同時發生憂鬱症、心血管疾病有關的胎兒風險因素


  【24drs.com】根據發表於美國神經生理藥理學會(ACNP)第50屆年會的研究,發生子癇前症及胎兒發育限制有助於發現哪些婦女在成年時更可能同時發生憂鬱和心血管疾病(CVD)。
  
  哈佛醫學院、布萊根婦女醫院的Jill Goldstein博士向參與記者會的記者們表示,同時發生憂鬱和心血管疾病將會是2020年全球第一大失能原因,女性風險是男性的兩倍,而我們還不知道為何如此。
  
  目前的研究結果指出,婦女同時有重度憂鬱和CVD風險者,有共同的胎兒期風險因素。
  
  Goldstein博士等人在一篇長期研究中,追蹤了曝露於子癇前症和胎兒發育限制成人子代與他們沒有曝露於相同狀況的兄弟姐妹;這個世代包括了295名40多歲的成人,進行了一系列精神與心臟檢測以及抽取血液樣本;研究者也分析母親懷孕時儲存的血液樣本。
  
  Goldstein博士表示,我們發現這些疾病或狀況會影響母親懷孕時的免疫、內分泌或荷爾蒙,而有一些指標可以在母親懷孕時的血液中偵測出來,藉由這些指標,我們可以發現哪些人的孩子比較可能或不可能在中年時有同時發生憂鬱或心血管疾病的因素。
  
  她指出,關鍵結果是,胎兒時期曝露於子癇前症和胎兒發育限制的婦女,中年時同時發生重度憂鬱和CVD的風險顯著高於男性(風險比1.38;P <.01)。
  
  曝露於子癇前症和胎兒發育限制的婦女,下視丘-腦垂腺-腎上腺軸(HPA)也有缺陷,這是與壓力反應、心情及心臟功能有關的腦部區域。
  
  研究者指出,和重度憂鬱及CVD有關的子癇前症和胎兒發育限制,與母親的免疫活性與胎兒HPA發育受阻有關。
  
  Goldstein博士表示,壓力是憂鬱和CVD等慢性病的因素,壓力反應系統包括的腦部區域,在兩性之間有很大的差異。這些區域調節情緒和心臟功能,在兩性的腦部發育不同,在青春期和成年時的功能也不一樣。
  
  我們從基本上連結了三個時間點:懷孕時發生的疾病、之後影響了母親的健康狀態(例如她的免疫與內分泌系統)、之後導致孩子在成年時比較容易發生憂鬱或心血管疾病。
  
  她解釋,在這篇特別的研究中,我們發現憂鬱和心臟功能不佳的性別特定風險,特別是女性,將母親產前的免疫功能不佳指標,和子代在40多歲時的壓力反應及心率異常之間的性別差異做了連結。
  
  Goldstein博士表示,藉由暸解早期徵兆與原因,我們希望可以及早介入、減少失能,最終希望可預防疾病。我們需透過瞭解此疾病在兩性的差異,以發展出性別特定的治療或預防方法。
  
  紐約市美國神經生理藥理學會公共資訊委員會主席、哥倫比亞大學外科學院精神科教授M. Katherine Shear醫師表示,這是篇重要研究,因為它提出母親懷孕時的健康狀態會影響子代在40歲左右的健康。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6670&x_classno=0&x_chkdelpoint=Y
  

Fetal Risk Factors Linked to Co-Occurring Depression, CVD

By Megan Brooks
Medscape Medical News

December 5, 2011 (Waikoloa, Hawaii) — Exposure to preeclampsia and fetal growth restriction may help identify individuals, particularly women, who are susceptible to the co-occurrence of depression and cardiovascular disease (CVD) in adulthood, according to research presented here at the American College of Neuropsychopharmacology (ACNP) 50th Annual Meeting.

"Co-occurring depression and cardiovascular disease will be the number 1 cause of disability worldwide by 2020, and women are at twice the risk as men, and we don't understand why," lead investigator and presenter Jill Goldstein, PhD, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, told reporters attending a press briefing.

The current findings point to "shared fetal risk factors" for comorbid major depressive disorder and CVD risk in women.

40-Year Cohort Study

In a long-running study, Dr. Goldstein and colleagues have been following up both adult offspring exposed to preeclampsia and growth restriction and their unexposed adult siblings.

The cohort includes 295 adults in their 40s who underwent a battery of psychiatric and cardiac tests and provided blood samples. The researchers also analyzed stored blood samples given by the mothers when they were pregnant.

"We've shown that indicators of illnesses or conditions that affect the mother's immune, endocrine, or hormone system during pregnancy can be detected in the mother's blood during pregnancy, from which we can identify factors that make it more or less likely that her child will be at risk for co-occurring depression or cardiovascular disease during midlife," Dr. Goldstein said.

A key finding, she noted, is that women exposed to preeclampsia and fetal growth restriction in the womb were at significantly higher risk than men for the co-occurrence of major depression and CVD in midlife (risk ratio, 1.38; P < .01).

Women exposed to preeclampsia and growth restriction also had deficits in the hypothalamic-pituitary-adrenal axis (HPA), a region of brain associated with stress response, mood, and cardiac function.

Preeclampsia and growth restriction, which are implicated in both major depressive disorder and CVD, are associated with maternal immune activation and fetal disruption of the development of the HPA, the investigators note.

Connecting the Dots

Stress is a factor in chronic disease, including depression and CVD risk, and stress response circuitry includes brain regions that show "some of the largest sex differences in the brain," Dr. Goldstein noted. These regions regulate mood and cardiac function and develop differently in the male and female brain, and they also function differently in puberty and adulthood, she explained.

"We are essentially connecting 3 dots in time: illnesses that happen during pregnancy, that then affect the state of the mother's health (like her immune and endocrine system), that then result in the child becoming more susceptible to depression or cardiovascular disease in adulthood."

In this particular study, she explained, "we identified sex-specific effects on the risk for depression and cardiac dysfunction, particularly for women, connecting prenatal blood indicators of immune dysfunction in the mother with sex-specific differences in the stress response circuitry and heart rate abnormalities in the offspring in their 40s."

"By understanding the early signs and pathways, we hope to intervene early and lessen disability and to eventually prevent the illnesses," Dr. Goldstein said. "We need to approach this through the lens of understanding sex differences in diseases in order to develop treatments or prevention strategies that are sex-specific."

M. Katherine Shear, MD, professor of psychiatry, Columbia University College of Physicians and Surgeons, New York City, and chair of the American College of Neuropsychopharmacology's Public Information Committee, who moderated the press conference, said this research is "important" because it suggests that the state of the mother's health during pregnancy affects her offspring's health 40 years later.

Dr. Goldstein and Dr. Shear have disclosed no relevant financial relationships.

American College of Neuropsychopharmacology (ACNP) 50th Annual Meeting. Presented December 4, 2011.

    
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