impact on parents: The less soothable the infant, the more distressed the mother.
Mothers of highly irritable infants experience greater depressive symptoms, according to new University of Michigan-led research. The nationally representative study, which included data from more than 8,200 children and their parents, appears in Academic Pediatrics.
The study is also believed to be the first to explore whether the degree of a baby's prematurity in combination with infant fussiness may influence the severity of maternal depressive symptoms.
Researchers found that mothers of very preterm, fussy infants (born at 24-31 weeks) had about twice the odds of experiencing mild depressive symptoms compared to moms of very preterm infants without fussiness.
However, mothers of fussy babies born moderate-late preterm (32-36 weeks gestation) as well as mothers of full-term infants were about twice as likely to report moderate to severe depressive symptoms as moms of less irritable babies born at the same gestational age.
"We found that maternal depression risk varied by gestational age and infant fussiness," says senior author Prachi Shah, M.D., a developmental and behavioral pediatrician at U-M C.S. Mott Children's Hospital and an associate research scientist at U-M's Center for Human Growth and Development. "Mothers of fussy infants born late preterm and full term are more likely to experience more severe levels of maternal depression, than mothers of fussy infants who were born more preterm."
"These findings reinforce that all mothers caring for babies with more difficult temperaments may need extra help managing the emotional toll," she adds. "Early screening for infant fussiness may help identify mothers with depressive symptoms in need of support, but may be especially important for mothers of infants born mildly preterm, in whom the symptoms of depression are more severe."
Shah notes that while very preterm infants have higher morbidity than babies born later, the perinatal care of infants born very preterm may actually help buffer against more severe maternal depression.
Very preterm infants are often cared for in a neonatal ICU setting where part of the specialized care includes guidance focused on the vulnerabilities associated with preterm birth. As parents transition home they often receive an enhanced level of postnatal support and developmental follow up, including referrals to early intervention programs, home visiting and subsequent care in neonatal clinics.
"The additional support and services provided to families of very premature children help prepare parents for the potential challenges associated with caring for a preterm infant and may help mitigate the risk for maternal depressive symptoms," Shah says.
However, she notes that mild depressive symptoms may progress into more severe depressive symptoms, and should also be addressed as early as possible.
Additionally, researchers found that maternal characteristics associated with prenatal stress and socioeconomic disadvantages -- such as lower income, unmarried status and smoking -were associated with greater odds of both mild and moderate-severe maternal depressive symptoms.
Asian and black race were also associated with greater odds of moderate-severe depressive symptoms whereas Hispanic ethnicity was associated with lower odds of maternal depression. Authors say this raises questions regarding the role of culture as a potential risk or protective factor in the development of maternal depression.
The study included data from the Early Childhood Longitudinal Study, Birth Cohort. Maternal depressive symptoms were assessed through self-reported questionnaires at the baby's nine-month visit.
The study adds to previous research suggesting that mothers of more irritable infants report significantly less confidence and more stress than mothers of less fussy infants.
"Pediatricians and providers should pay close attention to mothers who describe difficulty soothing their babies," Shah says. "Early interventions may help reduce the risk of maternal depression that negatively impacts a child-parent relationship and that may be harmful to both the health of a mother and child."
https://www.sciencedaily.com/releases/2019/03/190325110321.htm
Forgotten fathers: New dads also at risk for postpartum depression
Study provides an in-depth look at new fathers' experiences with PPD
March 7, 2019
Science Daily/University of Nevada, Las Vegas
A new study offers an in-depth view of new fathers' experiences with postpartum depression (PPD). The study explores issues they encounter and how they can move beyond barriers they face in receiving diagnoses and treatment of the little-known phenomenon.
It's increasingly common to hear about new moms suffering from the baby blues. But what about new dads?
A new UNLV study, published last week in the Journal of Family Issues, offers an in-depth view of new fathers' experiences with postpartum depression (PPD). The study explores issues they encounter and how they can move beyond barriers they face in receiving diagnoses and treatment of the little-known phenomenon.
