Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort

Background Postpartum depression is a serious problem for women and their offspring. Micronutrient supplements are recommended for pregnant women because of their documented protective effects for the offspring, but their potential beneficial effects on maternal mental health are unknown. This study investigated the association between prenatal micronutrient supplementation and the risk for symptoms of postpartum depression in a longitudinal pregnancy cohort from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Methods Participants came from a cohort of the first 600 APrON women. Supplemental nutrient intake and symptoms of depression (measured with the Edinburgh Postnatal Depression Scale (EPDS)) were collected at each trimester and 12 weeks postpartum. Results Of the 475 participants who completed the EPDS at least twice in pregnancy and at 12 weeks postpartum, 416 (88%) scored <10 and 59 (12%) scored ≥10, where an EPDS ≥10 is considered to be “at least probable minor depression”. Mean nutrient intakes from supplements were higher in women with lower EPDS scores, particularly selenium (p = 0.0015) and omega-3s (p = 0.01). Bivariate analyses showed that several demographic and social/lifestyle variables were associated with EPDS ≥10: not having been born in Canada (p = 0.01), greater number of chronic conditions (p = 0.05), greater number of stressful life events during this pregnancy (p = 0.02), and lower prenatal and postnatal support (p = 0.0043 and p = 0.0001, respectively). Adjusting for covariates and nutrients known to be associated with postpartum depression, logistic regression showed that having a prenatal EPDS ≥ 10 increased the odds of postpartum depressive symptoms (second and third trimester OR = 3.29, 95% CI = 1.55 - 7.01, p = 0.004 and OR = 4.26, 95% CI = 2.05 - 8.85, p < 0.0001, respectively), while prenatal supplemental selenium (per 10 mcg, OR = 0.76, 95% CI = 0.74 - 0.78, p = 0.0019) and postnatal social support (OR = 0.87, 95% CI = 0.78 - 0.97, p = 0.0015) were protective. Conclusions Multiple factors, including supplementary selenium intake, are associated with the risk of postpartum depressive symptoms. Future research on dietary supplementation in pregnancy with special attention to selenium intake is warranted. Keywords: Postpartum depression, Dietary supplements, Selenium, Omega-

The Effects of ‘Does Not Apply’ on Measurement of Temperament with the Infant Behavior Questionnaire-Revised: A Cautionary Tale for Very Young Infants

Author's accepted manuscript deposited according to Elsevier sharing policies http://www.elsevier.com/about/company-information/policies/policy-faq November 18, 2015Background: The Infant Behavior Questionnaire-Revised (IBQ-R) is a widely used parent report measure of infant temperament. Items marked 'does not apply' (NA) are treated as missing data when calculating scale scores, but the effect of this practice on assessment of infant temperament has not been reported. Aims: To determine the effect of NA responses on assessment of infant temperament and to evaluate the remedy offered by several missing data strategies. Study design: A prospective, community-based longitudinal cohort study. Subjects: 401 infants who were born >37 weeks of gestation. Outcome measures: Mothers completed the short form of the IBQ-R when infants were 3-months and 6-months of age. Results: The rate of NA responses at the 3-month assessment was three times as high (22%) as the rate at six months (7%). Internal consistency was appreciably reduced and scale means were inflated in the presence of NA responses, especially at 3-months. The total number of NA items endorsed by individual parents was associated with infant age and parity. None of the missing data strategies completely eliminated problems related to NA responses but the Expectation Maximization algorithm greatly reduced these problems. Conclusions: The findings suggest that researchers should exercise caution when interpreting results obtained from infants at 3 months of age. Careful selection of scales, selecting a full length version of the IBQ-R, and use of a modern missing data technique may help to maintain the quality of data obtained from very young infants.YesThis research was supported in part by grants from Alberta Innovates Health Solutions and the Alberta Children’s Hospital Foundation

Affective Experience in Ecologically Relevant Contexts is Dynamic, and Not Progressively Attenuated During Pregnancy

Author's accepted manuscript deposited according to Elsevier sharing policies http://www.elsevier.com/about/company-information/policies/policy-faq Oct 28, 2015Pregnancy is thought to diminish a woman’s appraisals of and affective responses to stressors. To examine this assumption, we used an electronic diary and an ecological momentary assessment strategy to record women’s (n=85) experiences of positive and negative affect five times each day over two days within each trimester of pregnancy. Women also completed the Edinburgh Postnatal Depression Scale each trimester. Multi-level modeling indicated non-linear patterns for both positive and negative affect that differed by level of depressive symptoms. The findings suggest that changes in psychological experience over the course of pregnancy are dynamic and not progressively attenuated.YesThis research was supported in part by funding from Alberta Innovates Health Solutions and the Alberta Children’s Hospital Research Institute. The authors thank Codie Rouleau, Amy Hampson, Diego Padilla-Ontanon and the participants of the Pregnancy Mood and Cortisol study for their contributions to this research

