No association between perinatal mood disorders and hypertensive pregnancies.
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ABSTRACT:
SUBMITTER: Araji S
PROVIDER: S-EPMC9412728 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
Publications
No association between perinatal mood disorders and hypertensive pregnancies.
Araji Sarah S Griffin Ashley A Kassahun-Yimer Wondwosen W Dixon Laura L Spencer Shauna-Kay SK Belk Sheila S Ohaegbulam Gail G Wallace Kedra K
Frontiers in psychiatry 20220812
Mental health disorders such as anxiety and/or depression are the most common mental health disorders seen among reproductive aged women and can increase during pregnancy. Many sociodemographic risk factors have been associated with anxiety and/or depression in pregnancy, which can lead to adverse maternal and infant outcomes including the risk of a hypertensive pregnancy. The current study prospectively examined self-reported anxiety, depression and stress in pregnant women without a history of ...[more]
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Project description:ObjectiveThis study aimed to identify gestational weight change trajectories and examine their association with perinatal outcomes.MethodsPrenatal and delivery records of 3393 twin pregnancies were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. Generalized gestational weight gain (GWG) was calculated by dividing the total GWG by the length of gestation in weeks and multiplying by 37 weeks. Latent class growth modeling (LCGM) was used to identify GWG patterns. Multivariable logistic regression and generalized estimating equations (GEE) were used to analyze the associations between GWG trajectories and perinatal outcomes. The included adverse perinatal outcomes were preterm birth, low birth weight (LBW), small for gestational age (SGA), and large for gestational age (LGA).ResultsThe mean ± SD of GWG for underweight women was 17.87 ± 5.67 kg, 16.76 ± 6.22 kg for normal weight, 14.34 ± 6.60 kg for overweight, and 14.27 ± 4.94 kg for obese. Three gestational weight change trajectory groups were identified: low-increase (32.36%), moderate-increase (56.26%), and high-increase (11.38%). Compared to the moderate-increase group, the high-increase group showed a reduced risk of LBW (aOR 0.68, 95%CI 0.56, 0.83), and SGA (aOR 0.49, 95%CI 0.40, 0.60) but an increased risk of LGA (aOR 2.23, 95%CI 1.48, 3.35). No significant change was observed in the risk of preterm birth in the high-increase group. The low-increase group had a higher risk of preterm birth (aOR 1.66 95%CI 1.42, 1.94), LBW (aOR 2.44 95%CI 2.13,2.80), and SGA (aOR 1.32 95%CI 1.16, 1.51), with no significant difference in the risk of LGA (aOR 1.11 95%CI 0.78,1.58).ConclusionsDistinct patterns of GWG in twin pregnancies are associated with varying risks of adverse perinatal outcomes. These findings highlight the importance of monitoring and managing GWG in twin pregnancies.
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Project description:ImportanceHypertensive disorders of pregnancy (HDP) have been associated with poorer neurodevelopmental outcomes in offspring, but the role of familial confounding in these associations is unclear.ObjectiveTo investigate associations of maternal HDP with risks in offspring of autism spectrum disorders (ASDs), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability (ID), as well as variation in overall cognitive performance in offspring.Design, setting, and participantsThis Swedish register-based study used data from a birth cohort divided into 1 085 024 individuals born between 1987 and 1996 and followed up until December 31, 2014, and 285 901 men born between 1982 and 1992 who attended assessments for military conscription, including a cognitive function test. Statistical analysis was performed from April 1, 2019, to June 1, 2020.ExposuresDiagnoses of HDP, which were provided by the Medical Birth Register.Main outcomes and measuresDiagnoses of ASDs, ADHD, and ID were extracted from the National Patient Register. Cognitive function was assessed using written tests and summarized as a single 9-point score. Whole-cohort and within-sibship analyses were performed; the latter accounted for unmeasured familial confounding factors shared by siblings.ResultsThe study included 1 085 024 individuals (556 912 male participants [51.3%]) born between 1987 and 1996 and 285 901 men born between 1982 and 1992 who attended assessments for military conscription. The prevalence of maternal HDP was 4.0% in the 1987-1996 birth cohort (n = 42 980) and 5.1% in the military conscription cohort (n = 14 515). A total of 15 858 participants received a diagnosis of ASD, 36 852 received a diagnosis of ADHD, and 8454 received a diagnosis of ID. The mean (SD) cognitive score among the men in the conscription cohort was 5.1 (1.9). In whole-cohort analyses with multivariable adjustment, HDP were associated with offspring ASDs (hazard ratio [HR], 1.22; 95% CI, 1.13-1.31), ADHD (HR, 1.10; 95% CI, 1.05-1.16), and ID (HR, 1.39; 95% CI, 1.27-1.53). Analyses comparing siblings discordant for HDP were less statistically powered but indicated estimates of similar magnitude for ASDs (HR, 1.19; 95% CI, 1.00-1.42) and possibly ADHD (HR, 1.09; 95% CI, 0.95-1.24), but not for ID (HR, 1.04; 95% CI, 0.83-1.29). Hypertensive disorders of pregnancy were associated with somewhat lower cognitive scores in whole-cohort analysis (mean difference comparing offspring exposed with those unexposed, -0.10; 95% CI, -0.13 to -0.07), but in within-sibship analysis, the association was null (mean difference, 0.00; 95% CI, -0.09 to 0.08).Conclusions and relevanceThe study results suggest that HDP are associated with small increased risks of ASDs and possibly ADHD in offspring, whereas associations with ID and cognitive performance are likely confounded by shared familial (environmental or genetic) factors.
