| 1. |
- Björn, Inger, 1953-
(författare)
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Hormone replacement therapy and effects on mood
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: During the past 5 decades, hormone replacement therapy (HRT) has been used, and appreciated for its beneficial effects, by millions of women in their menopause. As treatment for climacteric symptoms, estrogen is outstanding, and effects on hot flushes, vaginal dryness, and insomnia have been widely documented. The increased risks of venous thrombosis and breast cancer, however, restrict the use of estrogen.Estrogen treatment in women with a remaining uterus includes a progestin, added to protect the endometrium from hyperplasia and malignancies. The long-standing clinical impression, that progestin addition negatively influences mood, has been discussed in previous studies. Mood deterioration is, however, not mortal, although mood is important to the wellbeing and daily functioning of women treated with hormones. Studies of the mental side effects of HRT add to our understanding of steroid effects in the brain.Aims and methods: In our studies, we aimed to establish to what extent negative side effects cause women to discontinue HRT, and find out which drug compounds lead to mood deterioration. The questions asked were whether the type and dose of progestin and the estrogen dose during the progestin addition influence the mood and physical symptoms during sequential HRT.Compliance with HRT and reasons for discontinuing the therapy were evaluated in a retrospective longitudinal follow-up study. Treatment effects were studied in three randomized, double-blind, cross-over trials. During continuous estrogen treatment, effects of sequential addition of a progestin were studied by comparing two different progestins, medroxyprogesterone acetate (MPA) andnorethisterone acetate (NETA), comparing different doses of the same progestin, MPA, and comparing two doses of estrogen during addition of the same dose of MPA. The main outcome measure was the daily rating on mood and physical symptoms kept by the participants throughout the studies. The clinical trials were carried out at three gynecological centers in northern Sweden.Results and conclusions: Besides fear of cancer and a wish to determine whether climacteric symptoms had meanwhile disappeared, negative side effects was the most common reason or discontinuing HRT. Tension in the breasts, weight gain, a depressed mood, abdominal bloating, and irritability were the most important side effects seen both in women who continued HRT and in women who had discontinued the therapy.In our clinical trials, we showed that addition of a progestin to estrogen treatment induces cyclic mood swings characterized by tension, irritability, and depression, as well as increased breast tension, bloatedness, and hot flushes. Women with a history of premenstrual syndrome (PMS) appeared to be more sensitive to the progestin addition and responded with lower mood scores compared with women without previous PMS. In our studies, MPA provoked depressed mood to a lesser extent than did NETA. Surprisingly, the higher dose of MPA (20 mg) enhanced the mood, compared with 10 mg, when added to estrogen treatment. In women continuously treated with 3 mg estradiol, mood and physical symptoms worsened during the progestin addition, as compared with treatment with 2 mg estradiol. The negative side effects seen during sequential HRT have much in common with symptoms seen in the premenstrual dysphoric disorder (PMDD), which is a psychoneuroendocrine disorder with psychiatric expression. Explanations for treatment effects on mood are likely to be found in drug interactions with neurotransmitter systems of the brain.
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| 2. |
- Wallin Lundell, Inger, 1958-
(författare)
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Induced Abortions and Posttraumatic Stress - Is there any relation? : A Swedish multi-centre study
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion
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| 3. |
- Dabo Pettersson, Fatimah, 1975-
(författare)
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Genetics and Labor Pain Behavior
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Labor may perhaps be the most painful a woman might experience, although characterized by large inter-individual variability. The perceived pain during labor is the result of diverse factors, i.e. her previous pain experiences, the analgesia she receives and maybe also her genes. The overall aim of this thesis was to investigate biological and psychological mechanisms underlying inter-individual differences in labor pain related behaviors. The mechanisms that characterize endogenous pain relief during labor are not fully understood, though it is known to be partly explained by the effects of β-endorphin (BE). BE plasma levels were followed longitudinally in a cohort of pregnant women and were found to remain unchanged between early and late pregnancy, although with a nadir in the beginning of the third trimester. Furthermore, women with low levels of BE in plasma at the end of the third trimester, required second line labor analgesia to a significantly higher extent than women with normal levels. In a population-based sample of 814 pregnant women we investigated if inter-individual differences in labor pain related behavior was influenced by the pain-protective single nucleotide polymorphism (SNP) combination of guanosine triphosphate cyclohydrolase (GCH1) and the opioid receptor µ-1 gene (OPRM1) A118G SNP. We identified a possible association between the pain-protective SNP combination of GCH1 and use of second line analgesia. No association was found between the OPRM1 and use of analgesia or labor pain related behavior. The association between self-rated antenatal depressed mood and anxiety in relation to pain behaviors and self-reported pain during labor was investigated. We found that depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia. In conclusion, although an increasing number of studies strongly suggest that genetic predisposition plays an important role in pain and pain-related mechanisms, GCH1 and OPRM1 has little to offer in terms of individual counseling on labor analgesia. To enable the future use of genetic variability for pre-labor testing and counseling, a number of different genes reflecting pain mediation pathways, involving biological and psychological mechanisms, need to be analyzed in combination.
