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Seasonal aspects of peripartum depressive symptoms
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Every year, a large proportion of pregnant and newly delivered women develop peripartum depression, a condition that may cause long-term suffering for the entire family. Although there is a lack of consensus, some studies propose an association between season and the risk of developing depression during pregnancy and the postpartum period. Furthermore, the immune system, which undergoes numerous structural changes during pregnancy, has been suggested to exhibit seasonal variations. In addition, discrepancies in metabolic profiles have been reported between women with and without depression after childbirth. This thesis aimed to investigate seasonal aspects of peripartum depressive symptoms (PPDS) and biological markers during the peripartum period. The data mainly derived from the prospective population-based Biology, Affect, Stress, Imaging, and Cognition (BASIC) study, but data were also included from the longitudinal population-based Uppsala-Athens (UPPSAT) study. The presence of depressive symptoms was primarily assessed using the Edinburgh Postnatal Depression Scale (EPDS). There were no consistent associations between season, meteorological parameters, air pollen count, and PPDS. Moreover, a number of inflammatory markers were identified as having seasonal variations among samples from pregnant women. On the contrary, only one marker had a seasonal pattern during the early postpartum period. Furthermore, metabolic profiles were not discriminatory between pregnant women with and without depressive symptoms. However, when divided into summer and winter childbirths, discrepancies were identified in metabolic profiles between summer cases and controls, as well as between summer and winter controls. In summary, the studies included in this thesis suggest that season, specifically, is not associated with PPDS. However, season may have a moderating effect on the association between depressive symptoms and the metabolic profile of pregnant women. In addition, the seasonal variations appears more prominent among inflammatory markers during late pregnancy, compared with the early postpartum period. These findings suggest that women need equal attention in clinical care regardless of the season during which they give birth. Future studies on biological aspects of PPDS and immune-associated conditions are encouraged to also assess seasonality.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 70
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1573
Keywords [en]
peripartum depressive symptoms, pregnancy, postpartum, seasonality, meteorological parameters, inflammatory markers, proximity extension assay, metabolomics, gas chromatography-mass spectrometry
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-381426ISBN: 978-91-513-0658-2 (print)OAI: oai:DiVA.org:uu-381426DiVA, id: diva2:1305550
Public defence
2019-06-12, lecture hall IX, University Main Building, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2019-05-21 Created: 2019-04-17 Last updated: 2019-06-17
List of papers
1. Seasonal patterns in self-reported peripartum depressive symptoms
Open this publication in new window or tab >>Seasonal patterns in self-reported peripartum depressive symptoms
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2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 43, p. 99-108Article in journal (Refereed) Published
Abstract [en]

Background: In the peripartum period, the literature on seasonality in depression is still scarce and studies present varying findings. The aims of this study were to investigate whether seasonal patterns in postpartum depressive symptoms previously identified in a Swedish study could be replicated in a larger study, as well as to assess seasonal patterns in depressive symptoms during pregnancy.

Methods: This was a nested case-control study comprised of 4129 women who participated in the BASIC project and gave birth at Uppsala University Hospital, Uppsala, Sweden, between February 2010 and December 2015.

Results: Women who gave birth in October-December 2011 had an increased odds of depressive symptoms at 6 weeks postpartum, when compared with women giving birth in April-June 2011 (aOR = 2.42; 95% CI: 1.12-5.26). The same pattern was found among women with a history of depression. No other seasonal patterns for depressive symptoms during pregnancy or at 6 weeks postpartum were identified.

Conclusions: In general, no consistent seasonal patterns were found in peripartum depressive symptoms. Whether the seasonal patterns found in some studies during certain years may be due to other factors relating to specific years and seasons, such as extreme climatic conditions or other particular events, warrants further investigation.

Keywords
Peripartum depression, Antenatal depression, Postpartum depression, Depressive symptoms, Seasonality, BASIC study
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-332209 (URN)10.1016/j.eurpsy.2017.03.001 (DOI)000406391700014 ()28391103 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Society of Medicine, SLS-250581Marianne and Marcus Wallenberg Foundation, MMW2011.0115
Available from: 2017-10-26 Created: 2017-10-26 Last updated: 2019-04-17Bibliographically approved
2. Meteorological parameters and air pollen count in association with self-reported peripartum depressive symptoms
Open this publication in new window or tab >>Meteorological parameters and air pollen count in association with self-reported peripartum depressive symptoms
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2018 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 54, p. 10-18Article in journal (Refereed) Published
Abstract [en]

Background: Meteorological parameters and air pollen count have been associated with affective disorders and suicide. Regarding peripartum depression, the literature is restricted and inconclusive.

