同时发生忧郁症、心血管疾病有关的胎儿风险因素


  【24drs.com】根据发表于美国神经生理药理学会(ACNP)第50届年会的研究,发生子痫前症及胎儿发育限制有助于发现哪里些妇女在成年时更可能同时发生忧郁和心血管疾病(CVD)。
  
  哈佛医学院、布莱根妇女医院的Jill Goldstein博士向参与记者会的记者们表示,同时发生忧郁和心血管疾病将会是2020年全球第一大失能原因,女性风险是男性的两倍,而我们还不知道为何如此。
  
  目前的研究结果指出,妇女同时有重度忧郁和CVD风险者,有共同的胎儿期风险因素。
  
  Goldstein博士等人在一篇长期研究中,追踪了曝露于子痫前症和胎儿发育限制成人子代与他们没有曝露于相同状况的兄弟姐妹;这个世代包括了295名40多岁的成人,进行了一系列精神与心脏检测以及抽取血液样本;研究者也分析母亲怀孕时储存的血液样本。
  
  Goldstein博士表示,我们发现这些疾病或状况会影响母亲怀孕时的免疫、内分泌或荷尔蒙,而有一些指标可以在母亲怀孕时的血液中侦测出来,藉由这些指标,我们可以发现哪里些人的孩子比较可能或不可能在中年时有同时发生忧郁或心血管疾病的因素。
  
  她指出,关键结果是,胎儿时期曝露于子痫前症和胎儿发育限制的妇女,中年时同时发生重度忧郁和CVD的风险显著高于男性(风险比1.38;P <.01)。
  
  曝露于子痫前症和胎儿发育限制的妇女,下视丘-脑垂腺-肾上腺轴(HPA)也有缺陷,这是与压力反应、心情及心脏功能有关的脑部区域。
  
  研究者指出,和重度忧郁及CVD有关的子痫前症和胎儿发育限制,与母亲的免疫活性与胎儿HPA发育受阻有关。
  
  Goldstein博士表示,压力是忧郁和CVD等慢性病的因素,压力反应系统包括的脑部区域,在两性之间有很大的差异。这些区域调节情绪和心脏功能,在两性的脑部发育不同,在青春期和成年时的功能也不一样。
  
  我们从基本上连结了三个时间点:怀孕时发生的疾病、之后影响了母亲的健康状态(例如她的免疫与内分泌系统)、之后导致孩子在成年时比较容易发生忧郁或心血管疾病。
  
  她解释,在这篇特别的研究中,我们发现忧郁和心脏功能不佳的性别特定风险,特别是女性,将母亲产前的免疫功能不佳指标,和子代在40多岁时的压力反应及心率异常之间的性别差异做了连结。
  
  Goldstein博士表示,藉由了解早期征兆与原因,我们希望可以及早介入、减少失能,最终希望可预防疾病。我们需透过了解此疾病在两性的差异,以发展出性别特定的治疗或预防方法。
  
  纽约市美国神经生理药理学会公共信息委员会主席、哥伦比亚大学外科学院精神科教授M. Katherine Shear医师表示,这是篇重要研究,因为它提出母亲怀孕时的健康状态会影响子代在40岁左右的健康。
  
  资料来源: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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