Perinatal depression—The fourth inflammatory morbidity of pregnancy?: Theory and literature review

Research in the field of psychoneuroimmunology (PNI) has revealed that depression is associated with inflammation manifested by increased levels of proinflammatory cytokines. The old paradigm described inflammation as simply one of many risk factors for depression. The new paradigm is based on more recent research that has indicated that physical and psychological stressors increase inflammation. These recent studies constitute an important shift in the depression paradigm: inflammation is not simply a risk factor; it is the risk factor that underlies all the others. Moreover, inflammation explains why psychosocial, behavioral and physical risk factors increase the risk of depression. This is true for depression in general and for postpartum depression in particular. Puerperal women are especially vulnerable to these effects because their levels of proinflammatory cytokines significantly increase during the last trimester of pregnancy – a time when they are also at high risk for depression. Moreover, common experiences of new motherhood, such as sleep disturbance, postpartum pain, and past or current psychological trauma, act as stressors that cause proinflammatory cytokine levels to rise. Breastfeeding has a protective effect on maternal mental health because it attenuates stress and modulates the inflammatory response. However, breastfeeding difficulties, such as nipple pain, can increase the risk of depression and must be addressed promptly. PNI research suggests two goals for the prevention and treatment of postpartum depression: reducing maternal stress and reducing inflammation. Breastfeeding and exercise reduce maternal stress and are protective of maternal mood. In addition, most current treatments for depression are anti-inflammatory. These include long-chain omega-3 fatty acids, cognitive therapy, St. John's wort, and conventional antidepressants.

https://link.springer.com/content/pdf/10.1186%2F1746-4358-2-6.pdf

A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health

This longitudinal study investigated body image changes and possible predictors of multiple dimensions of body image in the first year postpartum. Women (N = 79) who had been followed up since early pregnancy (including reporting retrospectively about pre-pregnancy and concurrently about late pregnancy) completed questionnaires at 6 weeks, 6 months, and 12 months postpartum that focused on body image measures of feeling fat, attractiveness, salience of shape and weight, and strength and fitness. Women experienced greater body dissatisfaction in the postpartum in comparison to pre-pregnancy and late pregnancy, with 6 months postpartum being the time of most body concern. In ratings of perceived current and ideal figure size, women decreased their current size ratings over the postpartum period; however, ratings of ideal figure remained stable over the three time points. The findings also revealed that higher frequency of physical comparison tendencies at 6 weeks postpartum, and depressive symptoms...

Predictors of body image during the first year postpartum:a prospective study.

Objectives This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. Methods As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance. Results Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night. Conclusions Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.

Breast-feeding increases sleep duration of new parents.

Purpose Postpartum mothers experience certain physical health conditions that may affect their quality of life, future health, and health of their children. Yet, the physical health of postpartum mothers is relatively neglected in both research and practice. The purpose of this review is to describe the general health status and prevalence of common physical health conditions of postpartum mothers. Methods The review followed standard procedures for integrative literature reviews. Twenty-two articles were reviewed from searches in scientific databases, reference lists, and an up-to-date survey. Three tables were designed to answer review questions. Findings In general, postpartum mothers self-rate their health as good. They experience certain physical conditions such as fatigue/physical exhaustion, sleep-related problems, pain, sex-related concerns, hemorrhoids/constipation, and breast problems. Conclusions Despite a limited number of studies, the findings provide a glimpse of the presence of a number of physical health conditions experienced by women in the 2 years postpartum. In the articles reviewed, physical health conditions and postpartum period were poorly defined, no standard scales existed, and the administration of surveys varied widely in time. Those disparities prevented systematic comparisons of results and made it difficult to gain a coherent understanding of the physical health conditions of postpartum mothers. More longitudinal research is needed that focuses on the etiology, predictors, and management of the health conditions most prevalent among postpartum mothers. Instruments are needed that target a broader range of physical conditions in respect to type and severity.

Integrative review of research on general health status and prevalence of common physical health conditions of women after childbirth.

Purpose To explore relationships between fatigue, depression, stress, and infection in the postpartum. Study design and methods This was a cross-sectional, correlational design with a sample of 119 new mothers at 4 to 6 weeks postpartum. Mothers completed fatigue, mood, and stress instruments as well as maternal and infant infection checklists. Morning blood and hindmilk (in breastfeeders) samples were collected. ELISA was used to measure prolactin, cortisol, melatonin, and secretory IgA (sIgA). Correlations between psychosocial, health, and biologic variables were explored. Results Fatigue was correlated with symptoms of infection in both mothers and babies, with perceived stress and postpartum stress as well as with depression. Serum prolactin was inversely associated with depression. Milk sIgA was related to milk prolactin and inversely related to stress. Milk melatonin and prolactin were inversely related, and fatigue scores were correlated with melatonin and inversely with prolactin. Clinical implications The data suggest that fatigue, stress, depression, and infection are related in postpartum mothers and that these relationships extend to levels of serum hormones and milk factors. It is possible that a cycle is established that multiplies the effects of fatigue when mothers experience stress and that this cycle of stress and fatigue may lead to immune deficits and infectious illnesses.

Blair Short

Papers

Neuroendocrine and immune relationships in postpartum fatigue.

Neuroendocrine and Immune Relationships in Postpartum Fatigue