Zachary N. Stowe

Depressive Disorders in Women

INTRODUCTION In the United States, over 30 million people experience clinical depression each year (Kessler et al., 2003), with the majority of these patients being female. The rate of depression in women is typically twice that of men, with several studies reporting variability in the lifetime ratios in different countries, for example ratios ranging from 1.6 in Beirut and Taiwan to 3.1 in West Germany (Weissman et al., 1996). The identification and treatment of depression in women has garnered increasing attention over the past decade, particularly with respect to the impact of reproductive life events on mood disorders. The National Institutes of Health has issued several announcements requesting applications to investigate this understudied area. A major impetus for this increased research focus is that distribution of major depression across the female reproductive life cycle is variable. Women are at greatest risk for the first episode of major depression during the childbearing years (Angold, Costello, & Worthman, 1998; Bebbington et al., 1998; Weissman, 1996). The overlap between the symptoms of depression and many complaints considered by clinicians to be the normal sequelae of reproductive life events, such as menstruation, pregnancy, postpartum, and the transition to menopause, presents challenges to the accurate diagnosis as well as calls to question the validity of applying the same diagnostic criteria to women during these life events (Stowe & Newport, 1998).

Course of ante-and postnatal depressive symptoms related to mothers' HPA axis regulation

Given high health costs of depression during pregnancy and the first postnatal year, it is important to understand mechanisms involved in the emergence and perpetuation of symptoms during this time. In a series of 2 studies, we aim to clarify bidirectional relations between mothers’ physiological stress regulation—stress-related activation of the hypothalamic-pituitary-adrenal (HPA) axis—and their course of depressive symptoms. In Study 1, 230 pregnant women recruited from a women’s mental health program gave 3 saliva samples in the context of psychosocial stress at 24, 30, and 36-weeks gestation. They self-reported depressive symptoms across the three trimesters of pregnancy and first year postpartum. Multilevel models revealed women with elevated salivary cortisol during pregnancy showed a course of escalating ante- and postnatal symptoms, implicating HPA hyperactivation as a precursor to worsening mood problems. In Study 2, 54 mothers from a community sample self-reported depressive symptoms at 3, 6, 12, and 18 months postnatal. At 18 months, they participated in a dyadic stress task with their infant and gave 4 saliva samples for cortisol assay. For mothers with a lifetime depression diagnosis, an escalating course of postnatal symptoms predicted a higher, flatter cortisol response profile. Together, the results of these studies suggest that for high-risk mothers, a trajectory of worsening depression may both follow from and give rise to neuroendocrine stress hyperactivation. These findings suggest greater attention is warranted to course of depressive symptoms across the ante- and postnatal period, rather than symptom levels at any given time, to characterize health risks.

An exploratory study of whether pregnancy outcomes influence maternal self-reported history of child maltreatment

Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to womens experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most womens reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes.

Fetal assessment in buprenorphine-maintained women using fetal magnetoencephalography: a pilot study: Fetal MEG assessment in BUP-maintained women

BACKGROUND AND AIMSnIn-utero exposure to opioids including buprenorphine (BUP) has been shown to affect fetal activity, specifically heart-rate variability (FHRV) and fetal movement (FM). Our objective was to extract simultaneous recordings of fetal cardiac and brain-related activity in BUP-maintained and non-opioid exposed pregnant women using a novel non-invasive biomagnetic technique.nnnDESIGNnA pilot study was conducted, recording and analyzing biomagnetic data from fetuses of BUP-maintained and non-opioid exposed pregnant women. Signals were acquired with the non-invasive 151-channel SARA (SQUID-Array for Reproductive Assessment) system. Advanced signal-processing techniques were applied to extract fetal heart and brain activity.nnnSETTINGnUniversity of Arkansas for Medical Sciences (UAMS, Little Rock, Arkansas, USA).nnnPARTICIPANTSnEight BUP-maintained pregnant women from UAMS Womens Mental Health Program between gestational ages (GA) of 29-37xa0weeks who were treated with 8-24xa0mg of BUP daily. Sixteen pregnant women with no known opioid exposure in the same GA range were also included.nnnMEASUREMENTSnOutcome measures from the fetal heart and brain signals included: heart rate (FHR), FM, FHR accelerations, FHR-FM coupling, FHRV, fetal behavioral states (FBS) and power spectral density (PSD) of spontaneous brain activity. These measures were analyzed at three GA intervals.nnnFINDINGSnFetal heart and brain activity parameters were extracted and quantified successfully from 18 non-opioid and 16 BUP recordings. Overall analysis in both groups show that: FHR and FM ranged from 131 to 141xa0beats per minute (b.p.m.) and 5 to 11 counts, respectively. In the 35-37xa0weeks GA, the coupling duration (~9xa0s) was the shortest, while three of the FHRV parameters were the highest. The PSD of brain activity revealed highest power in 0.5-4xa0Hz bandwidth. Transitions in FBS from quiet to active sleep werexa0>xa050% of sessions.nnnCONCLUSIONSnThis pilot study showed that a novel biomagnetic technique allows simultaneous quantification of cardiac and brain activities of a group of buprenorphine-exposed and non-exposed fetuses in the third trimester.

Physiological attunement in mother–infant dyads at clinical high risk: The influence of maternal depression and positive parenting

A growing number of research studies have examined the intradyadic coregulation (or attunement) of hypothalamus-pituitary-adrenal axis functioning in mothers and their children. However, it is unclear how early this coregulation may be present in dyads at clinical high risk and whether certain factors, such as maternal depression or positive parenting, are associated with the strength of this coregulation. The present study examined cortisol attunement within mother-infant dyads in a high-risk sample of 233 mothers who received treatment for psychiatric illness during pregnancy and whose infants were 6 months old at the study visit. Results showed that maternal and infant cortisol covaried across four time points that included a stressor paradigm and a mother-infant interaction task. Greater maternal positive affect, but not depression, predicted stronger cortisol attunement. In addition, infants cortisol level following separation from the mother predicted mothers cortisol level at the next time point. Mothers cortisol level following the separation and the laboratory stress paradigm predicted infants cortisol levels at each successive time point, over and above infants own cortisol at the previous time point. These findings suggest that maternal and infant cortisol levels influence one another in a bidirectional fashion that may be temporally and context dependent.

Women and Depression: Depressive Disorders in Women

INTRODUCTION In the United States, over 30 million people experience clinical depression each year (Kessler et al., 2003), with the majority of these patients being female. The rate of depression in women is typically twice that of men, with several studies reporting variability in the lifetime ratios in different countries, for example ratios ranging from 1.6 in Beirut and Taiwan to 3.1 in West Germany (Weissman et al., 1996). The identification and treatment of depression in women has garnered increasing attention over the past decade, particularly with respect to the impact of reproductive life events on mood disorders. The National Institutes of Health has issued several announcements requesting applications to investigate this understudied area. A major impetus for this increased research focus is that distribution of major depression across the female reproductive life cycle is variable. Women are at greatest risk for the first episode of major depression during the childbearing years (Angold, Costello, & Worthman, 1998; Bebbington et al., 1998; Weissman, 1996). The overlap between the symptoms of depression and many complaints considered by clinicians to be the normal sequelae of reproductive life events, such as menstruation, pregnancy, postpartum, and the transition to menopause, presents challenges to the accurate diagnosis as well as calls to question the validity of applying the same diagnostic criteria to women during these life events (Stowe & Newport, 1998).