Psychological Prevention Trial, Risks, And Association Study Using Single Nucleotide Polymorphisms In The Estrogen Receptor (ERβ) Gene For Postpartum Depression

[Objectives] 1．To test the effectiveness of a prenatal group psychological intervention in reducing the incidence of postpartum depression. 2．To detect the related risks for postpartum depression. 3．To investigate the ER? gene susceptivitity for postpartum depression.[Methods] (1) Using a randomized controlled trial design for the intervention. 800 pregnant women at 16-20 weeks gestation were selected parted-continuly from The International Peace Maternity & Child Health Hospital of China Welfare Institute in Shanghai. All the women were randomly aollotted to the intervention group(int group ,n=386) or control group(con group ,n=414) .The intervention consisted of six sessions(five sessions for pregnant women+one session for husband) called "how to treat the postpartum depression". Both of the two groups attended the normal hospital education equally. All the subjects were evaluated by HAD once a month prenatally, and EPDS additionally at 3 days, 42 days, 3 month postpartum. SCID clinical interviews would be given at different level across to HAD and EPDS scores. Analysis of the mental health outcomes, by intention to treat, was adjusted for the correlated structure of the data. (2) Self-compiled risk questionnaires,LES,the obstetrical checks and EPQ were asked to fulfilled. Dimensional and Categorical assessment were performed sequencedly when regressing the risks for postpartum depression. (3) 70 cases (depressed women postpartum) and 110 control (non-depressed women postpartum) choosed among the subjects were genotyped by ERβgene two SNPs with PCR-RFLP. A modified association,case-control association and two-point haplotype association with postpartum depression were performed.[Results]PartⅠ: (1) In the PP dataset, we find the intervention can weaken the anxious emotion during pregnant periods and postpartum periods according to HAD scores, but not seen according to EPDS scores. In the FAS dataset, no effect was given by the intervention whether evaluated by HAD or EPDS. The intervention on husband can help well-recept women prevent the anxious emotion in postpartum. "A" value of HAD at 32-36 weeks and 38-40 weeks gestation were negativly correlated wth intervention times recept by pregnant women or with their husbands. (2) According to HAD or EPDS cut-off, the intervention couldn't play role on the anxious symptoms or depressive symptoms at any time-point postpartum. (3) By SCID interview, we couldn't seen the effect of the intervention, whether in major depressive disorder non-specific depressive disorder or in any depressive disorder at each time-point or in the whole three months. The prevalence of major depressive disorder at each time-point was 4．04%,14．92%,7．85% in the int. group and 4．04%,14．92%,7．85% in the con. group. The prevalence of postpartum depressive disorder during the total three months was 11．79% and 12．68% at each group. The prevalence of major depressive disorder in the whole three months for the entire sample was 12．24%, non-specific depressive disorder 12．98%, and any depressive disorder 27．82%. (4) The intervention can significantly increase the portion of "easy type" of infant temperament, and significantly decrease the "escaption" and "response threshold" dimension values.PartⅡ: By the dimensional regression, the same risks for postpartum depression in the three time points were infant care stress,neuroticism,past depression episode and dissatisfaction with parents. There were yet other risks-worrying about absence of nursing herself,infant infectiveness,relaxation and common wards at 3days postpartum, pregnant anxiety,life events stress,dissatisfaction with husband,dissatisfaction with friends,dissatisfaction with dong-the-month,bad dwelling and postpartum bleeding at 42 days postpartum, and pregnant depression,life events stress,worrying about work,bad sleep and bad dwelling at 3 month postpartum. By the categorical regression, past depression episode,neuroticism,infant care stress,pregnant depression and postpartum bleeding became the risks for postpartum depression, almost nearly to the risks by the dimensional regression.PartⅢ: The genotype "T/T" according to ERβgene rs3020444 (T/C) polymorphism was found to be associated with postpartum depression in our study. The case who had the "T/T" genotype developed postpartum depression 2．91 times the control (P<0．05) . The case who had the "T" allele developed postpartum depression 2．72 times the control (P<0．05) . The haplotype "C-C" based on rs1256030 (C/T) and rs3020444 (T/C) polymorphisms had a protective effect on postpartum depression, OR=0．312[0．104-0．942] , P=0．039。However, we couldn't find the rs1256030 (C/T) alleles or genotypes were associated with postpartum depression.[Conclus i ons] (1) The prenatal psychological intervention can prevent pregnant and postpartum anxious emotion at some extent. The intervention on husband can help well-recept women prevent the anxious emotion in postpartum. The more times of intervention recept by pregnant women and their husbands, the more effect on the anxious emotion at middle and late pregnant periods.(2) The prenatal psychological intervention couldn't act on postpartum depression apparently. (3) The intervention can play a positive action on the psychological development of infants. (4) The highest prevalence of postpartum depression will occur at 42days postpartum, and 3 month postpartum the next, 3 days postpartum the last. (5) The cut-off 8/9 of HAD isn't compatible with SCID when determining postpartum depression, so is the cut-off 12/13 of EPDS. Dropping the cut-off point will be better. There are high false negativity inherent in the HAD and EPDS, when screened for postpartum depression.(6) The dimensional regression is a good way when deducing the risks for postpartum depression. Because the dimensional regression can use the data wholly, and had higher statistical power compared with categorical regression. Furthermore, the risks according to the dimensional regression are almost same to the categorical regression.(7) Infant care stress,past depression episode,neuroticism and dissatisfaction with parents are the most important risks for postpartum depression among one part of Shanghai postpartum women. (8) ERβgene may join in the pathogenesis of postpartum depression. Women who had the genotype rs3020444 (T/C) "T/T"may develop depression because of abnormal ERβgene transcription with the withdrawal of estrogen after birth. But the detail steps are not clear. The haplotype "C-C" based on rs1256030 (C/T) and rs3020444 (T/C) polymorphisms is a protective locus of postpartum depression.