This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Postpartum depression, most often occurring 4-6 weeks postpartum, is the most common psychiatric complication of childbearing, affecting 10-15% of women and, as such, represents a significant public health concern. Depressive illness following childbirth can be detrimental to the mother, to her children, and to her immediate family. If untreated, postpartum depression can have serious long-term consequences. After one postpartum depressive episode, the risk of recurrence of major depression in is 25%. Untreated depression in the mother leads to long-term emotional, behavioral, cognitive, and interpersonal problems in her children. The most severe cases of postpartum affective or psychotic illness may lead to suicide in the mother or infanticide. Because of these serious consequences, early diagnosis, early treatment and continued research on the etiologies of postpartum depression is imperative in order to better understand the health and well being of both mother and child. Cytokines are a heterogeneous group of messenger molecules that are produced by immunocompetent cells such as lymphocytes and macrophages in order to regulate immune responses. Administration of certain cytokines to patients for therapeutic purposes and induction of cytokines experimentally in healthy subjects results in increased severity of depression. Descriptions of maternal immune system changes during pregnancy include evidence of immune system activation, immune system suppression, and immunological tolerance. Consistent with expected biological functions, cytokine levels in women at end of term are higher than cytokine levels in non-pregnant women. We hypothesize that inflammation in the immediate postpartum period may trigger depressive symptoms postpartum in vulnerable women. Primary aim: 1) To assess a possible relationship between markers of inflammation in the immediate postpartum period, and the severity of depressive symptoms in the late postpartum period. Secondary aims: 2) To assess the relationship between depressive scores and inflammatory markers at each time point: prepartum, early postpartum and late postpartum. 3) To evaluate the relationship between changes in depression scores and changes in inflammatory markers from prepartum to early postpartum, from prepartum to late postpartum, and from early postpartum to late postpartum. Fifty pregnant women 18 years of age or older who are at high risk for postpartum depression will be recruited from the University of Maryland Department of Obstetrics and Gynecology. Women will have to meet at least one of the high-risk criteria for postpartum depression. Subjects will be studied at three time points: at 35-38 weeks gestation, 1-5 days after delivery, and 5-6 weeks after delivery. At each time point there will be a rating of depressive scores and a blood draw of 5 teaspoons from a peripheral vein for measurement of subjects' serum levels for the following inflammatory markers: C-reactive protein, Interleukin-6, and Interleukin-6 Receptor. Additional serum for kynurenine and tryptophan measurements will be frozen for future study when additional funds become available. Initial analyses will be descriptive (means and standard deviations for continuous data and proportions for categorical data). Changes from pre-birth values on all continuous variables will be calculated for 1-5 days postpartum and 5-6 weeks postpartum. Correlations between changes in inflammatory markers and changes on the Hamilton Depression Scale, a standardized rating scale for the severity of depression will be calculated and then tested for significance of difference. Our long-term goal is to describe inflammatory mechanisms of postpartum depression and potentially identify novel therapeutic targets that may lead to prophylactic treatments of postpartum depression. The purpose of this application is to gather preliminary data for a larger NIH grant application.
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