| ObjectivesTo assess the associations between postpartum depression(PPD) with antenatal and postnatal social support,neurotransmitters,and polymorphisms of GNB3 and TPH1 genes.Materials and Methods1.Prospective cohort study We recruited study subjects between February and September 2007 at Hunan Maternal and Infant Hospital,the Xiangya and the Third Xiangya Hospitals of the Central South University in Changsha,Hunan,People's Republic of China,during their prenatal visit.All eligible pregnant women who consented to participate were recruited into the study.We collected baseline demographic and clinical data and measured their level of social support by Social Support Rate Scale(SSRS)at 30 to 32 weeks of gestation.Social support level was measured again using SSRS at 2 weeks postpartum.The Chinese version of the Edinbough Postnatal Depression Scale(EPDS)was used at 2 weeks postpartum to assess PPD,with a score of 13 or higher as the cut-off for PPD.2.Nested case-control study was conducted to assess the associations between PPD with neurotransmitters and with polymorphisms of GNB3 and TPH1 genes.For each PPD case,one subject(for neurotransmitters)or two subjects(for polymorphisms) without PPD(matched by hospital at childbirth(same)and age(within 5 years)were selected.High performance liquid chromatogram(HPLC)was used to measure 5-HT,5-HIAA,DA,DOPAC,HAV,NE,MHPG concentrations,enzyme-linked immunosorbent assay test(ELISA)was used to measure QFQ,NPY,SP concentrations,and ligase detection reaction(LDR)was used to measure GNB3 Rs544SNP and TPH1Rs1800532 SNP polymorphisms.3.Statistical analysis software package of SPSS(version 13.0)was used in all analyses,including descriptive analysis,Chi-square test,t test, unconditional multiple logistic analysis,Pearson correlation coefficient analysis,and analysis of variance(ANOVA).Results1.Six hundred and sixty-six subjects were recruited into the study, and 534(80.2%)completed the follow up and were included in the final analysis.Among them,103(19.29%)met the criterion of PPD(EPDS score of 13 or higher).42 PPD cases and 42 controls were selected for the analysis of neurotransmitters,and 43 PPD cases and 86 controls were selected for the analysis of genetic polymorphisms.2.Association between social support and PPD①Association between prenatal social support and PPD PPD rate was 9.90%in the highest quartile of total social support score whereas the rate in the lowest quartile was 28.20%(P＜0.01),with adjusted OR of 3.33(95%CI 1.61,6.90).PPD rate was 13.30%in the highest quartile of subjective social support score and 21.40%in the lowest quartile(P＞0.05).PPD rate was 11.90%in the highest quartile of objective social support score and 32.70%in the lowest quartile(P＜0.01),with adjusted OR of 3.31(95%CI 1.60,6.84).PPD rate was 17.00%in the higher availability of social support group and 24.30 in the lower group(P＜0.01),with adjusted OR of 0.69(95%CI 0.42,1.13).②Association between postnatal social support and PPD PPD rate was 5.40%in the highest quartile of total social support score whereas the rate in the lowest quartile was 44.10%(P＜0.01),with adjusted OR of 10.01(95%CI 4.22,23.73).PPD rate was 7.70%in the highest quartile of subjective social support score and 45.50%in the lowest quartile(P＜0.01),with adjusted OR of 5.76(95%CI 2.67,12.46). PPD rate was 7.50%in the highest quartile of objective social support score and 44.90%in the lowest quartile(P＜0.01),with adjusted OR of 7.03(95%CI 3.04,16.30).PPD rate was 16.00%in the higher availability of social support group and 23.30%in the lower group(P＜0.05),with adjusted OR of 0.79(95%CI 0.49,1.28).③Fetal gender,social support,and PPD There was no difference in prenatal social support level(both in total score and in the three dimensions of the SSRS)between women who gave birth to a male infant and those who gave birth to a female infant(P＞0.05),while the postnatal social support level(both in total score and in the three dimensions of the SSRS)was significantly higher in women who gave birth to a male infant than those who gave birth to a female infant(P＜0.01).The rate of PPD of women who gave birth to a female infant was 3.67 times of the rate in those women who gave birth to a male infant.The higher risk of PPD in women who gave birth to female infant remained after adjustment for demographic factors,obstetric factors,and prenatal social support(total score)(OR=3.76,95%CI:2.31,6.10).However,the difference in PPD between women who gave birth to a female infant and those women who gave birth to a male infant disappeared after adjustment for demographic factors,obstetric factors,and postnatal social support(total score) (OR=1.47,95%CI:0.82,2.61).3.Association between PPD and neurotransmitters and their metabolitesPlasma 5-HT(7.21±2.06ug/L versus 8.25±2.24ug/L),5-HIAA (3.82±1.34)ug/L versus 4.53±1.77ug/L),and NPY(6.14±0.97 versus 6.66±0.79ng/ml)levels were significantly lower in PPD cases than that of in the controls(P＜0.05),while plasma NE(60.53±10.52 versus 55.04±11.99)and SP(884.15±246.78 versus 771.45±267.54)levels were significantly higher in PPD cases than that of in the controls(P＜0.05).There was no significant difference in plasma 5-HIAA/5-HT, MHPG,DA,HVA,DOPAC,and OFQ levels between the two groups. Among PPD subjects,there were negative correlations between EPDS score with plasma 5-HT(r=0.41,P＜0.01)and NPY(r=0.36,P＜0.05) level,while there were positive correlations between EPDS score with plasma NE(r=0.37,P＜0.05 and SP(r=0.44,P＜0.01)levels.There was negative correlation between NPY and NE(r=0.36,P＜0.05) among these neurotransmitters.4.Association between PPD and polymorphisms of GNβ3 Rs544SNP and TPH1 Rs1800532SNP genesThere were no differences in GNβ3 Rs544SNP genotypes between PPD subjects(CC=23.30%,C/T=51.2%,TT=25.6%,C=48.84%, T=51.16%)and controls(CC=30.20%,C/T=39.50%,TT=30.20%, C=50.00%,T=50.00%)(P＞0.05).Among PPD subjects,gene expressions were not associated with age,neurotransmitters levels,and EPDS total score or subunit scores(P＞0.05).There were no difference in TPH1 Rs1800532SNP genotypes between PPD subjects(AA=18.60%, A/C=46.5%,CC=34.90%,A=41.86%,C=58.14%)and controls (AA=19.80%,A/C=58.10%,CC=22.10%,C=48.84%,T=51.16%)(P＞0.05).Among PPD subjects,gene expressions were not associated with age,neurotransmitters levels,and EPDS total score or subunit scores(P＞0.05). Conclusions1.About 20%women developed PPD 2 weeks postpartum.2.Lower or lack of social support is a risk factor of PPD.3.The association between postnatal social support and PPD is much stronger than that of prenatal social support.4.Lack of postnatal social support is a significant risk of PPD for women giving birth to a female infant.5.Changes in plasma 5-HT,5-HIAA,NPY,NE,and SP levels are strongly associated with PPD.6.No association between GNβ3 Rs544SNPpolymorphism or TPH1 Rs1800532SNPpolymorphism and PPD is observed in this study. |
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