Etiology Of Postpartum Depression Research Articles

The role of gut microbiota and blood metabolites in postpartum depression: a Mendelian randomization analysis.

Postpartum depression (PPD) is a common complication of pregnancy that imposes a heavy health and economic burden on individuals, families and society. The etiology of PPD is complex and incompletely defined, and recent studies have identified an important role for gut microbiota (GM) and their metabolites in neurological disorders. However, fewer studies on GM and PPD are available and have not yielded uniform results. Instrumental variables for GM and blood metabolites were obtained from the MiBioGen consortium and metabolomics GWAS server. Single nucleotide polymorphisms (SNPs) associated with PPD phenotypes were obtained from the FinnGen consortium. Inverse variance weighted (IVW), weighted median, weighted mode, and MR-Egger methods were used to assess causal effects. Inverse MR analysis and sensitivity analysis were also utilized to improve the stability of the results. In this study, 5 intestinal species and 24 blood metabolites causally associated with PPD were identified using MR analysis. In addition, MR analysis showed that Prevotellaceae and Bifidobacteria may reduce the risk of PPD by elevating Xanthine and 1-arachidonoylglycerophosphoinositol (LysoPI) levels. This study identified GM and blood metabolites causally associated with PPD. The results of this study may provide a theoretical basis for the discovery of PPD-related biomarkers and the treatment of the disease by regulating the gut microenvironment.

Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses.

Postpartum depression (PPD) is the most common psychiatric condition after childbirth which not only effects the mother's health, but also might have impact on child's development and parenting behaviors. Because the etiology of PPD has not been fully cleared, the efforts towards identification of risk factors are crucial for both the children and mother's health. PubMed, EMBASE and PsycINFO databases were searched since inception until July 2019 to collect data about the risk factors of PPD and only systematic review and meta-analysis can be included. To identify the real risk factors, protective factors and controversial factors, nineteen parts of the interpretation were adopted. The risk factors are mainly concentrated in the following aspects: violence and abuse, immigration status, gestational diabetes, cesarean section, depressive history, vitamin D deficiency, obese and overweight, postpartum sleep disruption and poor postpartum sleep, lack of social support, traditional dietary pattern (Japanese, Indian, United Kingdom, and Brazilian dietary pattern), multiple births, preterm and low-birth-weight infants, postpartum anemia, negative birth experience. The controversial factors are serum level of cortisol, thyroid peroxidase autoantibodies status, acculturation, traditional confinement practices. Skin-to-skin care, higher concentrations of DHA in mothers' milk, greater seafood consumption, healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium are protective factors. Thirteen risk factors were identified, but five factors still controversial due to the insufficient of the evidence. What's more, skin-to-skin care and some nutrition related factors are protective factors against PPD.

Dependent Personality, Mindful Awareness, and Marital Satisfaction and their Association with Postpartum Psychological Distress in Two Tertiary Hospitals, Southeast Nigeria

This study assessed dependent personality, marital satisfaction, and mindful awareness and their association with postpartum depression and anxiety. It was a cross-sectional study of nursing mothers, within 6-14 weeks postpartum, at the postnatal and children's welfare clinics of two tertiary hospitals in Enugu, southeastern Nigeria. The nursing mothers responded to different questionnaires that measure each of these variables. Correlations and multiple regression analyses were used to measure the strength of association between the variables in the study and to identify predictors for the outcome variables of interest, respectively. Low mindful attention awareness, poor marital satisfaction, and low dependency predicted an increased risk of postpartum depression and anxiety, with low mindful attention awareness as the strongest predictor. The findings from the study carry significant implications for the roles of dependent personality, marital satisfaction, and mindful awareness in the etiology of postpartum depression and anxiety in Southeast Nigeria.

Neuroactive Molecules in the Etiology of Postpartum Depression. An overview

Postpartum depression is a serious and frequent condition that affects a significant proportion of new mothers in developed countries. Despite its high prevalence and proven deleterious outcomes for both mother and child, there remains an increasing need to expand our knowledge regarding new methods that ensure the discovery of at-risk patients. Many theories have been developed over the years, mainly focusing on hormonal imbalances that occur after childbirth. This review has the purpose to analyze the existing literature and to summarize the latest findings on neuroactive molecules which may predict postpartum depression in new mothers.

