Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY 10016, USA.
Hassenfeld Children's Hospital at NYU Langone; Department of Child and Adolescent Psychiatry, New York, NY 10016, USA.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):1887-1899. doi: 10.1210/clinem/dgab199.
Postpartum depression (PPD) is a serious psychiatric disorder. While causes remain poorly understood, perinatal sex hormone fluctuations are an important factor, and allopregnanolone in particular has emerged as a key determinant. Although synthetic environmental chemicals such as bisphenols and phthalates are known to affect sex hormones, no studies have measured allopregnanolone and the consequences of these hormonal changes on PPD have not been interrogated.
To investigate associations of repeated measures of urinary bisphenols and phthalates in early and midpregnancy with serum pregnenolone, progesterone, allopregnanolone, and pregnanolone concentrations in midpregnancy and PPD symptoms at 4 months postpartum.
Prospective cohort study of 139 pregnant women recruited between 2016 and 2018. Bisphenols and phthalates were measured in early and midpregnancy urine samples. Serum sex steroid hormone concentrations were measured in midpregnancy. PPD was assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multiple informant models were fit using generalized estimating equations. Serum levels of allopregnanolone, progesterone, pregnanolone, and pregnenolone were examined as log-transformed continuous variables. PPD symptoms were examined as continuous EPDS scores and dichotomously with scores ≥10 defined as PPD.
Di-n-octyl phthalate (DnOP) and diisononyl phthalate (DiNP) metabolites were associated with reduced progesterone concentrations. Log-unit increases in ∑DnOP and ∑DiNP predicted 8.1% (95% CI -15.2%, -0.4%) and 7.7% (95% CI -13.3%, -1.7%) lower progesterone, respectively. ∑DnOP was associated with increased odds of PPD (odds ratio 1.48; 95% CI 1.04, 2.11).
Endocrine disrupting chemicals may influence hormonal shifts during pregnancy as well as contribute to PPD.
产后抑郁症（PPD）是一种严重的精神疾病。虽然其病因仍不清楚，但围产期性激素波动是一个重要因素，特别是别孕烷醇酮已成为一个关键决定因素。虽然已知合成环境化学物质如双酚类和邻苯二甲酸酯会影响性激素，但尚无研究测量别孕烷醇酮，也没有研究这些激素变化对 PPD 的影响。
调查妊娠早期和中期反复测量尿液中的双酚类和邻苯二甲酸酯与妊娠中期血清孕烯醇酮、孕酮、别孕烷醇酮和孕烷醇酮浓度以及产后 4 个月 PPD 症状之间的关联。
这是一项前瞻性队列研究，纳入了 2016 年至 2018 年间招募的 139 名孕妇。在妊娠早期和中期尿液样本中测量双酚类和邻苯二甲酸酯。在妊娠中期测量血清性激素浓度。产后 4 个月使用爱丁堡产后抑郁量表（EPDS）评估 PPD。使用广义估计方程拟合多信息模型。将血清别孕烷醇酮、孕酮、孕烷醇酮和孕烯醇酮水平作为对数转换的连续变量进行检查。将 PPD 症状作为连续 EPDS 评分进行检查，并将得分≥10 定义为 PPD 进行二分法检查。
邻苯二甲酸二辛酯（DnOP）和邻苯二甲酸二异壬酯（DiNP）代谢物与孕酮浓度降低有关。∑DnOP 和 ∑DiNP 的单位对数增加分别预测孕酮降低 8.1%（95%CI-15.2%，-0.4%）和 7.7%（95%CI-13.3%，-1.7%）。∑DnOP 与 PPD 的发生几率增加相关（比值比 1.48；95%CI 1.04，2.11）。
内分泌干扰化学物质可能会影响妊娠期间的激素变化，并导致 PPD。