Between 5 and 10 percent of new fathers in the United States suffer from PPD, according to U.S. Centers for Disease Control and Prevention data. One study shows that the risk goes up to 24 to 50 percent for men whose partners suffer from PPD.
A team of researchers, led by UNLV Couple and Family Therapy professor Brandon Eddy, scoured blogs, websites, forums, and chat rooms for first-hand accounts from new dads. Six themes emerged:
· Needing education.Fathers didn't know men could suffer from PPD and were surprised to learn others experienced it. Women who saw PPD in men were unsure of what to call it. Men complained about pushback or not receiving information from doctors or therapists, or frustration that the PPD resources they did manage to find focused solely on how to help their wives.
· Adhering to gender expectations. Many dads felt pressured to espouse traditional "tough guy" stereotypes. In fact, one man who told another father to "suck it up" said he knew it was bad advice but explained that it's what's expected of men.
· Repressing feelings.Men were reluctant to share their feelings for fear of sounding ridiculous or looking weak to their wives, who were the primary caregivers.
· Overwhelmed.Many of the new dads found it difficult to express their emotions of confusion, exhaustion, helplessness, loneliness, and feeling trapped. Parents often suffer from lack of sleep after birth, which can exacerbate stress and depressive symptoms -- making them more irritable to their children's crying.
· Resentment of baby.While many fathers expressed joy and excitement for the arrival of their children, others resented their baby's constant needs and attention. A few talked about suppressing urges to hurt the baby or themselves.
· Experience of neglect.The dads felt lost, forgotten, and neglected -- by their wives, the health care system, and society. One father described "uncomfortably laughing" while reading PPD screening questions typically asked of women during routine checkups: "I began to feel like someone should be asking me the same questions." Another said men, who must simply wait while women do the hard work of pregnancy and labor and lack an umbilical cord connection to their children, had often shared with him similar stories of struggling with PPD: "There's no truly acceptable place or context for men to publicly reveal being challenged -- much less rocked to the core -- by what I call 'sudden parenthood'."
Overall, the findings complement previous studies on barriers for fathers suffering from PPD. UNLV researchers said encountering a lack of information and stigma often causes dads to distance themselves from their child and has been associated with marital difficulties.
Previous research elsewhere has found that paternal involvement has many positive outcomes for children, such as boys displaying less hostile behavior then children with absent dads, reduced delinquency for both sexes, considerably higher IQ scores for children in their early development years, and lower levels of emotional distress. That's on top of studies showing fathers who suffer from PPD report lower levels of communication with their partners, as well as increased rates of substance abuse and domestic violence.
"The expectations society gives to men of what they are supposed to be, what they are supposed to do, and how they do it was a significant factor on how many of these men chose to cope with life stressors," the UNLV researchers wrote.
"Because men are already less likely than women to seek professional help for depression, it is vital that the stigma of PPD decreases," they added. "Because paternal involvement is a significant factor in the healthy development of children, it would seem wise to make information about paternal PPD more available in order to combat its negative impact on families."
The U.S. Preventative Services Task Force -- an independent coalition of national experts -- recently recommended that all women be screened for depression before and after giving birth. There is no current assessment designed to specifically screen men for PPD.
"With the vast amount of research conducted on the importance of paternal involvement and the rising rates of PPD in fathers," researchers wrote, "it seems logical that fathers should also be included in this recommendation."
https://www.sciencedaily.com/releases/2019/03/190307091448.htm
Postpartum depression linked to mother's pain after childbirth
New study underscores importance of managing pain during recovery
Science Daily/October 14, 2018
American Society of Anesthesiologists
While childbirth pain has been linked to postpartum depression, the culprit may be the pain experienced by the mother following childbirth, rather than during the labor and delivery process.
Previous research has demonstrated the pain associated with giving birth may increase the risk of postpartum depression but has not specified which part of the labor process (e.g., before, during or after delivery) may be the source of the problem. This is the first study to differentiate postpartum pain from labor and delivery pain and identify it as a significant risk factor for postpartum depression.