Delineating the association between mode of delivery and postpartum depression symptoms: a longitudinal study.

Although a number of perinatal factors have been implicated in the etiology of postpartum depression, the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. In a longitudinal-cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self-reported postpartum depression symptoms (Edinburgh Postnatal Depression Scale ≥12) at 6 weeks postpartum was investigated through logistic regression models and path analysis. The overall prevalence of postpartum depression was 13%. Compared with spontaneous vaginal delivery, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04-2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of postpartum depression and led more frequently to elective cesarean section; however, it was associated with a positive delivery experience. Mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.

Early life social stress and resting state functional connectivity in postpartum rat anterior cingulate circuits

IntroductionContinued development and refinement of resting state functional connectivity (RSFC) fMRI techniques in both animal and clinical studies has enhanced our comprehension of the adverse effects of stress on psychiatric health. The objective of the current study was to assess both maternal behavior and resting state functional connectivity (RSFC) changes in these animals when they were dams caring for their own young. It was hypothesized that ECSS exposed dams would express depressed maternal care and exhibit similar (same networks), yet different specific changes in RSFC (different individual nuclei) than reported when they were adult females. MethodsWe have developed an ethologically relevant transgenerational model of the role of chronic social stress (CSS) in the etiology of postpartum depression and anxiety. Initial fMRI investigation of the CSS model indicates that early life exposure to CSS (ECSS) induces long term changes in functional connectivity in adult nulliparous female F1 offspring. ResultsECSS in F1 dams resulted in depressed maternal care specifically during early lactation, consistent with previous CSS studies, and induced changes in functional connectivity in regions associated with sensory processing, maternal and emotional responsiveness, memory, and the reward pathway, with robust changes in anterior cingulate circuits. LimitationsThe sample sizes for the fMRI groups were low, limiting statistical power. ConclusionThis behavioral and functional neuroanatomical foundation can now be used to enhance our understanding of the neural etiology of early life stress associated disorders and test preventative measures and treatments for stress related disorders.

Etiology of Postpartum Depression: Culture Effect

Etiology of Postpartum Depression: Culture Effect

Interaction between oxytocin receptor DNA methylation and genotype is associated with risk of postpartum depression in women without depression in pregnancy.

Postpartum depression (PPD) affects up to 19% of women, negatively impacting maternal and infant health. Reductions in plasma oxytocin levels have been associated with PPD and heritability studies have established a genetic contribution. Epigenetic regulation of the oxytocin receptor gene (OXTR) has been demonstrated and we hypothesized that individual epigenetic variability at OXTR may impact the development of PPD and that such variability may be central to predicting risk. This case-control study is nested within the Avon Longitudinal Study of Parents and Children and included 269 cases with PPD and 276 controls matched on age group, parity, and presence or absence of depressive symptoms in pregnancy as assessed by the Edinburgh Postnatal Depression Scale. OXTR DNA methylation (CpG site -934) and genotype (rs53576 and rs2254298) were assayed from DNA extracted from blood collected during pregnancy. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of elevated symptoms of PPD with genotype, methylation, and their interaction adjusted for psychosocial factors (n = 500). There was evidence of an interaction between rs53576 and methylation in the OXTR gene amongst women who did not have depression prenatally but developed PPD (p interaction = 0.026, adjusted for covariates, n = 257). Those women with GG genotype showed 2.63 greater odds of PPD for every 10% increase in methylation level (95% CI: 1.37, 5.03), whereas methylation was unrelated to PPD amongst “A” carriers (OR = 1.00, 95% CI: 0.58, 1.73). There was no such interaction among women with PPD and prenatal depression. These data indicate that epigenetic variation that decreases expression of OXTR in a susceptible genotype may play a contributory role in the etiology of PPD.

