The biological underpinnings of perinatal depressive symptoms: A multisystems approach

Background: Well-established evidence exists of an association between depressive symptoms and alterations in<br> the stress and inflammatory response systems; however, the picture is far less coherent during the perinatal<br> period. This study combines the assessment of multiple stress and inflammatory biomarkers in late pregnancy<br> and after delivery in order to investigate cross-sectional and prospective associations with perinatal depressive<br> symptoms.<br> Methods: One-hundred-ten healthy women were assessed in late pregnancy (mean gestational age=34.76;<br> SD=1.12) and 89 were re-evaluated after delivery (mean hours after delivery=52.36; SD=19.70) for depressive<br> and anxiety symptoms through the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory.<br> Serum Interleukin-6 (IL-6), C-Reactive Protein (CRP) and diurnal salivary cortisol levels were measured on both<br> occasions, while diurnal salivary alpha amylase (sAA) levels were assessed in late pregnancy.<br> Results: Using Hierarchical Linear Models, higher depressive symptoms were found to be associated with higher<br> IL-6 levels, lower morning cortisol levels and a flatter cortisol diurnal slope during pregnancy, while adjusting<br> for potential confounders. No significant associations were found after delivery or with change in biomarker<br> levels from pre- to post-partum. Furthermore, preliminary evidence of a positive association between inflammation<br> and stress markers in women with higher antenatal depressive symptoms was found.<br> Limitations: The sample was relatively small and highly selected, thus limiting generalizability of the findings.<br> Conclusions: Results emphasize the need for an integrated multi-systems approach to the understanding of the<br> biological underpinnings of perinatal depression and suggest that the stress-immune interactions represent a promising avenue for future endeavor背景：已有充分确凿的研究证据表明，抑郁症状与应激及炎症应答系统的异常存在关联，但围产期（perinatal）的相关关联图景仍远未明晰。本研究对妊娠晚期及产后个体的多种应激与炎症生物标志物进行联合检测，旨在探究其与围产期抑郁症状的横断面及前瞻性关联。 方法：本研究共纳入110名健康女性，在其妊娠晚期（平均孕周=34.76；标准差SD=1.12）开展抑郁与焦虑症状评估，其中89名女性在产后（平均产后时长=52.36小时；标准差SD=19.70）接受了复测。症状评估采用爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale）与状态-特质焦虑问卷（State-Trait Anxiety Inventory）。两次检测均采集了血清白细胞介素-6（Interleukin-6, IL-6）、C反应蛋白（C-Reactive Protein, CRP）及昼夜节律唾液皮质醇水平，而唾液α淀粉酶（salivary alpha amylase, sAA）的昼夜节律水平仅在妊娠晚期进行检测。 结果：采用分层线性模型（Hierarchical Linear Models）校正潜在混杂因素后分析显示，妊娠晚期抑郁症状评分越高的受试者，其血清IL-6水平越高、晨起皮质醇水平越低，且皮质醇昼夜节律斜率越平缓。产后阶段未发现显著关联，产前至产后的生物标志物水平变化也与抑郁症状无显著相关性。此外，本研究还初步发现，产前抑郁症状更严重的女性，其炎症与应激标志物水平呈正相关。 局限性：本研究样本量相对较小且筛选严格，因此研究结果的外推性受到一定限制。 结论：本研究结果凸显了采用整合性多系统方法解析围产期抑郁生物学基础的必要性，并提示应激-免疫交互作用是未来相关研究极具前景的方向。