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| 4. |
- Lundin, Cecilia
(författare)
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Hormonal contraception, mood and sexual function
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hormonal contraceptives (HCs) are used by millions of women worldwide. Apart from their contraceptive effect, they also offer additional health benefits such as decreased menstrual bleedings and amelioration of menstrual-related pain. Adverse mood and sexual side-effects during HC-use are commonly reported, and women who discontinue treatment with HCs often claim these side effects as reason for cessation.Although several studies have investigated associations of HCs and adverse mood and sexual side-effects, little is known about causally drug-related outcomes. Few randomised controlled trials (RCTs) have been conducted, and observational studies in the field are subject to several methodological caveats which limit what conclusions that can be drawn from them.The overall aim of this thesis was to investigate the effect of HCs on various aspects of mood and sexual function.Study one was a randomised controlled trial where participant women received a combined oral contraceptive (COC) or placebo. Mood and sexual function were assessesed through daily ratings and questionnaires and measured at baseline and after three months treatment. Study two was a cross-sectional study that assessed which demographic, reproductive, and psychiatric factors are associated with self-reported HC-induced adverse mood symptoms.Study three was a register-based cohort study including all Nordic-born women aged 15-24 residing in Sweden between 2010 and 2017. Risk of depression – captured as redeemed prescription of antidepressant treatment or a depression diagnosis – among HC-users compared to non-users were estimated. Women who were randomised to a COC reported increased anxiety, mood swings and irritability compared to women randomised to placebo. In contrast, women who received a COC improved in depressive symptoms (paper I). Compared to women randomised to placebo, women who received a COC deteriorated regarding sexual interest and vaginal lubrication. Only deterioration in sexual interest remained after adjustments for depressive symptoms (paper II). Compared to women with no self-reported HC-induced adverse mood symptoms, women with such experience more often suffered from an ongoing minor depressive disorder, had more often experienced any previous mental health problem, and had more often undergone induced abortion (paper III). No uniform associations between use of HCs and subsequent risk of depression were found. In general, oral contraceptives conferred lower or no risk, while non-oral contraceptives were associated with small increased risks. Higher risks were found among HC-users aged 15-19 years compared to older HC-users (paper IV).
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| 5. |
- Axfors, Cathrine, et al.
(författare)
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Investigating the association between neuroticism and adverse obstetric and neonatal outcomes
- 2019
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.
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| 6. |
- Axfors, Cathrine, et al.
(författare)
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Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 98:4, s. 470-478
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionElevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.Material and methodsParticipants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).ResultsAfter adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).ConclusionsNeuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.
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| 7. |
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| 8. |
- Bannbers, Elin, 1984-
(författare)
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The Effect of Steroid Hormones in the Female Brain During Different Reproductive States
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Women are twice as likely as men to suffer from depression and anxiety disorders and have an increased risk of onset during periods associated with hormonal changes, such as the postpartum period and the menopausal transition. Furthermore, some women seem more sensitive to normal hormone fluctuations across the menstrual cycle, since approximately 3-5% suffers from premenstrual dysphoric disorder (PMDD). Why these disorders are so common in women has not been established but there is a probable involvement of the ovarian hormones.The aim of this thesis was to investigate the effect of the ovarian hormones on the female brain during different reproductive states using psychological tests known to affect brain activity in different ways.Paper one examined the effect of the ovarian hormones on prepulse inhibition (PPI) on the acoustic startle response (ASR) and comprised cycling women and postmenopausal women. The cycling women had lower levels of PPI compared to postmenopausal women and postmenopausal women with moderate estradiol levels had lower PPI compared to postmenopausal women with low estradiol levels.Paper two examined the effect of anticipation and affective modulation on the ASR in women with PMDD and healthy controls. Women with PMDD have an increased modulation during anticipation of affective pictures compared to healthy controls during the luteal phase of the menstrual cycle.Paper three examined brain activity during response inhibition among women with PMDD and healthy controls by the use of a Go/NoGo task and fMRI. Women with PMDD displayed a decreased activity in the left insula during follicular phase and an increased activity during the luteal phase compared to controls.Paper four comprised women in the postpartum period and non-pregnant controls to examine brain activity during response inhibition. While this study revealed decreased activity at 4 weeks postpartum compared to 48 hours postpartum we cannot ascertain the role of the ovarian steroids, since none of the significant brain areas correlated with ovarian steroid or neurosteroid serum concentrations.The results of this thesis demonstrate that the ovarian hormones, or at least various hormonal states, have a probable impact on how the female brain works.