Diyarbakır'da postpartum depresyonu etkileyen faktörler

Objective: The aim of this study is to investigate the factors affect- ing postpartum depression (PPD) according to age groups in Diyarbak›r city located on the southeastern part of Turkey. Methods: The questions of Edinburgh postpartum depression scale (EPDS) were asked to 495 women who referred to our clinic at their postpartum periods. A separate statistical analysis was carried out for 51 adolescent women (below 18-year-old) and 72 puerperant women over 35-year-old. Score 13 according to EPDS score result was determined as cut-off value. Results: In 101 out of 495 (20.4%) patients, EPDS score was 13 and above. This rate was 27.4% in adolescent puerperant women, and 19.4% in puerperant women over 35-year-old. It was found that depression history was a significant variable affecting postpartum depression (p<0.005). Conclusion: Postpartum depression is a significant disease possible to overlook which affects the health of mother and baby. This is risky especially during adolescent period. Depression history is an important variable in the etiology of postpartum depression. This period can be screened for postpartum depression. The greatest fac- tor limiting postpartum depression in Southeastern Anatolia Region which has the highest reproduction rate in Turkey can be the sup- port provided to the puerperant women by relatives and friends dur- ing puerperal period.

A Review of Postpartum Depression: Focused on Psychoneuroimmunological Interaction.

The purpose of this review was to describe a psychoneuroimmunology (PNI) framework for postpartum depression (PPD) and discuss its implications for nursing research and practice for postpartum women. This study explored the role of hypothalamic-pituitary-adrenal (HPA) axis and inflammation as possible mediators of risk factors for PPD through literature review. From this PNI view, human bodies are designed to respond with the reciprocal interactions among the neuro-endocrine and immune system when they are faced with physical or psychological stressors. Chronic stress induces alterations in the function of HPA axis, and a chronic low-grade inflammatory response is associated with depression. The dysfunctions of cytokines and HPA axis have been observed during the postpartum period. Stress promotes glucocorticoid receptor resistance, which can promote inflammatory responses. This, in turn, can contribute to the pathophysiology of depression. This can especially affect populations at vulnerable time-points, such as women in the postpartum. From a PNI perspective, well-designed prospective research evaluating the role of stress and inflammation as an etiology of PPD and the effect of stress reduction is warranted to prevent PPD.

Association study of the estrogen receptor gene ESR1 with postpartum depression—a pilot study

Perinatal mood disorders, such as postpartum depression (PPD), are costly for society, with potentially serious consequences for mother and child. While multiple genes appear to play a role in PPD susceptibility, the contributions of specific genetic variations remain unclear. Previously implicated as a candidate gene, the estrogen receptor alpha gene (ESR1) is a key player in mediating hormonal differences during pregnancy and the postpartum period. This study addresses genetic factors in perinatal mood disorders, testing nine polymorphisms in ESR1. Two hundred fifty-seven postpartum women were screened for mood disorders, including 52 women with PPD and 32 without any symptoms of mood disorders. We detected a significant association for the upstream TA microsatellite repeat with Edinburgh Postnatal Depression Scale scores (p = 0.007). The same variant was also associated with the occurrence of PPD. Separately, 11 candidate functional polymorphisms in 7 additional genes were genotyped to investigate gene-gene interaction with the ESR1 TA repeat, identifying a potential interaction with the serotonin transporter. Our results support a role for ESR1 in the etiology of PPD, possibly through the modulation of serotonin signaling. Our findings for ESR1 could have broad implications for other disorders and therapies that involve estrogens.

Social relationships and postpartum depression in South Asia: A systematic review

Evidence suggests a much higher prevalence of postpartum depression in South Asia than in 'western' contexts. To conduct a rapid systematic review of evidence on the association between social relationships and postpartum depression in South Asia. Five databases were searched to identify relevant studies. Studies meeting the selection and quality criteria were analysed and integrated in a narrative review. Nine mostly quantitative studies were included in the review. Low support and poor relationships with the husband and parents-in-law were associated with postpartum depression, although associations were weakened in multivariate analyses. The different dimensions of support have not yet been systematically investigated and the likely complex interrelationships between social relationship risk factors are not yet well understood. Findings mirror those from 'western' contexts, showing the key role of social relationships in the aetiology of postpartum depression. Yet, they also reinforce the hypothesis that the social and cultural context influences the association. The importance of relationships with the extended family, as well as the husband, in South Asia is highlighted. Further research is recommended to develop an understanding of these relationships to better inform interventions.