"For many years, we have been concerned about how to manage labor pain, but recovery pain after labor and delivery often is overlooked," said Jie Zhou, M.D., M.B.A., lead author of the study and assistant professor of anesthesia at Brigham and Women's Hospital and Harvard Medical School, Boston. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."
Symptoms of postpartum depression -- including extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns -- affect about 1 in 9 women, according to the Centers for Disease Control and Prevention (CDC). Postpartum depression can lead to lower rates of breastfeeding and poor bonding with the baby.
In the study, Dr. Zhou's research group reviewed pain scores (from the start of labor to hospital discharge) for 4,327 first-time mothers delivering a single child vaginally or by cesarean delivery (C-section) at Brigham and Women's Hospital between June 1, 2015 and Dec. 31, 2017. They compared pain scores to the mothers' Edinburgh postnatal depression scale (EPDS) scores one week after delivery.
Dr. Zhou found postpartum depression was significantly associated with higher postpartum pain scores. Mothers with postpartum depression demonstrated more pain-related complaints during recovery and often needed additional pain medication. Women in the postpartum depression group were more likely to have delivered by C-section. They also had more reports of inadequate postpartum pain control.
A number of factors can contribute to postpartum depression. Researchers determined postpartum depression was higher among women who were overweight or obese; who suffered from a torn perineum (the area adjacent to the vaginal opening); who had a history of depression, anxiety or chronic pain; and whose babies were smaller and had lower Apgar scores, a scoring system used to assess the physical health of newborns one minute and five minutes after birth.
"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain," said Dr. Zhou. "We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care."
https://www.sciencedaily.com/releases/2018/10/181014142700.htm
Hair cortisol levels predict which mothers are more likely to suffer postpartum depression
November 13, 2017
Science Daily/University of Granada
Researchers from the University of Granada (UGR), who belong to the Brain, Mind and Behavior Research Center (CIMCYC, from its abbreviation in Spanish) and the Faculty of Psychology, have proven that cortisol levels (a steroid hormone secreted as a response to stress) present in the hair of pregnant women during the first or third trimesters of pregnancy may indicate which of them are more likely to suffer postpartum depression.
Their work, published in the PLoS ONE journal, showed that hair cortisol levels in women who developed postpartum depression were higher throughout pregnancy than those seen in women who hadn't developed it, being that difference statistically more significant during the first and third trimesters.
The UGR researchers carried out their study doing a follow-up on 44 pregnant women throughout the whole gestation period and after giving birth. Each trimester the mothers underwent a series of tests that evaluated their stress and psychopathological symptoms while simultaneously taking hair samples from which the researchers extracted the cortisol corresponding to the last three months.
The following days after labor the researchers evaluated the mothers' emotional state in order to assess who among them had developed postpartum depression.
Quarterly psychopathological symptoms
Additionally, the results of the study showed that the participants which developed postpartum depression showed higher levels of somatization during the first trimester. During the second trimester they showed higher levels of somatization, obsession-compulsion, depression and anxiety, and during the third trimester they showed higher levels of somatization and pregnancy-specific stress. Therefore, all those symptoms along with higher levels of cortisol would be indicators of a future postpartum depression.
As María Isabel Peralta Ramírez, lead researcher of the project says, the consequences of those results are very important in the prevention of postpartum depression, "since they show that there are various altered psychological and hormonal variables throughout the whole gestation period in comparison to those women who will not suffer postpartum depression. Detecting those differences is the key to anticipate the psychological state of the mother as well as the consequences for the baby that said state could mean."
This study belongs to the GESTASTRESS research project, in the research excellence framework of the Spanish Ministry of Economy and Competitiveness. Its primary goal has been to assess the effects of psychological stress on the mother throughout the whole gestation period as well as on birth variables, and on the baby's stress and neurodevelopment.
https://www.sciencedaily.com/releases/2017/11/171113111040.htm
Postpartum depression risk, duration and recurrence
September 26, 2017
Science Daily/PLOS
Postpartum affective disorder (AD), including postpartum depression (PPD), affects more than one in two hundred women with no history of prior psychiatric episodes, and raises the risk of later affective disorder for those women, according to a new study.