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| 9. |
- 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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| 10. |
- Jonasson, My, et al.
(författare)
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Quantification of aromatase binding in the female human brain using [11 C]cetrozole positron emission tomography.
- 2020
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Ingår i: Journal of Neuroscience Research. - : Wiley. - 0360-4012 .- 1097-4547. ; 98:11, s. 2208-2218
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Tidskriftsartikel (refereegranskat)abstract
- Aromatase, the enzyme that in the brain converts testosterone and androstenedione to estradiol and estrone, respectively, is a putative key factor in psychoneuroendocrinology. In vivo assessment of aromatase was performed to evaluate tracer kinetic models and optimal scan duration, for quantitative analysis of the aromatase positron emission tomography (PET) ligand [11 C]cetrozole. Anatomical magnetic resonance and 90-min dynamic [11 C]cetrozole PET-CT scans were performed on healthy women. Volume of interest (VOI)-based analyses with a plasma-input function were performed using the single-tissue and two-tissue (2TCM) reversible compartment models and plasma-input Logan analysis. Additionally, the simplified reference tissue model (SRTM), Logan reference tissue model (LRTM), and standardized uptake volume ratio model, with cerebellum as reference region, were evaluated. Parametric images were generated and regionally averaged voxel values were compared with VOI-based analyses of the reference tissue models. The optimal reference model was used for evaluation of a decreased scan duration. Differences between the plasma-input- and reference tissue-based methods and comparisons between scan durations were assessed by linear regression. The [11 C]cetrozole time-activity curves were best described by the 2TCM. SRTM nondisplaceable binding potential (BPND ), with cerebellum as reference region, can be used to estimate [11 C]cetrozole binding and generated robust and quantitatively accurate results for a reduced scan duration of 60 min. Receptor parametric mapping, a basis function implementation of SRTM, as well as LRTM, produced quantitatively accurate parametric images, showing BPND at the voxel level. As PET tracer, [11 C]cetrozole can be employed for relatively short brain scans to measure aromatase binding using a reference tissue-based approach.
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| 11. |
- Jónsdottir, Björg, 1982-
(författare)
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The extent of gynaecological cancer : Evaluation, outcome and quality of life
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to enhance treatment planning for gynaecological cancer patients and identify women that are more likely to have impaired quality of life (QoL) after treatment. In a retrospective cohort study on ovarian cancer, the peritoneal cancer index (PCI) was examined in relation to incomplete cytoreductive surgeries (CRS) and surgical complications (n=167). The PCI was found to be an excellent predictor of incomplete CRS (AUC 0.94). Complete CRS was obtained for only 67.2% of the patients with a PCI score higher than 24, who also experienced an increased rate of complications (p = 0.008). In a prospective study, radiologic PCI assessed with integrated PET/MRI and DW-MRI was compared with the surgical PCI as the gold standard (n=34). The median total PCI for PET/MRI (21.5) was closer to the surgical PCI (24.5) (p = 0.6) than to DW-MRI (20.0, p = 0.007). PET/MRI was more accurate (p = 0.3) for evaluating patients at primary diagnosis and for evaluating high tumour burden in inoperable patients.In a nationwide study, endometrial cancer patients included in the Swedish Quality Registry for Gynaecologic Cancer 2017-2019 (n=1401) were analysed with the aim of describing methods of evaluating myometrial invasion (MI). The main methods for the MI assessment were transvaginal sonography (59%) and MRI (28%). The sensitivity of transvaginal sonography (65.6%) was lower than for the other methods.In a longitudinal questionnaire-study, QoL in women with advanced gynaecological cancer was compared to women with local disease (n=372). No difference in QoL was found at the one-year follow-up. With multiple regression analyses, previous psychiatric illness, high BMI and comorbidities were identified as risk factors for impaired QoL.In conclusion, the PCI is an excellent predictor of incomplete CRS, and PCI ≥24 is a possible cut-off. PET/MRI is superior to DW-MRI for estimating total PCI. The assessment of MI in endometrial cancer in Sweden is usually performed with transvaginal sonography, but the sensitivity is lower than for other methods. Women with advanced gynaecological cancer have equally good QoL one year after diagnosis as women with limited disease, and psychiatric illness, high BMI, and comorbidities are risk factors for impaired mental health.
