Summary: Study reveals women who develop anxiety and mood disorders such as perinatal depression during pregnancy have specific altered proteins circulating in their bloodstream during the third trimester.
Source: Cedars Sinai Medical Center
Cedars-Sinai investigators found that women who developed mood and anxiety disorders associated with pregnancy and childbirth had specific altered proteins circulating in their bloodstream in the third trimester.
The study is published in the American Journal of Obstetrics & Gynecology.
“In this pilot study, we found that participants with perinatal mood and anxiety disorder (PMAD) symptoms had a unique and distinct prenatal plasma protein signature that regulated certain brain signaling activity and pro-inflammatory pathways,” said Eynav Accortt, Ph.D., director of the Reproductive Psychology Program at Cedars-Sinai and corresponding author of the study.
The controlled pilot study included 34 women at risk for developing PMAD and 18 controls. Mental health screening was conducted in the third trimester and again three months after giving birth. Investigators used a highly sensitive tool called slow off-rate modified aptamers (SOMA) scan technology to detect plasma biomarkers correlated with specific disorders, such as anxiety, depression and post-traumatic stress.
According to the Centers for Disease Control and Prevention, about 1 in 8 women experience significant symptoms of perinatal mood and anxiety disorders that can interfere with overall health, daily activities and family life.
“The critical first step in prevention of any disease is knowing if you are at risk. The process of discovering a diagnostic test for perinatal mood and anxiety disorders, through biomarker research like this, is our holy grail,” said Accortt, a clinical psychologist.
“It can be incredibly challenging for a woman who is distressed to identify her need for intervention. Family members and friends can look for red flags but may not know how to help. If we had an early blood test, like the test all women take for gestational diabetes, she and her family would know that she is at higher risk and begin to get education and consider treatment options much earlier,” said Accortt.
A previous study led by Accortt and published in the American Journal of Reproductive Immunology found that women with prolonged mental health problems up to three years after childbirth may be suffering from chronic irregularities in their immune system.
Larger validation studies are needed to determine whether biomarkers identified in this pilot study can be used with traditional risk factors—such as a previous history of depression or medical complications during pregnancy or childbirth—to develop protocols for early detection.
The financial and societal costs for untreated maternal mental illness are enormous. One study published in the American Journal of Public Health estimated the national cost in 2017 to be $14 billion.
“In addition to the financial costs of mood disorders associated with pregnancy and childbirth, including reduced economic productivity and more preterm births, children and the family structure can be deeply affected.
“We need research-based diagnostics developed so we can help women find a pathway to wellness and be able to emerge out of the shadow of debilitating mood disorders that harm their health and the health of their families,” said Sarah Kilpatrick, MD, Ph.D., chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and study co-author.
About this perinatal depression research news
Author: Press Office
Source: Cedars Sinai Medical Center
Contact: Press Office – Cedars Sinai Medical Center
Image: The image is in the public domain
Original Research: Closed access.
“Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics” by Eynav Accortt et al. American Journal of Obstetrics and Gynecology
Abstract
Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics
Background
Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders. Better diagnostic and prognostic models are needed for early identification and referral to treatment.
Objective
This study aimed to determine if a panel of novel third-trimester plasma protein biomarkers in pregnant women can be used to identify those who have a high predisposed risk for perinatal mood and anxiety disorders within 3 months postpartum.
Study Design
We studied 52 women (n=34 with a risk for perinatal mood and anxiety disorders and n=18 controls) among whom mental health screening was conducted at 2 time points, namely in the third trimester and again at 3 months postdelivery. An elevated perinatal mood and anxiety disorder risk was identified by screening individuals with above-validated cutoffs for depression (Edinburgh Postnatal Depression Scale ≥12), anxiety (Overall Anxiety Severity and Impairment Scale ≥7), and/or posttraumatic stress disorder (Impact of Events Scale >26) at both time points. Plasma samples collected in the third trimester were screened using the aptamer-based SomaLogic SomaScan proteomic assay technology to evaluate perinatal mood and anxiety disorder–associated changes in the expression of 1305 protein analytes. Ingenuity Pathway Analysis was conducted to highlight pathophysiological relationships between perinatal mood and anxiety disorder–specific proteins found to be significantly up- or down-regulated in all subjects with perinatal mood and anxiety disorder and in those with perinatal mood and anxiety disorders and no preeclampsia.
Results
From a panel of 53 significant perinatal mood and anxiety disorder–associated proteins, a unique 20-protein signature differentiated perinatal mood and anxiety disorder cases from controls in a principal component analysis (P<.05). This protein signature included NCAM1, NRCAM, and NTRK3 that converge around neuronal signaling pathways regulating axonal guidance, astrocyte differentiation, and maintenance of GABAergic neurons. Interestingly, when we restricted the analysis to subjects without preeclampsia, a 30-protein signature differentiated perinatal mood and anxiety disorder cases from all controls without overlap on the principal component analysis (P<.001). In the nonpreeclamptic perinatal mood and anxiety disorder group, we observed increased expression of proteins, such as CXCL11, CXCL6, MIC-B, and B2MG, which regulate leucocyte migration, inflammation, and immune function.
Conclusion
Participants with perinatal mood and anxiety disorders had a unique and distinct plasma protein signature that regulated a variety of neuronal signaling and proinflammatory pathways. Additional validation studies with larger sample sizes are needed to determine whether some of these molecules can be used in conjunction with traditional risk factors for the early detection of perinatal mood and anxiety disorders.
