Anton Bergant

Early postnatal depressive mood: associations with obstetric and psychosocial factors.

The central purpose of this investigation was to detect incidence and influencing factors on early postnatal depressive mood in a large hospital sample. By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, and obstetric and psychologic variables. The Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive mood of our patients. The interview was carried out on 1250 women at two postnatal wards 5 days after delivery. According to the results of the German validation of the EPDS, where a cutoff of 9/10 indicates at least mild depressive disorder, the whole sample was divided into group A (EPDS score < or = 9; n = 996, 79.7%) and group B (EPDS score > or = 10; n = 254, 20.3%). Early postnatal depressive mood, as assessed by the EPDS, appeared with 20% of all women taking part in our investigation on the fifth postnatal day. Subjective measurements such as high childbirth burden, elevated trait anxiety, low life satisfaction and lower social class, and low birth weight of the infant seem to be of predominant relevance for early postnatal depressive mood.

Longitudinal study of tryptophan degradation during and after pregnancy

In mice, activation of indoleamine-2,3-dioxygenase (IDO), an enzyme converting tryptophan to N-formyl-kynurenine, was found to be necessary requirement to achieve immunotolerance against the fetus and thus uncomplicated pregnancy. In plasma from 20 healthy pregnant women with singleton pregnancies we consecutively analyzed kynurenine and tryptophan concentrations during pregnancy (1 specimen at each trimester of gestation) and postpartum (week 6). None of the women had any signs of infection at the time of plasma sampling, but the study population was otherwise unselected. The kynurenine to tryptophan ratio (kyn/trp) was calculated as an estimate of IDO activity, and data were compared to concentrations of neopterin and 55kD soluble tumor necrosis factor receptor (sTNF-R55), two indicators of immune activation, and to alanineaminotransferase (ALT) levels. Increasing kynurenine and decreasing tryptophan concentrations were found during pregnancy, data suggesting significant degradation of tryptophan. In parallel, increasing concentrations of immune activation markers neopterin and sTNF-R55 were observed, correlating significantly to kyn/trp. The data point to an involvement of cytokine-induced IDO activation in the degradation of tryptophan observed during pregnancy. After pregnancy, sTNF-R55 and also neopterin concentrations declined, whereas tryptophan concentrations increased, indicating that immune activation and activation-induced tryptophan degradation returned to baseline. By contrast, still increased kynurenine concentrations and also increased kyn/trp point to continuing catabolism of tryptophan. Postpartum elevation of liver enzyme ALT may suggest that increased activity of hepatic tryptophan pyrrolase could be involved in increased conversion of tryptophan despite low degree of immune activation. We conclude that IDO is activated in pregnancy and that the decrease of tryptophan might be related to immune activation phenomena. Sustained increase of kynurenine postpartum seems independent from immune activation process.

Tryptophan Degradation During And After Gestation

In mice, activation of indoleamine-(2,3)-dioxygenase (IDO), an enzyme converting tryptophan to N-formyl-kynurenine, is required to achieve immunotolerance against the fetus and thus uncomplicated pregnancy. On the other hand, postpartum blues and depression appear to be related to reduced availability of tryptophan and serotonin. In healthy pregnant women with singleton pregnancies we consecutively analyzed kynurenine and tryptophan concentrations during pregnancy and postpartum. The kynurenine to tryptophan ratio (kyn/trp) was calculated as an estimate of IDO activity, and data were compared to concentrations of neopterin and 55kD soluble tumor necrosis factor receptor, two indicators of immune activation, and to alanineaminotransferase (ALT) levels. Increasing kynurenine and decreasing tryptophan concentrations were found during pregnancy. The data confirm earlier results and suggest significant degradation of tryptophan. In parallel, increasing concentrations of immune activation markers neopterin and sTNF-R55 were found, correlating significantly to the kyn/trp. The data point to an involvement of cytokine-induced IDO activation in the degradation of tryptophan observed during pregnancy. After pregnancy, sTNF-R55 and also neopterin concentrations declined, whereas tryptophan concentrations increased, indicating that immune activation and activation-induced tryptophan degradation has ceased. By contrast, still increased kynurenine concentrations and also increased kyn/trp suggest continuing turnover of tryptophan. Because also ALT was increased postpartum, abnormal activity of hepatic tryptophan pyrrolase and possibly other enzymes could be involved. We conclude that the decrease of tryptophan during pregnancy might be related to immune activation phenomena. Sustained increase of kynurenine postpartum seems independent from immune activation process, rather it seems related to abnormal activity of liver enzymes.