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| 12. |
- Persson, Sofia, 1985-
(författare)
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Polycystic ovary syndrome : Long-term health aspects
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, affecting many aspects of women’s health such as fertility, cardiovascular health and quality of life. However, less is known about later life stages, as well as the impact of hyperandrogenism and PCOS itself, apart from risks associated with excess body weight. The overall aim with this thesis was therefore to study how PCOS, and its hyperandrogenic phenotype, is associated with general health, with focus on diabetes, hypertension, dyslipidaemia and fertility at a longer span of time than during the fertile period.Studies I-III were register-based cohort studies, linking six Swedish national registers. In total, >50 000 women with PCOS and ≈ 250 000 controls were included and followed up for up to 20 years. Study IV was a clinical cross-sectional study including 124 women with PCOS and 74 controls.The main results were that PCOS has a great impact on women’s lives extending beyond the fertile period. While women with PCOS achieve a first childbirth as often as non-PCOS women, they have fewer children overall and give birth at a later age. In addition, PCOS is a moderate risk factor for type 2 diabetes, hypertension and dyslipidaemia, regardless of body weight. The risk appears to be more pronounced in those with the hyperandrogenic phenotype. Finally, hyperandrogenism persists largely in midlife for women with PCOS, both through ongoing symptoms such as hirsutism and by having a negative impact on the women’s quality of life.In conclusion, women with PCOS should be informed that they have a good chance of conceiving, but that some may need assisted reproduction. We suggest that PCOS in general and the hyperandrogenic phenotype in particular be included as independent risk factors when counselling women on their likelihood to suffer from cardiovascular disease and its risk factors in particular such as type 2 diabetes, hypertension and dyslipidaemia.
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| 13. |
- Segebladh, Birgitta, 1956-
(författare)
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Is it Just the Hormones? : Sex Steroids, Chronic Stress and Violence in Premenstrual Dysphoric Disorder
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Premenstrual depressive symptoms and mood swings affect 3-8% of women in fertile age. The female hormones are believed to be the cause. Progesterone is well studied, but estrogen is not, and either are other causes such as intimate partner violence and chronic stress. The aim in this thesis was to investigate the influence of hormones as well as psychological aspects on the most common problems among women seeking care for premenstrual symptoms. In a cross-sectional study, four groups of women were included: ongoing users of oral contraceptives, with or without adverse mood symptoms and previous users, with or without experience of adverse mood. Depression and anxiety were significantly more common in both groups with reported adverse mood, in comparison with their control groups with no adverse mood. Self-reported PMS was significantly more common in those women who reported adverse mood, however, there was no difference in prospectively defined PMS or PMDD between the two groups of previous users. In a RCT with 25 women completing the study, GnRH treatment were tested in combination with two different HRT add-back doses of estradiol, in combination with progesterone and placebo. The higher dose of estrogen 1.5 mg in combination with progesterone induced significantly more pronounced symptoms than in combination with placebo. The lower dose, 0.5 mg gave less symptom recurrence in combination with progesterone. Exposure to violence was investigated among PMDD patients, healthy controls and gynecological patients. Among the participating women, gynecological patients, reported physical and/or emotional abuse significantly more often than did PMDD patients, as well as healthy controls. Chronic stress was investigated with diurnal cortisol, and low-dose dexamethasone test. There was no difference in diurnal secretion of cortisol between PMDD patients and controls. No difference in the degree of dexamethasone suppression was found between PMDD patients and controls. According to the results from these studies, the main symptom provoking factor in women with PMDD appears to be the estradiol and progesterone fluctuations across the menstrual cycle, whereas chronic stress and intimate partner violence appears to be less relevant.