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Project description:Objective Urban neighborhood greenness is associated with greater cardiovascular health in the general population, and with better pregnancy and neonatal outcomes. Hypertension in pregnancy is a leading cause of maternal mortality and long-term cardiovascular morbidity and mortality in women. We sought to examine the association between greenness and hypertensive disorders of pregnancy.Study design This study is a secondary analysis of a prospective cohort study of 1,943 women who received prenatal care from December 2013 to December 2016 at a single, urban, and tertiary academic medical center in Philadelphia, PA. Greenness measure was quantified via residential tree canopy cover within circumferential buffers of 100- and 500-meter radii around participants' homes. Associations between greenness and hypertensive disorders of pregnancy (defined as gestational hypertension or preeclampsia) were estimated by using multilevel logistic regression accounting for maternal sociodemographic information (race-ethnicity, insurance status, and age) medical history (diabetes, body mass index, smoking history, and parity), neighborhood deprivation index, and including 1,225 Philadelphia residents for whom key exposure and outcome data were available.Results At baseline, the participants' mean (SD) age was 27.5 (5.9) years, (range: 14-44 years). The majority of participants were non-Hispanic Black (857, 70.2%). Participants with less residential tree canopy cover were significantly more likely to have hypertensive disorders of pregnancy. The multivariable-adjusted odds ratio of hypertensive disorders of pregnancy among participants with less than 10% compared with those with greater than 30% tree canopy cover was 2.14 (95% confidence interval [CI]: 1.11-4.15) within 100-meter buffer.Conclusion In our cohort, greenness was associated with lower hypertensive disorders of pregnancy odds. Our findings add to evidence that greenness may confer health benefits and warrant further investigations in identifying whether there is a causal pathway through which greenness may be protective against hypertensive disorders of pregnancy.Key points· Low residential tree canopy is associated with increased risk of hypertensive disorders of pregnancy. · 100-meter buffers are most sensitive in identifying associations between tree canopy and HDP risk. · The role of greenness against hypertensive disorders of pregnancy should be further studied experimentally.
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Project description:Hypertensive disorders in pregnancy (HDPs) are leading perinatal diseases. Using a national cohort of 2,043,182 pregnant women in China, we evaluated the association between ambient temperatures and HDP subgroups, including preeclampsia or eclampsia, gestational hypertension, and superimposed preeclampsia. Under extreme temperatures, very cold exposure during preconception (12 weeks) increases odds of preeclampsia or eclampsia and gestational hypertension. Compared to preconception, in the first half of pregnancy, the impact of temperature on preeclampsia or eclampsia and gestational hypertension is opposite. Cold exposure decreases the odds, whereas hot exposure increases the odds. Under average temperatures, a temperature increase during preconception decreases the risk of preeclampsia or eclampsia and gestational hypertension. However, in the first half of pregnancy, temperature is positively associated with a higher risk. No significant association is observed between temperature and superimposed preeclampsia. Here we report a close relationship exists between ambient temperature and preeclampsia or eclampsia and gestational hypertension.
