Szpunar Mercedes J, Malaktaris Anne, Baca Selena A, Hauger Richard L, Lang Ariel J
Massachusetts General Hospital, Department of Psychiatry, USA.
Veterans Affairs San Diego Healthcare System (VASDHS), Department of Psychiatry, USA.
Brain Behav Immun Health. 2021 Jul 31;16:100309. doi: 10.1016/j.bbih.2021.100309. eCollection 2021 Oct.
Pregnant veterans are a subpopulation known to be at elevated risk of developing mental health symptoms, such as depression and suicidal ideation. Inflammation has been associated with depression, specifically during the perinatal period. Critical changes in estradiol, cortisol, and inflammatory cytokines are necessary for the progression of a healthy pregnancy, which are then rapidly altered in the postpartum period. We explored changes in estradiol, cortisol, and pro-inflammatory cytokines relative to depressive symptoms and suicidal thoughts across pregnancy and postpartum in this pilot and feasibility study.
We measured estradiol, cortisol, and the inflammatory cytokines IL-1β, IL-6, IL-8, IFN-γ, and TNF-α in 18 pregnant veterans and analyzed the data using descriptive statistics, dependent t-tests, and correlation analyses. We assessed depression severity with the Edinburgh Postnatal Depression Scale and suicidality with the Columbia-Suicide Severity Rating Scale. Thirteen of the women repeated assessments in the early postpartum period at an average of 6.7 weeks after birth.
As anticipated, estradiol ((12) = 12.47, < .001) and cortisol ((12) = 9.43, < .001) significantly decreased from pregnancy to postpartum. There were no differences in the means of gestational and postpartum IL-1β, IL-6, TNF-α, or IFN-γ, but IL-8 was significantly increased from pregnancy to postpartum ((12) = -4.60, = .001). Estradiol during pregnancy was positively correlated with IL-6 levels both during pregnancy ( = .656, = .008) and postpartum ( = 0.648, = .023). Elevated IL-1β was associated with suicidal thoughts during pregnancy ( = 0.529, = .029). Although not statistically significant, depressive symptom severity trended towards a positive association with larger increases in IL-1β ( = 0.535, = .09) and TNF-α ( = 0.501, = .08) from pregnancy to postpartum.
This preliminary study suggests the feasibility of our approach for exploring a complex interplay between hormonal and pro-inflammatory changes from pregnancy to postpartum, and their relationship with depressive symptoms. Given our small sample and the relatively exploratory nature of our analyses, additional investigation focusing on hormonal and inflammatory changes and their potential associations with perinatal mental health is necessary to confirm and extend our preliminary findings and examine additional potential covariates.
怀孕的退伍军人是一个已知患心理健康症状风险较高的亚群体，如抑郁和自杀意念。炎症与抑郁有关，特别是在围产期。雌二醇、皮质醇和炎性细胞因子的关键变化是健康怀孕进展所必需的，而这些在产后会迅速改变。在这项试点和可行性研究中，我们探讨了怀孕和产后雌二醇、皮质醇和促炎细胞因子相对于抑郁症状和自杀想法的变化。
我们测量了18名怀孕退伍军人的雌二醇、皮质醇和炎性细胞因子白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、干扰素-γ（IFN-γ）和肿瘤坏死因子-α（TNF-α），并使用描述性统计、配对t检验和相关分析对数据进行分析。我们用爱丁堡产后抑郁量表评估抑郁严重程度，用哥伦比亚自杀严重程度评定量表评估自杀倾向。其中13名女性在产后早期平均出生后6.7周重复进行了评估。
正如预期的那样，从怀孕到产后，雌二醇（t(12)=12.47，P<.001）和皮质醇（t(12)=9.43，P<.001）显著下降。孕期和产后IL-1β、IL-6、TNF-α或IFN-γ的平均值没有差异，但从怀孕到产后IL-8显著增加（t(12)= -4.60，P=.001）。孕期雌二醇与孕期（r=.656，P=.008）和产后（r=0.648，P=.023）的IL-6水平呈正相关。孕期IL-1β升高与自杀想法有关（r=0.529，P=.029）。虽然无统计学意义，但抑郁症状严重程度倾向于与从怀孕到产后IL-1β（r=0.535，P=.09）和TNF-α（r=0.501，P=.08）的更大增加呈正相关。
这项初步研究表明了我们探索从怀孕到产后激素和促炎变化之间复杂相互作用及其与抑郁症状关系的方法的可行性。鉴于我们的样本量小且分析具有相对探索性，有必要进行更多关注激素和炎症变化及其与围产期心理健康潜在关联的研究，以证实和扩展我们的初步发现，并检查其他潜在协变量。