PPD is estimated to affect more than 5 percent of all women following childbirth, making it the most common postnatal complication of childbearing. In the new study, researchers analyzed data from the Danish national registries on 457,317 women who had a first child (and subsequent births) between 1996 and 2013 and had no prior psychiatric hospital contacts or use of antidepressants. Postpartum AD was defined as an antidepressant prescription fill or hospital contact for depression within six months after birth.
In the Danish cohort, 0.6% of all childbirths among women with no history of psychiatric disease led to postpartum AD. A year after their first treatment, 27.9% of these women were still in treatment; after four years, that number was 5.4%. For women with a hospital contact for depression after a first birth, the risk of postpartum AD recurrence was 21%; the recurrence was 15% for women who took antidepressants after a first birth. These rates mean that, compared to women without history of AD, postpartum AD is 46 and 27 times higher in subsequent births for women with postpartum AD after their first birth.
"These population-based figures provide valuable guidance to physicians treating women with PPD," the authors say. "It underlines the seriousness of single initial episodes and highlights the necessity of both primary and secondary preventive measures of which several exist."
https://www.sciencedaily.com/releases/2017/09/170926143559.htm
Postpartum depression least severe form of depression in mothers
Time frame when pregnant woman first develops depression determines severity, treatment of it
June 15, 2016
Science Daily/Northwestern University
Postpartum depression -- a household term since actress Brooke Shields went public in 2005 about her struggle with it -- is indeed serious. But depression that begins before or during pregnancy is often more severe because it lasts longer and usually goes undetected until the doctor screens for it after the birth of the baby, according to a new study.
Deciphering the onset time can impact how the doctor treats the woman's depression, such as intervening earlier with psychiatric help, if needed, said Sheehan Fisher, the study's corresponding author and an instructor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
"There's a difference between postpartum depression and depression that started before or during the pregnancy. It's not a homogenous disorder, " Fisher said. "When clinicians see a mother during the postpartum period and diagnose her with depression, it's important for them to ask how long this depression has been an issue so they can assess the longevity and severity."
The study, recently published in the Journal of Affective Disorders, is one of the first to evaluate the rate of depression in mothers at the three onset time points: 24.9 percent of participants developed depression pre-pregnancy, 36.7 percent developed it during pregnancy (prenatal) and 38.4 percent developed depression during the postpartum period.
Mothers who develop depression during the postpartum period are more likely to be Caucasian, older, educated, married or cohabitating, and have private health insurance than mothers whose depression begins before or during pregnancy, the study found.
"Mothers who develop postpartum depression often experience protective risk factors such as better access to resources, fewer children and are more mature, which helps them adapt to the stress of pregnancy," Fisher said. "Once their babies are born, they show more obsessive-compulsive symptoms--like over-worrying about their baby's health--than mothers who developed depression before or during pregnancy."
Women who had depression before they became pregnant were more likely to experience hypersomnia or difficulty falling asleep. They also experienced more symptoms of paranoia, such as a psychotic episode, than women who developed depression during or after pregnancy. And they had a higher severity of postpartum depression than the other onset periods.
The proportion of mothers who had a bipolar disorder, which Fisher said is more severe than unipolar depression, was significantly higher among mothers whose depression onset was during the pre-pregnancy period (38.7 percent), compared with prenatal (22.6 percent) and postpartum (17.9 percent).
Agitation was the distinctive factor that differentiated mothers with unipolar and bipolar depression in the study. Mothers who had a bipolar disorder and developed depression during her pregnancy exhibited the highest amount of agitation.
The study evaluated depression symptoms during the four- to six-week postpartum period for 727 women from an urban women's hospital in Pittsburgh, Penn. This period was chosen because women typically visit their doctors for post-birth evaluations six weeks after birth, and the four- to six-week epoch is associated with the highest depression onset.
https://www.sciencedaily.com/releases/2016/06/160615142624.htm
Easing labor pain may help reduce postpartum depression in some women
October 26, 2016
Science Daily/American Society of Anesthesiologists (ASA)
Epidural anesthesia may do more than relieve pain during labor; in some women it may decrease the likelihood of postpartum depression, suggests a preliminary study.