| S-EPMC7286884 | biostudies-literature
Project description:ImportanceMachine learning for augmented screening of perinatal mood and anxiety disorders (PMADs) requires thorough consideration of clinical biases embedded in electronic health records (EHRs) and rigorous evaluations of model performance.ObjectiveTo mitigate bias in predictive models of PMADs trained on commonly available EHRs.Design, setting, and participantsThis diagnostic study collected data as part of a quality improvement initiative from 2020 to 2023 at Cedars-Sinai Medical Center in Los Angeles, California. The study inclusion criteria were birthing patients aged 14 to 59 years with live birth records and admission to the postpartum unit or the maternal-fetal care unit after delivery.ExposurePatient-reported race and ethnicity (7 levels) obtained through EHRs.Main outcomes and measuresLogistic regression, random forest, and extreme gradient boosting models were trained to predict 2 binary outcomes: moderate to high-risk (positive) screen assessed using the 9-item Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Each model was fitted with or without reweighing data during preprocessing and evaluated through repeated K-fold cross validation. In every iteration, each model was evaluated on its area under the receiver operating curve (AUROC) and on 2 fairness metrics: demographic parity (DP), and difference in false negatives between races and ethnicities (relative to non-Hispanic White patients).ResultsAmong 19 430 patients in this study, 1402 (7%) identified as African American or Black, 2371 (12%) as Asian American and Pacific Islander; 1842 (10%) as Hispanic White, 10 942 (56.3%) as non-Hispanic White, 606 (3%) as multiple races, 2146 (11%) as other (not further specified), and 121 (<1%) did not provide this information. The mean (SD) age was 34.1 (4.9) years, and all patients identified as female. Racial and ethnic minority patients were significantly more likely than non-Hispanic White patients to screen positive on both the PHQ-9 (odds ratio, 1.47 [95% CI, 1.23-1.77]) and the EPDS (odds ratio, 1.38 [95% CI, 1.20-1.57]). Mean AUROCs ranged from 0.610 to 0.635 without reweighing (baseline), and from 0.602 to 0.622 with reweighing. Baseline models predicted significantly greater prevalence of postpartum depression for patients who were not non-Hispanic White relative to those who were (mean DP, 0.238 [95% CI, 0.231-0.244]; P < .001) and displayed significantly lower false-negative rates (mean difference, -0.184 [95% CI, -0.195 to -0.174]; P < .001). Reweighing significantly reduced differences in DP (mean DP with reweighing, 0.022 [95% CI, 0.017-0.026]; P < .001) and false-negative rates (mean difference with reweighing, 0.018 [95% CI, 0.008-0.028]; P < .001) between racial and ethnic groups.Conclusions and relevanceIn this diagnostic study of predictive models of postpartum depression, clinical prediction models trained to predict psychometric screening results from commonly available EHRs achieved modest performance and were less likely to widen existing health disparities in PMAD diagnosis and potentially treatment. These findings suggest that is critical for researchers and physicians to consider their model design (eg, desired target and predictor variables) and evaluate model bias to minimize health disparities.
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Project description:This study aimed to examine the association between conduct problems and mood disorders, and to evaluate the mediating roles of personality traits in it. Adult participants (N = 309), for which patients with major depressive disorder (MDD) or bipolar disorder (BD), and controls without major psychiatric history were recruited. Juvenile conduct problem was defined by the items in Composite International Diagnosis Interview. We assessed personality traits of extraversion and neuroticism. Multiple mediation model was performed to investigate the intervening effect of personality traits between juvenile conduct problems and adulthood mood disorders. Participants had on average 2.7 symptoms of conduct problems, and 43.4% had conduct problems. Having more symptoms of conduct problems was associated with a higher likelihood of BD (OR = 1.20). Higher neuroticism was associated with elevated risks of both MDD and BD. There was no direct effect of binary conduct problems on the risk of BD, and showed significant total indirect effect mediated by neuroticism for BD (OR = 1.49; bias-corrected and accelerated 95% CI = 1.10-2.05), but not through extraversion. Conduct problems defined as a continuous variable had a direct effect on the risk of adult MDD (OR = 1.36; bias-corrected and accelerated 95% CI = 1.05-1.76), while had an indirect effect on the risk of BD via the mediation of neuroticism (OR = 1.08; bias-corrected and accelerated 95% CI = 1.02-1.14). Neuroticism mediates between the association of juvenile conduct problems and adult BD. This finding raises our attention to assess personality traits in individuals with juvenile conduct problems for timely intervention strategies of reducing the vulnerability for developing mood disorders.
| S-EPMC9132998 | biostudies-literature
Project description:BackgroundHypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data.MethodsThis was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies.ResultsAmongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9-58.3) per 100,000 person-years; n = 521, 85.8 (78.6-93.5) per 100,000 person-years; and n = 518, 99.3 (90.9-108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33-1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48-1.78) for women with prior pre-eclampsia. Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67-4.86), and unstable angina, aHR = 1.92 (1.33-2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49-7.19), and acute myocardial infarction, aHR = 2.46 (1.72-3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies.ConclusionsWomen with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.