Nutrition and the psychoneuroimmunology of postpartum depression

Postpartum depression (PPD) is a relatively common and often severe mood disorder that develops in women after childbirth. The aetiology of PPD is unclear, although there is emerging evidence to suggest a psychoneuroimmune connection. Additionally, deficiencies in n-3 PUFA, B vitamins, vitamin D and trace minerals have been implicated. This paper reviews evidence for a link between micronutrient status and PPD, analysing the potential contribution of each micronutrient to psychoneuroimmunological mechanisms of PPD. Articles related to PPD and women's levels of n-3 PUFA, B vitamins, vitamin D and the trace minerals Zn and Se were reviewed. Findings suggest that while n-3 PUFA levels have been shown to vary inversely with PPD and link with psychoneuroimmunology, there is mixed evidence regarding the ability of n-3 PUFA to prevent or treat PPD. B vitamin status is not clearly linked to PPD, even though it seems to vary inversely with depression in non-perinatal populations and may have an impact on immunity. Vitamin D and the trace minerals Zn and Se are linked to PPD and psychoneuroimmunology by intriguing, but small, studies. Overall, evidence suggests that certain micronutrient deficiencies contribute to the development of PPD, possibly through psychoneuroimmunological mechanisms. Developing a better understanding of these mechanisms is important for guiding future research, clinical practice and health education regarding PPD.

An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression

ContextIron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear. ObjectiveTo evaluate whether iron status 48h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD. DesignThis was a prospective cohort study of depression-free women studied in the postpartum period. SettingWomen who give birth at obstetric units in several general hospitals in Spain. ParticipantsA subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism. Main outcome measuresWe evaluated depressive symptoms at 48h, 8weeks and 32weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP. ResultsOverall, the women in the study had low iron concentrations (8.8±6.9μmol/L) and low TfS (12.6±9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32week postpartum period; these women also had a lower ferritin concentration (15.4±12.7μg/L vs. 21.6±13.5μg/L, P=0.002). A strong association between ferritin and PPD was observed (odds ratio=3.73, 95% CI: 1.84–7.56; P=0.0001 for ferritin cutoff value of 7.26μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD. ConclusionsThese findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.

Peripartum depression – does it occur in fathers and does it matter?

Epidemiologic studies have demonstrated that women experience depression about twice as frequently as men. However, there is a growing awareness that the incidence of depression in men is markedly underestimated because of diagnostic bias. Traditional masculinity norms might result in a lack of recognition, and barriers to treatment, of depression in men. This article reviews the evidence for the specific occurrence of depression in men following the birth of a child as illustrated by the case of a 36 year old first-time father. It further reviews ideas on the etiology of postpartum depression in fathers, and its impact on the family, concluding with a review of treatment options. Finally, a detailed discussion of the attempts at case resolution is given. Unfortunately, though perhaps not unexpectedly, this case failed to return for a follow-up visit and did not respond to efforts to contact him by phone.

Understanding the Pathophysiology of Postpartum Depression: Implications for the Development of Novel Treatments

Depression during pregnancy and in the postpartum period is common, devastating to mothers and their offspring, and poorly understood in terms of pathophysiology. In this issue of Neuron, Maguire and Mody provide evidence for a role for aberrant neurosteroid regulation of the GABA(A) receptor subunit in the etiology of postpartum depression, presaging elucidation of the pathophysiology and development of treatments of this depression endophenotype.

Endocrine factors in the etiology of postpartum depression.

This article reviews the literature regarding endocrine factors postulated or presumed to be relevant in postpartum depression (PPD), a condition affecting at least 10% of childbearing women. The phenomenology and epidemiology of PPD are also described. Data suggest that parturition-related endocrine changes are causally implicated in PPD in a vulnerable subgroup of women. More specifically, studies by our group and others suggest a role for changes in estradiol and progesterone in precipitating mood symptoms among women with PPD. The mechanisms underlying such differential sensitivities remain undetermined. Future directions for research are explored.

