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Schoretsanitis G, Deligiannidis KM. Prenatal complications and neurodevelopmental outcomes in offspring: interactions and confounders. Acta Psychiatr Scand 2020; 142:261-263. [PMID: 32956487 DOI: 10.1111/acps.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- G Schoretsanitis
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - K M Deligiannidis
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Departments of Obstetrics & Gynecology and Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,The Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Buglione-Corbett R, Deligiannidis KM, Leung K, Zhang N, Lee M, Rosal MC, Moore Simas TA. Expression of inflammatory markers in women with perinatal depressive symptoms. Arch Womens Ment Health 2018; 21:671-679. [PMID: 29603018 DOI: 10.1007/s00737-018-0834-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/21/2018] [Indexed: 01/05/2023]
Abstract
Perinatal depression affects 10-20% of women and is associated with poor outcomes for mother and child. Inflammation is associated with depression in non-pregnant adults. Perinatal depression and inflammation in pregnancy are independently associated with morbidities including obesity, gestational diabetes, preeclampsia, and preterm birth. The role of inflammation in perinatal depression has received little attention. We hypothesized an association between self-reported perinatal depressive symptoms and serum inflammatory biomarkers TNF-α, IL-6, IL-1β, and CRP. 110 healthy gravidas were recruited in third trimester from an academic medical center, with a baseline study visit at a mean of 32.5 (SD ± 1.8) weeks gestational age. Sixty-three participants completed the Edinburgh Postnatal Depression Scale (EPDS) and provided demographic information and serum samples upon enrollment and at 3 and 6 months postpartum. Serum inflammatory markers were quantified by multiplex array. Multiple linear mixed effects models were used to evaluate trends of biomarkers with the EPDS score in the third trimester of pregnancy and the postpartum period. Elevated serum TNF-α was associated with lower EPDS total score (β = - 0.90, p = 0.046) after adjusting for demographics and medication use. In contrast, IL-6, CRP, and IL-1β did not demonstrate statistically significant associations with depressive symptoms by the EPDS in either crude or adjusted models. Study findings showed no association or an inverse (TNF-α) association between inflammatory markers and perinatal depressive symptoms. Relevant literature evaluating a role for inflammation in depression in the unique context of pregnancy is both limited and inconsistent, and further exploration is merited.
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Affiliation(s)
- R Buglione-Corbett
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA.
| | - K M Deligiannidis
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - K Leung
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
| | - N Zhang
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - M Lee
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - M C Rosal
- Department of Medicine, Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - T A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, 119 Belmont Street, Worcester, MA, 01605, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis KM, Devouche E, Epperson CN, Guille C, Kim D, Lichtenstein P, Magnusson PKE, Martinez P, Munk-Olsen T, Newport J, Payne J, Penninx BW, O’Hara M, Robertson-Blackmore E, Roza SJ, Sharkey KM, Stuart S, Tiemeier H, Viktorin A, Schmidt PJ, Sullivan PF, Stowe ZN, Wisner KL, Jones I, Rubinow DR, Meltzer-Brody S. The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale. Psychol Med 2017; 47:787-799. [PMID: 27866476 PMCID: PMC5369767 DOI: 10.1017/s0033291716002087] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
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Affiliation(s)
- A. Di Florio
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - K. Putnam
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - G. Apter
- Erasme Hospital, Paris Diderot University, Paris, France
| | - V. Bergink
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Bilszta
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - R. Brock
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - A. Buist
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. M. Deligiannidis
- Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA
| | - E. Devouche
- Erasme Hospital, Paris Descartes University, Paris, France
| | - C. N. Epperson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Guille
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - D. Kim
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P. Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. Martinez
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - T. Munk-Olsen
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Newport
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - J. Payne
- Department of Psychiatry, The Johns Hopkins University, Baltimore, MD, USA
| | - B. W. Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - M. O’Hara
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - S. J. Roza
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - K. M. Sharkey
- Department of Psychiatry, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - S. Stuart
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - H. Tiemeier
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A. Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. J. Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - P. F. Sullivan
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Z. N. Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K. L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I. Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - D. R. Rubinow
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
OBJECTIVE Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations. METHOD MEDLINE/PubMed was searched for reports and studies on the risk of first-trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure. RESULTS While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association. CONCLUSION Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.
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Affiliation(s)
- N Byatt
- Psychiatry and Obstetrics & Gynecology, Psychosomatic Medicine, Women's Mental Health, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA 01655, USA.
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