EEG Correlates of Reward in Pregnancy

产后抑郁症（PPD）影响10-15%的妇女-并与一系列严重的 影响母亲和孩子福祉的负面结果。甚至抑郁症状加重 不符合完整的MDD标准会对母亲和婴儿产生削弱作用。因此，有一个关键的 机会和需要在产前期间验证风险标记，可用于指导早期 确定风险最高的妇女;这些标志物可用于预防工作， 作为新的干预策略的目标。因为妇女在怀孕期间经常获得医疗保健， 怀孕期间，这一时期提供了一个理想的机会，以测试和改善识别的风险。 有一个正在形成的共识，即快感缺乏-对奖励不敏感-是MDD的核心缺陷。 然而，快感缺乏的生物标志物尚未在围产期进行研究。现时的建议 重点是反映在事件相关电位（称为奖励）中的奖励相关神经活动 正性（RewP）。RewP在成人和儿童确诊的MDD患者中都是钝化的， 研究发现，RewP降低前瞻性地预测了抑郁症的增加， 严重抑郁发作-即使考虑到其他已知的风险措施。 这个提议的目的是将我们以前的工作扩展到PPD-并测试新的假设， 在怀孕期间获得的RewP将前瞻性地预测抑郁症状的增加和新的 产后抑郁症发作。我们将记录300名孕妇在奖励任务期间的脑电图 孕妇在怀孕16至32周期间在妇产科诊所接受产前检查。 抑郁症状和障碍将在基线和分娩后6周进行评估， 当控制其他已知的风险因素（例如， MDD病史和基线症状）。选择该样本量是为了确保 产后抑郁的结果和足够的PPD病例。目的1是研究 RewP和当前抑郁症状以及妊娠16周时的诊断。目标2评估是否 基线时较小的RewP将前瞻性地预测产后期间抑郁症的增加。目的 3将确定是否钝化的奖励相关神经活动（即，怀孕期间预测 即使在控制了产后抑郁症的其他基线预测因素后，抑郁症的结果也是如此。我们将 还检查基于时间-频率的奖励度量（即，奖励相关的δ带活动），并检查 奖励相关神经活动在预测抑郁症结局中的阳性和阴性预测值 产后期-单独和与基线风险因素结合。R21将提供第一个 有证据表明，在怀孕期间使用EEG评估的奖励相关神经活动减退， 产科/妇科访视，可用于提高预测增加抑郁症在产后期间。

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.