This revised competing continuation proposal is a request for funding to explore the patterns of immune, endocrine, and inflammatory changes over the postpartum period and to analyze potential relationships between these variables and trajectories as well as the development of postpartum thyroiditis (PPT), a common autoimmune disease of the postpartum. The initial funded project explored the relationship between lactation status and stress and immunity in postpartum mothers. The major findings from that cross sectional study were the presence of significant upregulation of cytokines and proteins and inflammatory responses in 4-6 week postpartum women compared to controls. This has led to the competing continuation request that seeks to explore the pattern of these changes over time, from the first week through the sixth postpartum month, in healthy control mothers and mothers at risk for PPT. This prospective approach will also allow us to examine relationships among endocrine, demographic, stress, mood and immunity variables and determine which of these variables predict and accompany onset and course of PPT. Many autoimmune diseases flare or have their onset in the postpartum, and breastfeeding increases risk. We will use PPT as a model of autoimmune disease, and identify low and high risk for PPT groups on the basis of the presence or absence of thyroid peroxidase enzyme (TPO) autoantibodies measured during pregnancy. We will prospectively study relationships between immune and inflammatory processes and trajectories, breastfeeding status, postpartum hormones, stress and dysphoric moods, general health, and the onset and course of PPT, which we anticipate will occur in about 50% of the TPO+ mothers. In addition, exploration of the normal changes in immunity, inflammation, and hormones in TPO- mothers will provide new understanding about the physiology of the postpartum, and will lay the groundwork for relating this physiology to many maternal health outcomes. The significance of this research to public health lies in the prominent incidences of autoimmune diseases in women, and the debilitating and long-term chronic illnesses that result from autoimmune processes. Genetics only plays a part in the pathogenesis of these illnesses, and the role of environment is critical to understand. The immunology and endocrinology of the postpartum provides a lens through which to study autoimmune disease, as the postpartum is a critical period for development or exacerbation of many autoimmune diseases.
Natural Killer cells are a major non-specific defense against tumor cells, foreign cells, and virally infected cells and are essential for suppression of maternal immunity against the fetus during pregnancy. Pregnancy associated NK suppression appears to continue into the postpartum in healthy mothers and may allow fetal microchimeric cells to survive and be tolerized. This research will explore potential biological mechanism through which postpartum NK suppression is produced, the findings of which have relevance for maternal health, and for potential application to the field of tumorogenesis, infection, and tissue graft acceptance.
| Groer, Maureen; Fuchs, Dietmar; Duffy, Allyson et al. (2018) Associations Among Obesity, Inflammation, and Tryptophan Catabolism in Pregnancy. Biol Res Nurs 20:284-291 |
| Hsu, Pao-Chu; Yolken, Robert H; Postolache, Teodor T et al. (2016) Association of Depressed Mood With Herpes Simplex Virus-2 Immunoglobulin-G Levels in Pregnancy. Psychosom Med 78:966-972 |
| Groer, Maureen E; Jevitt, Cecilia; Ji, Ming (2015) Immune changes and dysphoric moods across the postpartum. Am J Reprod Immunol 73:193-8 |
| Shelton, Melissa M; Schminkey, Donna L; Groer, Maureen W (2015) Relationships among prenatal depression, plasma cortisol, and inflammatory cytokines. Biol Res Nurs 17:295-302 |
| Groer, Maureen W; El-Badri, Nagwa; Djeu, Julie et al. (2014) Suppression of natural killer cell cytotoxicity in postpartum women: time course and potential mechanisms. Biol Res Nurs 16:320-6 |
| Groer, Maureen W; Vaughan, Jessica H (2013) Positive thyroid peroxidase antibody titer is associated with dysphoric moods during pregnancy and postpartum. J Obstet Gynecol Neonatal Nurs 42:E26-32 |
| Groer, Maureen W; Jevitt, Cecilia M; Sahebzamani, Frances et al. (2013) Breastfeeding status and maternal cardiovascular variables across the postpartum. J Womens Health (Larchmt) 22:453-9 |
| Jevitt, Cecilia M; Groer, Maureen W; Crist, Nancy F et al. (2012) Postpartum stressors: a content analysis. Issues Ment Health Nurs 33:309-18 |
| Groer, Maureen W; Yolken, Robert H; Xiao, J-C et al. (2011) Prenatal depression and anxiety in Toxoplasma gondii-positive women. Am J Obstet Gynecol 204:433.e1-7 |
| Groer, Maureen W; Beckstead, Jason W (2011) Multidimensional scaling of multiplex data: human milk cytokines. Biol Res Nurs 13:289-96 |
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