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| 14. |
- Sylvén, Sara M, 1982-
(författare)
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Biological and Psychosocial Aspects of Postpartum Depression
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postpartum depression (PPD) is one of the most common complications of childbirth around the world. Despite several studies on the underlying mechanisms, the pathophysiology remains elusive. The aims of this thesis were to assess possible associations between the risk for self reported PPD and serum levels of leptin, the season of delivery, the gender of the newborn, and the history of premenstrual symptoms, respectively. A population based cohort of 2318 newly delivered women in Sweden were screened five days, six weeks and six months postpartum, using the Edinburgh Postnatal Depression Scale. This cohort comprised 60% of the total population, and the prevalence of self reported PPD was 11.1% six weeks after the delivery. A negative association between leptin levels at delivery and self reported PPD at six weeks and six months postpartum was evident, even after adjusting for confounding factors. An increased risk for self reported PPD was noted among women delivering during the last three months of the year, compared to those giving birth in April through June. This is of clinical importance, since women delivering at the end of the year could benefit from a closer follow-up after delivery. Despite previous varying findings – depending on study population and consequently different cultural settings – in our study, no association between infant gender and self reported PPD could be detected at six weeks or six months postpartum. However, women giving birth to baby boys had a higher risk for postpartum blues. Lastly, an increased risk for self reported PPD among women with a history of premenstrual symptoms was noted. Interestingly, after stratification for parity, the association between PPD and premenstrual symptoms remained only among multiparas. The association between PPD and premenstrual symptoms might shed light on the many possible routes by which hormonal changes may influence mood in women. In conclusion, this population based study strengthens the notion that PPD is a complex multifactorial disorder, with biological, social and psychological parameters shaping each individual’s risk. Further research is needed in this field, in order to investigate underlying pathophysiological mechanisms, propose more effective diagnostic tests and assess therapeutic interventions.
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| 15. |
- Wesström, Jan, 1963-
(författare)
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Sleep Related Movement Disorders : Association with Menopause and Pregnancy
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is known that sleep problems affect people’s wellbeing and has great consequences for public health.Restless legs syndrome (RLS) gives uncomfortable sensations in the legs at rest, leading to an irresistible need for activity. It aggravates in evening and at night. Therefore, RLS provides poorer sleep and can affect quality of life through fatigue, family life and social activities, work, and comorbidity. It is demonstrated a dysfunction of the dopaminergic system in the brain with low levels of dopamine and / or less sensitive dopamine receptors. RLS is more common in women and the prevalence increases with age and during pregnancy.Periodic limb movements are characterized by uncontrolled stretching movements of the legs, especially the toes, ankles, knees and hips during sleep. They last between 0.5 and 5 seconds, and can cause brief awakenings leading to daytime sleepiness. The clinical significance of PLM is rather controversial and PLM is sometimes seen in healthy people with no daytime symptoms.RLS is a subjective diagnosis and translated with the help of questionnaires. PLM however, can objectively be evaluated by polysomnography.Depression is common during and after pregnancy. It is not known whether women with RLS during pregnancy have a higher risk of prenatal or postpartum depression.The aims of this thesis was to to examine the prevalence, associated symptoms and comorbidities, in particular, vasomotor symptoms, menopause, and hormone replacement therapy (HRT) use, among women who suffer from RLS and PLMs. We also evaluated the impact of RLS and PLMs on health related quality of life (HRQoL), and if RLS before and during pregnancy increases the risk of antenatal or postpartum depressive symptoms.Three different poulations were used. Paper 1-3 were cross-sectional and included 5000 resp. 10000 randomly selected women from the general populations of Dalarna and Uppsala County. Questionnaires, polysomnographic recordings, blodtests etc. were used. Paper 4 was a longitudinal cohort study where 1428 pregnant women in Uppsala County were followed.In summary, data included in this thesis points out that RLS and PLMs are more common in women with estrogendeficiency-related symptoms of menopause. RLS-positive women had an impaired mental HRQoL compared to RLS-negative women and more often suffered from comorbidities. Data also revealed that women with RLS before and during pregnancy are at increased risk for depression during and after pregnancy.
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