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Perinatal Depression & Anxiety: Relationships with Late Pregnancy Thyroid Status

围产期抑郁症

基本信息

批准号：
8212222
负责人：
CORT ANDREW PEDERSEN
金额：
$ 39.71万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-28 至 2014-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8212222
关键词：
Accounting Anxiety Anxiety Disorders Birth Data Depressed mood Depressive disorder Diagnosis Disease Drops Endogenous depression Equipment and supply inventories Estradiol Estriol Event General Population Goals Gonadal Steroid Hormones Hamilton Rating Scale for Depression Health Hormones Hydrocortisone Hypothalamic structure Interview Interviewer Life Major Depressive Disorder Measures Mental Depression Mothers Normal Range Perinatal Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women 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 depressive symptoms design improved indexing meetings minor depressive disorder physical abuse pituitary thyroid axis prenatal theories

项目摘要

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）：高达 30% 的产后女性出现抑郁症状，14% 出现重度或轻度抑郁症。尽管甲状腺状态与抑郁症之间的关系在一般人群中已得到充分证实，并且在怀孕期间和怀孕后会发生较大的甲状腺变化，但很少有关于甲状腺功能在产前或产后（围产期）抑郁症中的研究。我们发现妊娠晚期甲状腺素水平较低、甲状腺素范围内的总甲状腺素和游离甲状腺素（TT4、FT4）浓度与较高的围产期抑郁自评之间存在显着相关性。抑郁程度较低的母亲的产后 TSH 水平显着下降，但抑郁程度较高的母亲的产后 TSH 水平并未下降，并且显着升高。有抑郁症史的母亲中，产前 TT4 和 FT4 浓度较低的比例明显较高。我们将在更大的队列（N = 200）中测试我们研究结果的有效性，确定妊娠晚期较低的 TT4 和 FT4 水平是否也与围产期综合症（严重或轻微）抑郁或焦虑症状或疾病相关，确定产前较低的 TT4 和 FT4 水平是否与抑郁症史相关，并测试产前甲状腺测量是否可以改善产后抑郁症的预测，特别是与已知的危险因素（滥用史、压力大的生活事件、低社会支持）。我们假设围产期抑郁症与性激素对 HPT 轴抑制的敏感性增加有关，并且可能与怀孕期间皮质醇升高导致产前 TT4 和 FT4 水平较低有关。这会导致产后这些激素水平迅速下降后 HPT 轴的中枢驱动力激增，从而产生更高的产后 TSH 水平。 HPT 轴中枢驱动力增加的指数（脑脊液 TRH 浓度升高、TRH 释放 TSH 减弱）与重度抑郁症相关。为了检验我们的理论，我们将确定较低的产前 TT4 和 FT4 水平是否与较高的产后 TSH 水平显着相关，以及这种关系是否与围产期抑郁症相关。我们还将检查妊娠晚期性激素和皮质醇水平与妊娠晚期 TT4 和 FT4 水平在预测围产期抑郁症方面是否存在相互作用。公共卫生相关性：大约 14% 的母亲在产后前 3 个月内出现临床抑郁症，相似比例的母亲在怀孕期间出现抑郁症。该项目基于两项初步研究，发现产后抑郁程度较高的母亲在怀孕后期的甲状腺激素水平相对较低（但在正常范围内），但在分娩后其他甲状腺激素水平较高。该项目的目标是看看这些结果是否在更多的孕妇和产后妇女中得到证实，妊娠晚期的甲状腺激素水平是否有助于预测哪些母亲会变得抑郁，产前或产后的甲状腺测量是否与焦虑症状或疾病（这在产后也很常见）有关，并检验关于妊娠晚期甲状腺激素水平较低如何导致产后抑郁的理论。