Neuroimaging Epigenetics of Prospective Postpartum Depression Biomarkers
Condition: Post Partum Depression; Bipolar Disorder
MeSH terms: Depression, Postpartum; Depression; Depressive Disorder; Bipolar Disorder
Study type: Observational

Summary: 
      Through a recent cross species translational experiment, researchers have identified a set of
      epigenetic marks capable of predicting postpartum depression with greater than 85% accuracy.
      The researchers are looking to identify a group of women from both the general population and
      those with a history of mood disorders who are at risk for postpartum depression and obtain
      brain imaging data at a postpartum time period prior to the onset of depressive symptoms and
      compare it with those obtained during depressive episodes. The researchers will also evaluate
      the efficacy of postpartum depression biomarker prediction.
    

Detailed description: 
      Postpartum depression (PPD) occurs in approximately 10-18% of women from the general
      population, affecting ~400,000 to 800,000 women each year. PPD results in significant
      morbidity to both mother and child, with offspring risks including low self-esteem, low
      intellectual skills, child abuse, and infanticide. PPD occurs within four weeks following
      parturition according to Diagnostic and Statistical Manual (DSM)-IV criteria and follows a
      dramatic drop in the circulating levels of estradiol (E2) and progesterone (P4). While PPD
      risk is not predicted by serum levels of gonadal hormones in humans, numerous studies suggest
      that risk to PPD is mediated by hormonal sensitivity. Recently, the investigators
      demonstrated that women at risk to PPD demonstrate an increased sensitivity to E2 mediated
      DNA methylation reprogramming at hippocampally relevant genes and identified two biomarkers,
      Tetratricopeptide repeat protein 9B (TTC9B) and heterochromatin protein 1 binding protein 3
      (HP1BP3) that appeared functionally related to modulating neuroplasticity and which were
      predictive of PPD with 82-96% accuracy. Given that peripherally measurable epigenetic marks
      in genes implicated in hormone related neuroplastic changes may underlie risk to PPD, it is
      logical to next investigate neuroconnectivity alterations occurring longitudinally in the
      postpartum population at risk for PPD. The study is divided into two waves; in wave 1, the
      researchers will draw a tube of blood to be used as a biomarker screening to identify those
      at risk for PPD and matched controls, who will be asked to enter wave 2 of the study. In wave
      2, women will undergo neuroimaging at weeks 2 and 6 postpartum in hopes to gather a neural
      signature of PPD prior to the onset of symptoms and while experiencing the symptoms.
      Additionally, data on a variety of candidate moderators of depression during or after
      pregnancy will be collected at each visit. This includes history of premenstrual symptoms,
      use of oral contraceptives, use of hormonal treatments to promote pregnancy and psychiatric
      history during previous pregnancies and the postpartum. Several measures of mood symptoms and
      anxiety symptoms will be administered including: Edinburgh Postnatal Depression Rating Scale
      (EPDS) which measures depressive symptoms in pregnant and postpartum mothers, the Young Mania
      Rating Scale, which rates manic and hypomanic symptoms, and the State Trait Anxiety
      Inventory, Perinatal Anxiety Scale, and the Penn State Worry questionnaire which measure
      anxiety symptoms. The Pittsburgh Sleep Quality Index scale will be administered at every
      visit to assess the role of sleep in the relapse of depression in the mothers. Two scales
      designed to measure stress will be administered to allow examination of its potential role in
      Major Depressive Disorder (MDD) relapse. The Recent Life Changes Scale, which measures
      stressful life events, will be administered at the Screening, 3rd trimester and 6 week
      visits. The Perceived Stress Scale which provides a subjective rating of the stress of will
      be administered at every visit. The investigators will also administer measures of childhood
      trauma, and note demographic information, medication usage, clinical history (e.g. number of
      hospitalizations, medication trials, etc.) and birth outcomes. These measures will be used in
      future exploratory analyses of potential moderators of epigenetic changes seen during and
      after pregnancy.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population includes women 18 years or older, pregnant with a singleton pregnancy,
        and with or without a history of a mood disorder. Participants may take psychiatric
        medications, however they may not be currently suicidal, psychiatrically unstable, or be
        currently abusing substances.
      
Biospecimen description: 
      Blood
    
Keywords: Pregnancy; Postpartum