Depression and Suicide, Mood Disorders, Other Perinatal Conditions
Conditions
Keywords
depression, mood disorder, post-partum depression, suicidality, post-partum suicidality, perinatal depression, perinatal mood disorder, inflammation, kynurenine pathway, glutamate
Brief summary
The goal of the study is to define and measure biological processes that contribute to the underlying pathophysiologic process of peri-partum depression to be used for identifying those at risk for developing it. This knowledge may also generate novel drug targets for peripartum depression that may be applicable to other types of depression.
Detailed description
This study analyses the role of inflammation and metabolites of inflammation in perinatal depression. Psychiatric assessments of depression and suicidality will be compared to blood levels of two metabolites of inflammation, quinolinic acid (QUIN) and picolinic acid (PIC), that might regulate nerve cell communication. The levels of these metabolites are regulated by kynurenine pathway enzymes. Psychiatric symptoms, inflammatory cytokines and levels of the metabolites will be measured throughout pregnancy. Additionally, the investigators are gathering placentas at delivery and determining the degree of inflammation in the tissue in the investigators' laboratory. Inflammatory biomarkers, antibody titers, and key kynurenine pathway enzymes and metabolites from pre- and post partum women, placenta, and cord blood will be measured.
Interventions
None listed
Sponsors
Pine Rest Christian Mental Health Services
Van Andel Research Institute
Corewell Health West
National Institute of Mental Health (NIMH)
Michigan State University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Pre-partum cohort: * All races and national origins of pregnant females. * Age 18 and older. * English speaking. * Able to give informed consent. * Able to comply with study procedures.
Exclusion criteria
Pre-partum cohort: * Non-pregnant females * Patients with psychotic symptoms and/or severe cognitive impairment that interfere with their ability to give informed consent or to complete study assessments. * Patients that cannot read and write in English as research measures used have only been validated in English speaking populations. * Patients that have blood-borne chronic infections including hepatitis B, C, or HIV as established at routine pregnancy blood screens; they will be excluded as the laboratory facilities do not approve processing of their tissue for safety reasons. * Patients who have any schizophrenia spectrum disorder or bipolar disorder type 1 (based on self report and SCID interview); these patients will be excluded as the neurobiology of these disorders are different from peripartum depression. * Patients who report ongoing substance abuse or dependence (in the past 3 months). Inclusion criteria Post-partum cohort: * All races and national origins of females who delivered a child vaginally or by caesarian section up to 6 months prior to enrollment. * Age 18 and older. * Edinburgh Perinatal Depression Rating Scale score of 10 and above and/or endorsed suicide ideation on the CSSRS. * Depressive symptoms which began or worsened (if already present) during pregnancy or up to 4 weeks post-partum. * Able to give informed consent. * Able to comply with and complete study procedures. * English speaking.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in activity of the enzyme aminocarboxymuconate semialdehyde decarboxylase ACMSD in blood during pregnancy | Up to pregnancy week 13 (1st sample), up to week 25 (second sample) and up to delivery (3rd sample) and post-partum (4th sample, within 6 months after delivery) | Blood levels of quinolinic acid and picolinic acid (product of ACMSD) at three timepoints during pregnancy and one time-point after pregnancy |
| Activity of the enzyme aminocarboxymuconate semialdehyde decarboxylase ACMSD in placenta | At delivery | Placenta levels of quinolinic acid and picolinic acid |
| Increase in depressive symptoms | Up to pregnancy week 13 (1st assessment), up to week 25 (second assessment) and up to delivery (3rd assessment) and post-partum (4th assessment, within 6 months after delivery) | Assessment of depressive symptoms by means of the Edinburgh Postnatal Depression Scale |
| Suicidal symptoms | Post-partum (within 6 months after delivery). | Assessment of suicidal symptoms by means of the Columbia Suicide Severity Rating Scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in blood inflammation | Up to pregnancy week 13 (1st sample), up to week 25 (second sample) and up to delivery (3rd sample) and post-partum (4th sample, within 6 months after delivery) | Analysis of the inflammatory cytokine IL-6 in blood |
| Placenta inflammation | At delivery | Analysis of the expression of the inflammatory cytokine IL-6 in placental tissue |
Countries
United States
Outcome results
None listed