"Labor pain matters more than just for the birth experience. It may be psychologically harmful for some women and play a significant role in the development of postpartum depression," said Grace Lim, M.D., director of obstetric anesthesiology at Magee Women's Hospital of the University of Pittsburgh Medical Center and lead investigator on the study. "We found that certain women who experience good pain relief from epidural analgesia are less likely to exhibit depressive symptoms in the postpartum period."
The researchers controlled for factors already known to increase the risk for postpartum depression, including pre-existing depression and anxiety, as well as post-delivery pain caused by tissue trauma during childbirth. After accounting for these factors, the study found that in some women, labor pain was still a significant risk factor for postpartum depression symptoms. And therefore, alleviating this pain might help reduce the risk for postpartum depression.
In the study, researchers reviewed the medical records of 201 women who used epidural analgesia and had their pain assessed using a 0-10 scale during labor. They calculated the percent improvement in pain (PIP) throughout labor after the implementation of epidural analgesia. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) six weeks after childbirth. Researchers found the higher the PIP scores, the lower the EPDS scores.
"Although we found an association between women who experience less pain during labor and lower risk for postpartum depression, we do not know if effective pain control with epidural analgesia will assure avoidance of the condition," said Dr. Lim. "Postpartum depression can develop from a number of things including hormonal changes, psychological adjustment to motherhood, social support, and a history of psychiatric disorders."
Labor pain may be more problematic for some women than others, the authors note. Additional research is needed to identify which women are more likely to experience severe labor pain and who would benefit the most from effective labor pain-control strategies to help reduce the risk and impact of pain on postpartum recovery.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/10/161026113938.htm
Low levels of 'anti-anxiety' hormone linked to postpartum depression
Effect measured in women already diagnosed with mood disorders
March 14, 2017
Science Daily/Johns Hopkins Medicine
In a small-scale study of women with previously diagnosed mood disorders, researchers report that lower levels of the hormone allopregnanolone in the second trimester of pregnancy were associated with an increased chance of developing postpartum depression in women already known to be at risk for the disorder.
In a report on the study, published online on March 7 in Psychoneuroendocrinology, the researchers say the findings could lead to diagnostic markers and preventive strategies for the condition, which strikes an estimated 15 to 20 percent of American women who give birth.
The researchers caution that theirs was an observational study in women already diagnosed with a mood disorder and/or taking antidepressants or mood stabilizers, and does not establish cause and effect between the progesterone metabolite and postpartum depression. But it does, they say, add to evidence that hormonal disruptions during pregnancy point to opportunities for intervention.
Postpartum depression affects early bonding between the mother and child. Untreated, it has potentially devastating and even lethal consequences for both. Infants of women with the disorder may be neglected and have trouble eating, sleeping and developing normally, and an estimated 20 percent of postpartum maternal deaths are thought to be due to suicide, according to the National Institute of Mental Health.
"Many earlier studies haven't shown postpartum depression to be tied to actual levels of pregnancy hormones, but rather to an individual's vulnerability to fluctuations in these hormones, and they didn't identify any concrete way to tell whether a woman would develop postpartum depression," says Lauren M. Osborne, M.D., assistant director of the Johns Hopkins Women's Mood Disorders Center and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "For our study, we looked at a high-risk population of women already diagnosed with mood disorders and asked what might be making them more susceptible."
For the study, 60 pregnant women between the ages of 18 and 45 were recruited by investigators at study sites at The Johns Hopkins University and the University of North Carolina at Chapel Hill. About 70 percent were white and 21.5 percent were African-American. All women had been previously diagnosed with a mood disorder, such as major depression or bipolar disorder. Almost a third had been previously hospitalized due to complications from their mood disorder, and 73 percent had more than one mental illness.
During the study, 76 percent of the participants used psychiatric medications, including antidepressants or mood stabilizers, and about 75 percent of the participants were depressed at some point during the investigation, either during the pregnancy or shortly thereafter.