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Project description:Oxytocin (OXT) and prolactin (PRL) are neuropeptide hormones that interact with the serotonin system and are involved in the stress response and social affiliation. In human studies, serum OXT and PRL levels have been associated with depression and related phenotypes. Our purpose was to determine if single nucleotide polymorphisms (SNPs) at the loci for OXT, PRL and their receptors, OXTR and PRLR, were associated with childhood-onset mood disorders (COMD).Using 678 families in a family-based association design, we genotyped 16 SNPs at OXT, PRL, OXTR and PRLR to test for association with COMD.No significant associations were found for SNPs in the OXTR, PRL, or PRLR genes. Two of three SNPs 3' of the OXT gene were associated with COMD (p?0.02), significant after spectral decomposition, but were not significant after additionally correcting for the number of genes tested. Supplementary analyses of parent-of-origin and proband sex effects for OXT SNPs by Fisher's Exact test were not significant after Bonferroni correction.We have examined 16 OXT and PRL system gene variants, with no evidence of statistically significant association after correction for multiple tests.
| S-EPMC2941560 | biostudies-literature
Project description:Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in serotonin synthesis. TPH2 is a recently discovered isoform that is expressed predominantly in serotonin neurons. Associations are reported of TPH2 polymorphisms with MDD, bipolar disorder and suicidal behavior. This study examines a single nucleotide polymorphism in the putative promoter region of the TPH2 gene.One hundred nine bipolar, 324 major depressive disorder, and 130 healthy volunteers were genotyped for the rs4131347 (-C8347G) promoter SNP. Association was assessed with diagnosis, suicide attempt status, severity of psychopathology and cerebrospinal fluid monoamine metabolite levels of 5-HIAA, HVA, and MHPG. General linear models and logistic regression tested the effect of genotype*childhood abuse interactions on psychopathology severity and suicide attempt.There was no association between genotype and either mood disorder, suicide attempt status, psychopathology severity or CSF monoamine metabolite levels.No association was detected between the rs4131347 (-C8347G) SNP in the promoter region of the TPH2 gene and mood disorders, suicidal behavior or monoamine function.
| S-EPMC2756663 | biostudies-literature
Project description:ObjectiveTo examine the association between mood disorders in pregnancy and postpartum and peripartum cardiomyopathy (PPCM).MethodsRetrospective cohort study utilizing the National Inpatient Sample from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality of pregnant and postpartum patients from 2017-2019. Patients were separated into two groups based on ICD-10 coding for presence or absence of mood disorder (depression, bipolar depression, anxiety, or other mood diagnosis). The primary outcome was diagnosis of PPCM. Secondary outcomes included a composite of adverse cardiac events and maternal death. Groups were compared via t-tests, chi-squared analysis, and logistic regression that included all variables that differed between groups with p<0.05.ResultsOver 2.2 million subjects were analyzed and approximately 168,000 (7.4%) had an ICD-10 diagnosis of mood disorder. Those with mood disorders were more likely to be non-Hispanic white, obese, tobacco users, publicly insured, have comorbidities, and deliver at a large, private, non-profit hospital (all p<0.05). They were delivered at an earlier gestational age and were also more likely to undergo cesarean (37.0±4.6 vs 37.8±3.7 weeks and 35.8% vs 31.8%, respectively, p<0.001). The primary outcome of PPCM was identified more than twice as often in those with mood disorder (0.12% vs 0.05%, p<0.001). Composite cardiac events, consisting of incidence of acute myocardial infarction, cardiac arrest, cardioversion, cardiac failure, and pulmonary edema were more frequent among patients with mood disorders (0.36% vs 0.14%, p<0.001). After controlling for confounders, PPCM remained independently associated with diagnosis of mood disorders (aOR 1.36, 95%CI 1.03-1.80) as did the composite of adverse cardiac events (aOR 1.57, 95% CI 1.37-1.81).ConclusionMood disorders in pregnancy and postpartum are associated with increased rates of PPCM and other cardiac events.
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