Study of Exposure to Stress, Postpartum Mood, Adverse Life Events, and Hormonal Function Among Latinas (SEPAH Latina)
Condition: Postpartum Depression
MeSH terms: Depression, Postpartum; Depression; Depressive Disorder
Study type: Observational

Summary: 
      The purpose of the funded study is to determine a) examine associations among OT levels,
      stress, trauma history, PPD, and lactation failure in the full 60-subject sample and assess
      whether there are differences between immigrant women and non-immigrant Latina women on these
      measures; b) quantify whether there is a correlation between ACTH, cortisol, and PPD and
      whether there are differences between immigrant and non-immigrant Latina women; and c) assess
      the feasibility of enrolling Latinas into a laboratory-based study that includes the
      collection of venous blood for measurement of oxytocin, ACTH, and cortisol. Sixty prenatal
      (34 to 37 weeks) Latinas (30 immigrants and 30 U.S.-born) who are between the ages of 18 and
      45 will be enrolled. Women with a singleton pregnancy who are Latina, who intend to
      breastfeed for more than 2 months, who have or do not have a history of depression, and who
      are willing to be followed for 8 weeks after delivery will be enrolled in the study. Latinas
      who report maternal or infant disorder that may interfere with breastfeeding; those who
      endorse substance use, and/or who have or have had a psychiatric disorder (e.g., psychosis or
      serious personality disorders) other than depression or anxiety will be excluded to minimize
      risk and confounds with the outcomes of interest.
    

Detailed description: 
      Study Objective: The purpose of the funded study is to determine a) examine associations
      among OT levels, stress, trauma history, PPD, and lactation failure in the full 60-subject
      sample and assess whether there are differences between immigrant women and non-immigrant
      Latina women on these measures; b) quantify whether there is a correlation between ACTH,
      cortisol, and PPD and whether there are differences between immigrant and non-immigrant
      Latina women; and c) assess the feasibility of enrolling Latinas into a laboratory-based
      study that includes the collection of venous blood for measurement of oxytocin, ACTH, and
      cortisol.

      Research Aims: 1) To examine associations among OT levels, stress, trauma history, PPD, and
      lactation failure in the full 60-subject sample and assess whether there are differences
      between immigrant women and non-immigrant Latina women on these measures; 2) To quantify
      whether there is a correlation between ACTH, cortisol, and PPD and whether there are
      differences between immigrant and non-immigrant Latina women; 3) To assess the feasibility of
      enrolling Latinas into a laboratory-based study that includes the collection of venous blood
      for measurement of oxytocin, ACTH, and cortisol; and 4) Assess the performance of the Spanish
      language protocol and measures to identify barriers to implementation and address needed
      modifications prior to large-scale implementation.

      Subjects: Sixty prenatal (34 to 37 weeks) Latinas (30 immigrants and 30 U.S.-born) who are
      between the ages of 18 and 45 will be enrolled. Women with a singleton pregnancy who are
      Latina, who intend to breastfeed for more than 2 months, who have or do not have a history of
      depression, and who are willing to be followed for 8 weeks after delivery will be enrolled in
      the study. Latinas who report maternal or infant disorder that may interfere with
      breastfeeding; those who endorse substance use, and/or who have or have had a psychiatric
      disorder (e.g., psychosis or serious personality disorders) other than depression or anxiety
      will be excluded to minimize risk and confounds with the outcomes of interest.

      Methods: There will be four study-time points: prenatal visit, 4- and 12-weeks postpartum
      phone interviews, and one laboratory visit at 8-weeks postpartum. Participants will be
      compensating after each interview.

      Prenatal Visit: We will collect demographic information; assess depression and anxiety
      status, as well as breastfeeding intention. During the prenatal visit we will also inquire
      about acculturation and everyday stressors. English and Spanish validated measures will be
      used.

      Postpartum Phone Interviews: We will inquire about breastfeeding practices and self-efficacy
      using the Breastfeeding Self-Efficacy-Short Form as well as depression status using the EPDS.

      Laboratory Visit: At 8 weeks postpartum, biomarkers will be collected via blood draws during
      breastfeeding and the cold pressor stress test. Oxytocin will be collected during
      breastfeeding and adrenocorticotropic hormone (ACTH) and cortisol will be collected after a
      recovery period and during the cold pressor stress test. Childhood and Border-Crossing Trauma
      will be collected following the laboratory procedures.

      What will be gained: This study will enable us to begin to understand Latinas (immigrant and
      U.S.-born) neuroendocrine responses to high levels of stress, which will enable us to and
      determine associations between stress and trauma the development of postpartum depression.
      This study will also enable us to identify risk factors for postpartum depression among
      immigrant and U.S.-born Latinas.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Latinas (foreign and U.S.-born)
      
Biospecimen description: 
      oxytocin, cortisol, and adrenocorticotropic hormone (ACTH)
    
Keywords: postpartum depression