During the second trimester (about 20 weeks pregnant) and the third trimester (about 34 weeks pregnant), each participant took a mood test and gave 40 milliliters of blood. Forty participants participated in the second-trimester data collection, and 19 of these women, or 47.5 percent, developed postpartum depression at one or three months postpartum. The participants were assessed and diagnosed by a clinician using criteria from the Diagnostic and Statistical Manual of Mental Disorders, version IV for a major depressive episode.
Of the 58 women who participated in the third-trimester data collection, 25 of those women, or 43.1 percent, developed postpartum depression. Thirty-eight women participated in both trimester data collections.
Using the blood samples, the researchers measured the blood levels of progesterone and allopregnanolone, a byproduct made from the breakdown of progesterone and known for its calming, anti-anxiety effects.
The researchers found no relationship between progesterone levels in the second or third trimesters and the likelihood of developing postpartum depression. They also found no link between the third-trimester levels of allopregnanolone and postpartum depression. However, they did notice a link between postpartum depression and diminished levels of allopregnanolone levels in the second trimester.
For example, according to the study data, a woman with an allopregnanolone level of 7.5 nanograms per milliliter had a 1.5 percent chance of developing postpartum depression. At half that level of hormone (about 3.75 nanograms per milliliter), a mother had a 33 percent likelihood of developing the disorder. For every additional nanogram per milliliter increase in allopregnanolone, the risk of developing postpartum depression dropped by 63 percent.
"Every woman has high levels of certain hormones, including allopregnanolone, at the end of pregnancy, so we decided to look earlier in the pregnancy to see if we could tease apart small differences in hormone levels that might more accurately predict postpartum depression later," says Osborne. She says that many earlier studies on postpartum depression focused on a less ill population, often excluding women whose symptoms were serious enough to warrant psychiatric medication -- making it difficult to detect trends in those women most at risk.
Because the study data suggest that higher levels of allopregnanolone in the second trimester seem to protect against postpartum depression, Osborne says in the future, her group hopes to study whether allopregnanolone can be used in women at risk to prevent postpartum depression. She says Johns Hopkins is one of several institutions currently participating in a clinical trial led by Sage Therapeutics that is looking at allopregnanolone as a treatment for postpartum depression.
She also cautions that additional and larger studies are needed to determine whether women without mood disorders show the same patterns of allopregnanolone levels linked to postpartum depression risk.
If those future studies confirm a similar impact, Osborne says, then tests for low levels of allopregnanolone in the second trimester could be used as a biomarker to predict those mothers who are at risk of developing postpartum depression.
Osborne and her colleagues previously showed and replicated in Neuropsychopharmacology in 2016 that epigenetic modifications to two genes could be used as biomarkers to predict postpartum depression; these modifications target genes that work with estrogen receptors and are sensitive to hormones. These biomarkers were already about 80 percent effective at predicting postpartum depression, and Osborne hopes to examine whether combining allopregnanolone levels with the epigenetic biomarkers may improve the effectiveness of the tests to predict postpartum depression.
Of note and seemingly contradictory, she says, many of the participants in the study developed postpartum depression while on antidepressants or mood stabilizers. The researchers say that the medication dosages weren't prescribed by the study group and were monitored by the participant's primary care physician, psychiatrist or obstetrician instead. "We believe that many, if not most, women who become pregnant are undertreated for their depression because many physicians believe that smaller doses of antidepressants are safer for the baby, but we don't have any evidence that this is true," says Osborne. "If the medication dose is too low and the mother relapses into depression during pregnancy or the postpartum period, then the baby will be exposed to both the drugs and the mother's illness."
Osborne and her team are currently analyzing the medication doses used by women in this study to determine whether those given adequate doses of antidepressants were less likely to develop symptoms in pregnancy or in postpartum.
Only 15 percent of women with postpartum depression are estimated to ever receive professional treatment, according to the U.S. Centers for Disease Control and Prevention. Many physicians don't screen for it, and there is a stigma for mothers. A mother who asks for help may be seen as incapable of handling her situation as a mother, or may be criticized by friends or family for taking a medication during or shortly after pregnancy.