Methods: This cross-sectional study included women (pregnant, n = 3843; postpartum, n = 3757) who participated in the BASIC (Biology, Affect, Stress, Imaging, and Cognition) study 2010-2015 and the UPPSAT (Uppsala-Athens) study (postpartum, n = 1565) in 2006-2007. Cases were defined according to presence of depressive symptoms during pregnancy (gestational week 32) and 6 weeks postpartum, using the Edinburgh Postnatal Depression Scale (EPDS). Exposure of sunshine, temperature, precipitation, snow coverage, and air pollen counts of durations of 1, 7, and 42 days prior to the outcome were studied for associations with depressive symptoms, using negative binomial regression.

Results: Prior to Bonferroni correction, the concentration of mugwort pollen, both one week and six weeks before the EPDS assessment at gestational week 32, was inversely associated with depressive symptoms in pregnancy, both before and after adjustment for season. No associations were found between the exposure to meteorological parameters and pollen and depressive symptoms, at the same day of depressive symptoms' assessment, the previous week, or the six weeks prior to assessment, either during pregnancy or postpartum after Bonferroni correction.

Conclusions: There was no evidence that neither short-term nor long-term exposure to meteorological parameters or air pollen counts were associated with self-reported peripartum depressive symptoms in Uppsala, Sweden.

Place, publisher, year, edition, pages
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER, 2018
Keywords
Meteorological parameters, Pollen, Postpartum, Antenatal, Peripartum, Depressive symptoms
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-363217 (URN)10.1016/j.eurpsy.2018.06.010 (DOI)000445399800002 ()30031991 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Society of Medicine, SLS-250581Marianne and Marcus Wallenberg Foundation, MMW2011.0115Åke Wiberg FoundationStiftelsen Söderström - Königska sjukhemmet
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2019-04-17Bibliographically approved
3. Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period
Open this publication in new window or tab >>Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period
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(English)In: Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-381420 (URN)
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-17
4. Blood plasma metabolic profiling of pregnant women with antenatal depressive symptoms
Open this publication in new window or tab >>Blood plasma metabolic profiling of pregnant women with antenatal depressive symptoms
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2019 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 9, article id 204Article in journal (Refereed) Published
Abstract [en]

Antenatal depression affects similar to 9-19% of pregnant women and can exert persistent adverse effects on both mother and child. There is a need for a deeper understanding of antenatal depression mechanisms and the development of tools for reliable diagnosis and early identification of women at high risk. As the use of untargeted blood metabolomics in the investigation of psychiatric and neurological diseases has increased substantially, the main objective of this study was to investigate whether untargeted gas chromatography-mass spectrometry (GC-MS) plasma metabolomics in 45 women in late pregnancy, residing in Uppsala, Sweden, could indicate metabolic differences between women with and without depressive symptoms. Furthermore, seasonal differences in the metabolic profiles were explored. When comparing the profiles of cases with controls, independently of season, no differences were observed. However, seasonal differences were observed in the metabolic profiles of control samples, suggesting a favorable cardiometabolic profile in the summer vs. winter, as indicated by lower glucose and sugar acid concentrations and lactate to pyruvate ratio, and higher abundance of arginine and phosphate. Similar differences were identified between cases and controls among summer pregnancies, indicating an association between a stressed metabolism and depressive symptoms. No depression-specific differences were apparent among depressed and non-depressed women, in the winter pregnancies; this could be attributed to an already stressed metabolism due to the winter living conditions. Our results provide new insights into the pathophysiology of antenatal depression, and warrant further investigation of the use of metabolomics in antenatal depression in larger cohorts.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-381425 (URN)10.1038/s41398-019-0546-y (DOI)000483953900001 ()31444321 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Society of Medicine, SLS-250581Marianne and Marcus Wallenberg Foundation, MMW2011.0115
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-10-09Bibliographically approved

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