Erratum: Transactional conflict between psychobiology and culture in the etiology of postpartum depression

In vulnerable individuals, postpartum depression may be triggered by the disruption of neuropsychological processes during pregnancy and parturition. It is proposed that in Western societies pre- and postnatal psychological and instrumental needs are poorly met and this crisis may interact with neurophysiological factors in compromising maternal psychological functioning. The influence of developmental factors and psychological and physical stressors are discussed in relation to women’s neuropsychological health during the peripartal transition. It is hypothesized that the environmental milieu may support, neglect or derail the mother’s psychobiological transition from pregnancy to effective postnatal parenting and resumption of family and work roles.

Transactional conflict between psychobiology and culture in the etiology of postpartum depression

In vulnerable individuals, postpartum depression may be triggered by the disruption of neuropsychological processes during pregnancy and parturition. It is proposed that in Western societies pre- and postnatal psychological and instrumental needs are poorly met and this crisis may interact with neurophysiological factors in compromising maternal psychological functioning. The influence of developmental factors and psychological and physical stressors are discussed in relation to women's neuropsychological health during the peripartal transition. It is hypothesized that the environmental milieu may support, neglect or derail the mother's psychobiological transition from pregnancy to effective postnatal parenting and resumption of family and work roles.

"Feeling low and feeling really bad about feeling low": Women's experiences of motherhood and postpartum depression.

AbstractTwo bodies of work on postpartum depression are reviewed. Quantitative, positivist studies examine the epidemiology and aetiology of postpartum depression, adopt a medical model of explanation and conceptualize postpartum depression as a pathological response to motherhood. Social scientific studies, some from a feminist perspective, explore women's experiences of postpartum depression predominantly, but not exclusively, within a qualitative tradition. Postpartum depression is theorized as a normal response to motherhood and is linked to public-world losses of identity, autonomy, independence, power, and paid employment. Drawing on a qualitative study of 40 women's experiences of motherhood, this article argues that not all women become depressed following childbirth and women's varying responses to motherhood need to be recognized. A relational re-framing of postpartum depression is put forward. From this perspective, postpartum depression occurs when women are unable to experience, express and validate their feelings and needs within supportive, accepting and non-judgmental interpersonal relationships and cultural contexts.When you're depressed ... you think you're just in this little and you can't find your way out. It is absolutely horrible, it really is ... wanted my friends round me, but when they were around me, didn't want them around ... You feel so alone, but then again was making myself alone, if you know what mean? didn't want to mix with people and yet, at the same time, because didn't want to mix with them, so they sort of kept away from me ... They weren't or anything, but they sort of thought 'Oh well, leave her alone for a minute, she'll be all right.' thought, 'Oh they're rejecting me,' so they did wasn't right in my eyes, and I'm not normally like that.Sophie(f.1) lives in a council house with her three children aged 12, 6 and 2 years, and with the father of her third child. Six years ago she experienced a relatively shortlived (eight weeks) but highly distressing episode of depression which set in five months after the birth of her second child. She was 25 at the time, and a full-time mother of a six-year-old and her new baby. She was also a single mother having left the father of her second child shortly after she became pregnant. But she lived in a close-knit community, a few streets away from her parents, and surrounded by her friends. Sophie characterized her depression as feeling stuck in a dark space, a tunnel which she could not get out of. She went on to articulate the complex nature of this sense of isolation. She describes how alone she felt, but also points out that, as she says, I was making myself alone. Although she was surrounded by friends who were willing to help and support her, she withdrew from them, which in turn led them to distance themselves from her. Sophie explains how her depression, and the complex dynamics of her relationships, were not simply the result of her friends being nasty or anything. She was viewing the world from a particular perspective, and perceiving her friends in such a way that whatever they did wasn't right in my eyes. Sophie describes her depression as, in part, a self-imposed isolation, an active withdrawal from other people that was to some extent independent of the behaviour of others, but was related to the way in which she perceived those around her.Sophie was one of 40 women interviewed in a qualitative study of motherhood and postpartum depression. This excerpt from Sophie's interview reveals the lucid and articulate quality of mothers' accounts, and how much we can learn about their psychological and social worlds by eliciting and attending closely to their words. Yet, the majority of research in the area of postpartum depression has disregarded mothers as a source of knowledge or understanding about their experiences. Mothers' perceptions, subjectivities and accounts have been accorded little value in a field of inquiry which has been dominated by quantitative research within a positivist tradition. …