Perinatal Depression & Anxiety: Relationships with Late Pregnancy Thyroid Status

围产期抑郁症

• 批准号: 7617651
• 负责人: CORT ANDREW PEDERSEN
• 金额: $ 56.58万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-28 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7617651
• 关键词: Accounting; Anxiety; Anxiety Disorders; Birth; Data; Diagnosis; Disease; Drops; Endogenous depression; Equipment and supply inventories; Estradiol; Estriol; Event; Farnesyl Transferase Inhibitor; General Population; Goals; Gonadal Steroid Hormones; Hamilton Rating Scale for Depression; Hormones; Hydrocortisone; Hypothalamic structure; Interview; Interviewer; Life; Major Depressive Disorder; Measures; Mothers; Normal Range; Perinatal; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Progesterone; Puerperium; Recording of previous events; Research Personnel; Risk Factors; Social support; Stress; Symptoms; Testing; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Thyroxine; Woman; base; cohort; depressed; depression; depressive symptoms; design; falls; improved; indexing; meetings; minor depressive disorder; physical abuse; pituitary thyroid axis; pregnant; prenatal; public health relevance; theories

DESCRIPTION (provided by applicant): Up to 30 percent of postpartum women develop depressive symptoms and 14% develop major or minor depression. Although relationships between thyroid status and depression are well established in the general population and large thyroid changes occur during and following pregnancy, there have been few studies of thyroid function in pre or postpartum (perinatal) depression. We found robustly significant correlations between low, euthyroid range total and free thyroxine (TT4, FT4) concentrations during late pregnancy and higher perinatal depression self-ratings. Postpartum TSH levels fell significantly in mothers with low depression but did not decline and were significantly more elevated in mothers who were more depressed. A significantly higher fraction of mothers with depression history had lower prepartum TT4 & FT4 concentrations. We will test the validity of our findings in a larger cohort (N = 200), determine if lower late pregnancy TT4 & FT4 levels are also related to perinatal syndromal (major or minor) depression or anxiety symptoms or disorders, ascertain whether lower prepartum TT4 & FT4 levels are related to depression history and test whether prenatal thyroid measures improve prediction of postpartum depression especially when combined with known risk factors (abuse history, stressful life events, low social support). We hypothesize that perinatal depression is related to greater sensitivity to suppression of the HPT axis by sex hormone and possibly cortisol elevations during pregnancy producing lower prepartum TT4 & FT4 levels. This results in a surge of central drive in the HPT axis after the rapid postpartum drop in these hormone levels producing higher postpartum TSH levels. Indices of increased central drive in the HPT axis (elevated CSF TRH concentrations, blunted TSH release by TRH) are associated with major depression. To test our theory, we will determine if lower antenatal TT4 & FT4 levels are significantly related to higher postpartum TSH levels and if that relationship is associated with perinatal depression. We will also examine if there are interactions between late pregnancy sex hormone and cortisol levels and late pregnancy TT4 & FT4 levels in predicting perinatal depression. PUBLIC HEALTH RELEVANCE: About 14% of mothers develop clinical depression within the first 3 months after giving birth and a similar percentage become depressed during pregnancy. This project is based on two preliminary studies that found that mothers who are more depressed postpartum have relatively low (but normal range) thyroid hormone levels during late pregnancy but then have higher levels of other thyroid hormones after giving birth. The goals of this project are to see if these results are confirmed in a much larger number of pregnant and postpartum women, if thyroid hormone levels during late pregnancy might help predict which mothers will become depressed, if pre or postpartum thyroid measures are related to anxiety symptoms or disorders (which are also common in the postpartum period) and to test a theory about how lower late pregnancy thyroid hormone levels might contribute to postpartum depression.

描述（由申请人提供）：多达30％的产后妇女出现抑郁症状，有14％的抑郁症患者。尽管甲状腺状况与抑郁症之间的关系在普通人群中已经建立了，并且在怀孕期间和之后发生了巨大的甲状腺变化，但在产前或产后（围产期）抑郁症中甲状腺功能的研究很少。我们发现，妊娠晚期，低，甲状腺功能障碍范围和游离甲状腺素（TT4，FT4）浓度与较高的围产期抑郁症自我评价之间存在牢固的显着相关性。抑郁症低但没有下降，在沮丧的母亲中，产后TSH水平显着下降，但没有下降，并且升高得多。患有抑郁史的母亲的比例明显较高，其前产前TT4和FT4浓度较低。我们将在较大的队列（n = 200）中测试我们发现的有效性，确定较低的妊娠晚期TT4＆FT4水平是否与围产期综合征（主要或轻度）抑郁症或焦虑症状或疾病或疾病有关，确定较低的前TT4＆FT4水平是否与抑郁症史和抑郁症相关的抑制因素是否相关。压力性生活事件，社会支持低）。我们假设围产期抑郁症与性激素对抑制HPT轴的敏感性更大有关，并可能在怀孕期间可能会产生较低的前TT4和FT4水平的皮质醇升高。这导致在这些激素水平的产后迅速下降后，产后较高的TSH水平导致HPT轴中心驱动。 HPT轴中心驱动的指标（CSF TRH浓度升高，TRH钝化的TSH释放）与重大抑郁症有关。为了测试我们的理论，我们将确定较低的产前TT4和FT4水平是否与产后TSH水平较高以及这种关系是否与围产期抑郁有关。我们还将检查妊娠晚期性激素与皮质醇水平与妊娠晚期TT4＆FT4水平之间是否存在相互作用，以预测围产期抑郁症。公共卫生相关性：大约14％的母亲在分娩后的头三个月内发展出临床抑郁症，在怀孕期间，类似百分比抑郁。该项目基于两项初步研究，该研究发现，产后更抑郁的母亲在怀孕晚期的甲状腺激素水平相对较低（但正常），但随后出生后其他甲状腺激素水平较高。该项目的目标是查看这些结果是否在孕妇和产后女性中是否得到证实，如果怀孕晚期期间甲状腺激素水平是否可能有助于预测哪些母亲会变得沮丧，如果甲状腺甲状腺甲状腺甲状腺措施是否与焦虑症状或疾病有关（在产后和后期的抑郁症中也很常见）对较晚的抑制作用，则可能会造成较低的抑郁症。