Childbirth as a Biological Model for Stress

Objective: The aims of this investigation were to measure corticotropin-releasing hormone (CRH), corticotropin (ACTH) and cortisol before, during and after delivery searching for an endocrine intercorrelation of the hypothalamic-pituitary-adrenal (HPA) axis and to correlate these findings with obstetrical variables. Methods: Blood was sampled from 50 women with singleton pregnancies at term without uterine contractions, during delivery (after full cervical dilatation) and on the 4th postnatal day. Hormones were measured by radioimmunoassay (RIA). The correlation between obstetric variables, sociodemographic and endocrine data were evaluated using the Spearman rank coefficient. Group comparisons for continuous variables were calculated using the Mann-Whitney U test and Kruskal-Wallis test. Results: Maternal plasma ACTH and cortisol increased significantly during labor, declining toward the 4th postnatal day (p < 0.001) and showing a significant intercorrelation (p < 0.01). Compared to women without uterine contractions CRH rose during labor (p < 0.05) and decreased rapidly to the 4th postnatal day (p < 0.001). No correlations between CRH and ACTH or cortisol were observed. None of the obstetrical variables (parity, newborn’s weight, duration of delivery) revealed any significant correlation with ACTH. Analgetic medication (pethidine hydrochloride) was not able to influence the endocrine response to labor stress. Conclusions: Stressful experience during childbirth has an impact on endocrine response. However, this is not fully evident along the HPA axis in a simple biological model with monocausal dependencies. This ‘biological stress model’ is not sensitive enough to detect different childbirth conditions and the hormones in the maternal compartment have partially fetal (placental) origin.

Prävalenz depressiver Störungen im frühen Wochenbett

Fragestellung: Ziel dieser Untersuchung war es, die Prävalenz depressiver Störungen am fünften Tag postpartum mit der Edinburgh Postnatal Depression Scale (EPDS) zu untersuchen und Zusammenhänge mit geburtshilflichen und psychosozialen Variablen darzustellen. Methoden: Die Erfassung soziodemographischer Daten, somatischer und psychiatrischer Anamnesen sowie geburtshilflicher und psychologischer Variablen erfolgte mittels Interview bzw. der Krankengeschichte. An der Untersuchung nahmen 1250 Wöchnerinnen 5 Tage nach der Geburt teil. Ergebnisse: Gemäss den Resultaten der deutschen Validierung der EPDS zeigte sich für 254 (20,3%) Wöchnerinnen eine zumindest leichte depressive Störung. Der Vergleich zwischen nichtdepressiven Frauen (EPDS ≤9, n = 996) und depressiven Frauen (EPDS ≥10, n = 254) erbrachte folgende Risikofaktoren für eine depressive Störung: subjektiv erhöhte Geburtsbelastung, höhere Angstneigung, ungünstige Partnerbeziehung, niederer Sozialstatus und geringere Berufszufriedenheit. Hinsichtlich geburtshilflicher Variablen erwiesen sich vermehrte Schwangerschaftsrisiken, Fehlgeburten in der Anamnese, niederes Geburtsgewicht und Kaiserschnittentbindungen als Risikofaktoren. Schlussfolgerungen: Depressive Störungen im frühen Wochenbett treten bei 20% der Wöchnerinnen auf. Entsprechend der Literatur stellt diese Gruppe von Frauen das Risikokollektiv für eine spätere postpartale Depression dar. Unter Beachtung der psychosozialen und geburtshilflichen Risikovariablen sind präventive psychotherapeutische Interventionen bereits an der Wochenstation sinnvoll.

Type-Specific Antiviral Antibodies to Genital Human Papillomavirus Types in Mothers and Newborns

Type-specific antibodies to human papillomaviruses (HPVs) can be detected in most infected adult patients, and they have virus-neutralizing properties. However, there is a dearth of information on the seroprevalence of maternal and neonatal antibodies to HPV capsid antigens. Sera from 104 mothers, their newborns, and 3 twin pregnancies were analyzed by an enzyme-linked immunosorbent assay (ELISA) for the presence of specific IgG, IgM, and IgA antibodies to virus-like particles of HPV-6, -11, -16, -18, and -31. Maternal IgG positivity rates to HPV types 6, 11, 16, 18, and 31 were 23.1%, 2.9%, 8.7%, 5.8%, and 9.6%, respectively. Neonatal rates did not differ significantly, and individual IgG ELISA values of mothers and their infants and all paired twins showed a very high correlation. In contrast, nearly all IgM and IgA individual values in newborns were designated negative, whereas mothers positivity rates ranged as high as 19.2%. Infants showed no HPV-related lesions at birth or at 4-year follow-up. Seven of 8 tested children lost IgG HPV antibodies in a follow-up examination. Similar anti-HPV IgG seropositivity in mothers and newborns and a lack of neonatal IgA and IgM together with twin and follow-up results indicate that neonatal IgG is not a sign of intrauterine HPV infection but, rather, maternofetal antibody transmission.

