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- Bränn, Emma, 1988-
(författare)
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Biomarkers for Peripartum Depression : Focusing on aspects of the immune system and the metabolome
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Peripartum depression is a common, multifactorial, and potentially devastating disease among new mothers. A biological marker for peripartum depression would facilitate early detection, better understanding of the pathophysiology, and identification of targets for treatment. Evidence is growing for a potential role of the immune system in depression outside the peripartum period. Major adaptations of the immune system occur during pregnancy, justifying the search for immunological markers for peripartum depression. The immune system is very complex and dynamic during pregnancy, complicating the study of associations with depression. The metabolome is also affected by pregnancy and is linked to the immune system via, e.g., the microbiota. Hence, metabolomic profiling could increase the understanding of peripartum depression. This thesis aimed to explore inflammatory markers and metabolic profiles in the peripartum period, in order to discover possible biomarkers, and to increase the understanding of the pathophysiology of peripartum depression.All studies were conducted within the Biology, Affect, Stress, Imaging, and Cognition (BASIC) study. The Edinburgh Postnatal Depression Scale and the Mini International Neuropsychiatric Interview were used to assess depressive symptoms. Multiplex Proximity Extension assays were used to analyze inflammatory markers in pregnancy and postpartum. Luminex Bio-Plex Pro Human Cytokine Assays were used to analyze cytokine levels across the peripartum period, and gas chromatography-mass spectrometry metabolomics were used for metabolic profiling. No marker was discriminative enough to be used on its own as a biomarker for peripartum depression. However, several inflammatory markers (such as STAM-BP, TRANCE, HGF, IL-18, FGF-23, and CXCL1) were identified as possible candidates for more advanced diagnostic algorithms. The results further pointed towards the importance of adaptation of the immune system during pregnancy and postpartum, where levels of cytokines such as VEGF-A might have an important role in antenatal and postpartum depression. The results even highlight the importance of examination timing. Lastly, the metabolic profiling suggested different subgroups of women with postpartum depressive symptoms, supporting theories of peripartum depression being a heterogeneous disease in need of subgroup definition.
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| 2. |
- Henriksson, Hanna E., 1988-
(författare)
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Seasonal aspects of peripartum depressive symptoms
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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