Psychiatric Symptoms and Proinflammatory Cytokines in Pregnancy

Departments of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642-8409, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 09/2011; 73(8):656-63. DOI: 10.1097/PSY.0b013e31822fc277
Source: PubMed


Clinical studies suggest that psychiatric symptoms, particularly depression, anxiety, and trauma, may be associated with inflammation, as indexed by proinflammatory cytokines. Such a link may be especially significant in pregnancy and may shed additional light on the etiology of perinatal mood disorders.
We prospectively observed 145 women selected from a community obstetric clinic serving a primarily low-income, high-psychosocial risk population. Women without evidence of medical high-risk pregnancies were screened (including psychiatric and trauma histories) and then assessed in detail (e.g., mood symptoms) at approximately 18 and 32 weeks' gestation. Blood was drawn to measure key proinflammatory markers, interleukin 6 and tumor necrosis factor α (TNF-α). Data on pregnancy and obstetric outcome were derived from medical records.
There was considerable stability of cytokine levels within individuals and a significant mean increase across pregnancy observed for interleukin 6 (p < .001) and TNF-α (p < .001). History of trauma was associated with significantly elevated TNF-α levels (F(1,135) = 4.43, p < .05), controlling for psychosocial and obstetric covariates. In contrast, elevated measures of depression and anxiety were unrelated to proinflammatory cytokines (p > .1). Exploratory analyses indicated that neither psychiatric symptoms nor proinflammatory cytokines predicted birth weight, gestational age, or obstetric complications.
These findings suggest that antecedent trauma may be associated with persistently elevated TNF-α levels during pregnancy. The evidence that a generalized proinflammatory state was associated with symptoms of depression or anxiety in pregnant women was not found.

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    • "In contrast high levels of proinflammatory cytokines were not associated with elevated measures of depression and anxiety symptoms (p > 0.1). These findings suggested that trauma history could be linked with persistent increases in TNF-α during pregnancy, but not with depressive symptomatology and/or anxiety [2]. "
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    • "Other data suggest that sleep disturbance and depression may interact to promote inflammation in pregnancy (Okun, Luther, Wisniewski, & Wisner, 2013). In contrast, Blackmore et al. (2011) found that although depressive symptoms were not associated with inflammation, a history of trauma predicted elevations in TNF-α during pregnancy. These findings indicate that pregnant women with particular psychological risk factors may experience higher daily exposure to inflammatory mediators. "
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