Burden of childbirth

SummaryBackground: Aims of this investigation were to study the subjective psychological and physical stressful experience of childbirth burden on a scale with 7 choises and to determine physical and psychosocial factors, which influence delivery experience.nMethods: Information on sociodemographic data, physical and psychiatric anamnesis, as well as obstetrical and psychological variables were gained through a structured interview. This was carried out on 1250 women on the fifth postnatal day at the maternity ward.nResults: According to the burden of childbirth score all 1250 women were divided into three subgroups. Group A (low burden, n = 433), group B (medium burden, n = 516) and group C (high burden, n = 301). The comparison between these three groups with respect to burden of childbirth revealed sig-nificant differences for length and mode of delivery, parity, pregnancy risk factors, gestational age at delivery, prior psychopharmacologic medication, occupational satisfaction, trait anxiety and depressive mood. The multiple logistic regression analysis between group A and group C showed that length of delivery had the strongest impact on burden of childbirth followed by depressive mood, elevated trait anxiety score, mode of delivery (emergency cesarean section and delivery by vacuum extraction provide significant higher burden scores than elective cesarean section and spontaneous delivery), and occupational satisfaction (higher occupational satisfaction correlates with low burden of childbirth).nConclusions: In summary, burden of childbirth assessed on the fifth postnatal day is a result of a complex interaction between physical and psychological factors, whereby physical stressors such as length of labor, emergency surgical delivery and affective alterations such as elevated trait anxiety, depressive mood, and job satisfaction seem to be of predominant relevance.

Bilateral nipple ulcers in a breastfeeding woman: a manifestation of Behcet's disease?

After an uneventful pregnancy, a 28 year old woman of Mediterranean origin was admitted to the hospital at 40 weeks of gestation for caesarean section due to constricted pelvis. She had had one previous delivery by caesarean section under thromboprophylaxis with enoxaparin. She breastfed in her puerperium without any problems. In this pregnancy the caesarean resection was uncomplicated. During her caesarean section oxytocin (5 IU) was administered intravenously. Antibiotics (ampicillin), low molecular weight heparin (enoxaparin 40 mg once daily) for thromboprophylaxis and analgesics (diclofenac 100 mg suppositories) were given. Nine days after delivery, when enoxaparin was the only remaining medication, she developed a high fever (39.4”C) together with an inflammation of the left nipple, and one day later of the right nipple. Eleven days after delivery breastfeeding was stopped, using cabergolin, when both nipples developed deep ulcers (Fig. 1 a and b). Simultaneously she had erythematous nodules on the extensor surfaces of the lower extremities suggestive of erythema nodosum. Neither blood culture nor repeated bacteriological swabs of the nipples and the child’s throat showed any infection. Enoxaparin was discontinued 15 days after delivery. On the 18th day after her caesarean section she recovered, with oral cefalexin and local treatment of her nipples. Six weeks postpartum the woman had recovered completely (Fig. 1 bottom). In her medical history she had recurrent folliculitis, arthralgia and vulva1 aphthous ulcers, once accompanied by tongue ulcers, but no nipple ulceration. The clinical features suggested Behcet’s disease.

Tissue Polypeptide Antigen during Parturition and Puerperium

The tumour and cytoskeleton protein tissue polypeptide antigen (TPA) was determined in maternal serum taken during the second stage of labour and on the 4th postpartum day. Pregnant women at term (weeks 38-42) served as a control group. TPA levels of women during parturition (median 169 U/l) were higher than those of the control group (median 108.5 U/l) and those of women on the 4th postpartum day (median 66.5 U/l); p < 0.0001 in each case. The correlation between duration of labour and TPA concentration was positive and significant (rs = 0.3; p = 0.03). A significant negative correlation was found between placental weight and maternal serum TPA levels during parturition (rs = -0.3; p = 0.03). The decline of TPA after delivery indicated a serum half-life for TPA of less than 4 days.

Spezifische serologische Untersuchungen mit einem neuartigen authentischen HPV-Antigen (Virus-like Particles) auf HPV-6 Antikörper bei gynäkologischen Patientenkollektiven

OBJECTIVEnA serological assay for genital HPV infection would provide important additional information to HPV DNA diagnostic methods, since it would evaluate prior exposure to the viruses, detect significant systemic immunologic response to virus infection, and could be performed in most clinical laboratories.nnnMETHODSnSerum samples from three groups of patients attending a gynecology clinic were analysed by direct ELISA for specific IgG antibodies to baculovirus-expressed HPV-6 and BPV-1-L1-VLPs.nnnRESULTSnPositive IgG reactivity to HPV-6-L1-VLPs were 4/72 (6%) in a control group, 28/73 (38%) in a condyloma group and 17/62 (17%) in cervical intraepithelial neoplasia patients. Individual IgG ELISA values of condyloma and CIN patients for HPV-6-L1-VLPs demonstrated no correlation to results with BPV-1-L1-VLPs.nnnCONCLUSIONSnThese data show that HPV-6-L1-VLPs are effective antigens for serological studies and can detect species specific antibodies with important implications for diagnosis, epidemiology, insights to natural course of disease, prognosis and evaluation of vaccination.