Pařízek A, Mikešová M, Jirák R, Hill M, Koucký M, Pašková A, Velíková M, Adamcová K, Šrámková M, Jandíková H, Dušková M, Stárka L
Department of Obstetrics and Gynecology of the First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague, Czech Republic; Steroid Hormone Department, Institute of Endocrinology, Prague, Czech Republic.
Physiol Res. 2014;63(Suppl 2):S277-82. doi: 10.33549/physiolres.932788.
Postpartum depression affects 10-15 % women after childbirth. There is no currently generally accepted theory about the causes and mechanisms of postpartum mental disorders. The principal hypothesis concerns the association with sudden changes in the production of hormones affecting the nervous system of the mother and, on the other hand, with the ability of receptor systems to adapt to these changes. We observed changes in steroidogenesis in the period around spontaneous delivery. We collected three samples of maternal blood. The first sampling was 4 weeks prior to term; the second sampling was after the onset of uterine contractions (the beginning of spontaneous labour); the third sampling was during the third stage of labour (immediately after childbirth). Additionally, we collected mixed umbilical cord blood. The almost complete steroid metabolome was analyzed by gas chromatography-mass spectrometry followed by RIA for some steroids. Mental changes in women in the peripartum period were observed using the Hamilton Depression Rating Scale. The local Ethics Committee approved the study. We found already the changes in androgens levels correlating with postpartum mood disorders four weeks prior to childbirth. The strongest correlations between steroid and postpartum mood change were found in venous blood samples collected from mothers after childbirth and from umbilical cord blood. The main role played testosterone, possibly of maternal origin, and estrogens originating from the fetal compartment. These results suggest that changes in both maternal and fetal steroidogenesis are involved in the development of mental changes in the postpartum period. Descriptions of changes in steroidogenesis in relation to postpartum depression could help clarify the causes of this disease, and changes in some steroid hormones are a promising marker of mental changes in the postpartum period.
产后抑郁症影响着10% - 15%的产后女性。目前尚无关于产后精神障碍病因和机制的普遍接受的理论。主要假说是其与影响母亲神经系统的激素分泌突然变化有关，另一方面，与受体系统适应这些变化的能力有关。我们观察了自然分娩前后类固醇生成的变化。我们采集了三份母体血液样本。第一次采样是在预产期前4周；第二次采样是在子宫收缩开始（自然分娩开始）后；第三次采样是在分娩第三阶段（分娩后立即）。此外，我们还采集了混合脐带血。通过气相色谱 - 质谱联用仪分析几乎完整的类固醇代谢组，随后对一些类固醇进行放射免疫分析。使用汉密尔顿抑郁量表观察围产期女性的精神变化。当地伦理委员会批准了该研究。我们发现在分娩前四周雄激素水平的变化就与产后情绪障碍相关。类固醇与产后情绪变化之间的最强相关性出现在产后母亲的静脉血样本和脐带血样本中。主要起作用的是可能源自母体的睾酮以及源自胎儿部分的雌激素。这些结果表明，母体和胎儿类固醇生成的变化都与产后精神变化的发展有关。关于与产后抑郁症相关的类固醇生成变化的描述可能有助于阐明这种疾病的病因，并且一些类固醇激素的变化是产后精神变化的一个有前景的标志物。
