EEG Correlates of Reward in Pregnancy

产后抑郁症(PPD)影响着10%-15%的女性--并与一系列严重的 对母亲和孩子的幸福都有影响的负面结果。即使是抑郁症状加重 不完全符合MDD标准会对母亲和婴儿造成虚弱的影响。因此，有一个关键的 在产前验证可用于早期指导的风险标志物的机会和需要 确定最高风险的妇女；然后这些标记可用于预防工作和 作为新干预策略的目标。因为妇女经常在 在怀孕期间，这一时期是检测和改进风险识别的理想机会。 一个正在形成的共识是，快感缺乏--对奖励不敏感--是MDD的一个核心缺陷。 然而，在围产期缺乏快感的生物标志物还没有被研究过。目前的建议 重点关注与奖赏相关的神经活动，反映在被称为奖赏的事件相关电位中 正性(RewP)。REWP在诊断为MDD的成人和儿童中都是迟钝的-我们已经 研究发现，REWP降低可预测抑郁症症状和首次发病的增加。 严重的抑郁发作--即使考虑到其他已知的风险衡量标准。 这项提议旨在将我们之前的工作扩展到PPD-并测试新的假设：钝化的 怀孕期间获得的REWP将前瞻性地预测抑郁症状的增加和新的 产后抑郁发作。我们将记录300名孕妇在奖励任务中的脑电 怀孕16至32周的妇女在产科/妇产科办公室进行产前检查。 抑郁症状和障碍将在基线和分娩后六周进行评估-因此 在控制其他已知风险因素时可以检查REWP的预测能力(例如， MDD病史和基线症状)。选择这个样本量是为了确保在 产后抑郁结局和产后抑郁的足够病例。第一个目标是考察 妊娠16周时出现的抑郁症状和诊断。AIM 2评估是否存在 基线时较小的RewP将预测产后抑郁的增加。目标 3将确定怀孕期间迟钝的奖赏相关神经活动(即RewP)是否可以预测 即使在控制了产后抑郁的其他基线预测因素后，抑郁的结果也是如此。我们会 还要检查基于时间-频率的奖励测量(即，与奖励相关的增量频段活动)，并检查 奖赏相关神经活动在预测抑郁症预后中的阳性和阴性预测价值 产后期--单独或与基线风险因素联合使用。这款R21将提供第一款 有证据表明，在常规情况下，怀孕期间使用脑电评估与奖赏相关的神经活动不足 OB/GYN访视可改善产后抑郁加重的预测。

Postpartum depression (PPD) affects 10-15% of women – and is associated with a range of severe negative outcomes that impact both the mother's and child's well-being. Even elevated depressive symptoms not meeting full MDD criteria have a debilitating effect on the mother and infant. Therefore, there is a critical opportunity and need to validate markers of risk during the prenatal period that could be used to guide early identification of the highest risk women; these markers might then be leveraged for prevention efforts and serve as targets of novel intervention strategies. Because women regularly access health care during pregnancy, this period presents an ideal opportunity to test and improve identification of risk. There is an emerging consensus that anhedonia – insensitivity to reward – is a core deficit in MDD. However, biological markers of anhedonia have not been studied in the perinatal period. The present proposal focuses on reward-related neural activity reflected in an event-related potential referred to as the reward positivity (RewP). The RewP is blunted among both adults and children with diagnosed MDD—and we have found that a reduced RewP prospectively predicts increases in depressive symptomatology and first onset of major depressive episodes—even when accounting for other known measures of risk. This proposal aims to extend our previous work to PPD—and test the novel hypothesis that a blunted RewP obtained during pregnancy will prospectively predict increased depressive symptoms and new depressive episodes in the postpartum period. We will record EEG during a reward task in 300 pregnant women in conjunction with prenatal care visits at an OB/GYN office between 16 and 32 weeks gestation. Depressive symptoms and disorders will be assessed both at baseline and six weeks following delivery—so that the predictive ability of the RewP can be examined when controlling for other known risk factors (e.g., history of MDD and baseline symptoms). This sample size was chosen to assure adequate variability in postpartum depressive outcomes and sufficient cases of PPD. Aim 1 is to examine the relationship between the RewP and current depressive symptoms and diagnoses at 16 weeks gestation. Aim 2 assesses whether a smaller RewP at baseline will prospectively predict increases in depression during the postpartum period. Aim 3 will determine whether blunted reward-related neural activity (i.e., the RewP) during pregnancy predicts depressive outcomes even after controlling for other baseline predictors of postpartum depression. We will also examine time-frequency based measures of reward (i.e., reward-related delta band activity), and examine positive and negative predictive value of reward-related neural activity in predicting depressive outcomes in the postpartum period—both alone and in conjunction with baseline risk factors. This R21 will provide the first evidence that hypoactive reward-related neural activity, assessed using EEG during pregnancy at a routine OB/GYN visit, could be used to improve the prediction of increased depression during the postpartum period.