The effects of 'does not apply' on measurement of temperament with the Infant Behavior Questionnaire-Revised: A cautionary tale for very young infants

Background The Infant Behavior Questionnaire—Revised (IBQ-R) is a widely used parent report measure of infant temperament. Items marked ‘does not apply’ (NA) are treated as missing data when calculating scale scores, but the effect of this practice on assessment of infant temperament has not been reported. Aims To determine the effect of NA responses on assessment of infant temperament and to evaluate the remedy offered by several missing data strategies. Study design A prospective, community-based longitudinal cohort study.Subjects401 infants who were born > 37 weeks of gestation. Outcome measures Mothers completed the short form of the IBQ-R when infants were 3-months and 6-months of age. Results The rate of NA responses at the 3-month assessment was three times as high (22%) as the rate at six months (7%). Internal consistency was appreciably reduced and scale means were inflated in the presence of NA responses, especially at 3-months. The total number of NA items endorsed by individual parents was associated with infant age and parity. None of the missing data strategies completely eliminated problems related to NA responses but the Expectation Maximization algorithm greatly reduced these problems. Conclusions The findings suggest that researchers should exercise caution when interpreting results obtained from infants at 3 months of age. Careful selection of scales, selecting a full length version of the IBQ-R, and use of a modern missing data technique may help to maintain the quality of data obtained from very young infants

Advancing Gestation Does Not Attenuate Biobehavioural Coherence Between Psychological Distress and Cortisol

Author's accepted manuscript deposited according to Elsevier sharing policies http://www.elsevier.com/about/company-information/policies/policy-faq November 4, 2015Background: Despite little evidence to suggest that HPA axis responses to psychological provocation are attenuated during pregnancy, it is widely held that dampening of the HPA axis response to psychological distress serves a protective function for the mother and fetus. The current study was designed to assess changes in biobehavioral coherence between psychological distress and cortisol over the course of pregnancy. Methods: Ambulatory assessment of ecologically relevant psychological distress and salivary cortisol were repeated in all three trimesters for 82 pregnant women. Samples were collected 5 times per day over the course of 2 days in each trimester. Results: Psychological distress and cortisol were positively associated, β = .024, p < .01, indicating that increases in psychological distress were associated with increases in cortisol. Gestational age did not moderate this association, β = .0009, p = .13, suggesting that negative psychological experiences remain potent stimuli for the HPA axis during pregnancy. Conclusion: Biobehavioral coherence between ecologically relevant experiences of psychological distress and cortisol is not attenuated with advancing gestation.YesThis research was supported by funding from Alberta Innovates Health Solutions and the Alberta Children’s Hospital Research Institute for Child and Maternal Health. The sponsors had no influence over study design, data collection, data analysis or interpretation of the results, in writing this report or in the decision to submit this article for publication

Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants

Author's accepted manuscript deposited according to Elsevier sharing policies http://www.elsevier.com/about/company-information/policies/policy-faq November 18th, 2015Individual differences in the activity of the hypothalamic pituitary adrenal (HPA) axis are often operationalized using summary measures of cortisol that are taken to represent stable individual differences. Here we extend our understanding of a novel latent variable approach to latent trait cortisol (LTC) as a measure of trait-like HPA axis function during pregnancy. Pregnant women (n=380) prospectively collected 8 diurnal saliva samples (4 samples/day, 2 days) within each trimester. Saliva was assayed for cortisol. Confirmatory factor analyses were used to fit LTC models to early morning and daytime cortisol. For individual trimester data, only the daytime LTC models had adequate fit. These daytime LTC models were strongly correlated between trimesters and stable over pregnancy. Daytime LTC was unrelated to the cortisol awakening response and the daytime slope but strongly correlated with the area under the curve from ground. The findings support the validity of LTC as a measure of cortisol during pregnancy and suggest that it is not affected by pregnancy-related changes in HPA axis function.Ye

Salivary alpha-amylase during pregnancy: Diurnal course and associations with obstetric history, maternal demographics and mood

Author's accepted manuscript deposited according to Wiley archiving policies: http://olabout.wiley.com/WileyCDA/Section/id-820227.htmlDiurnal patterns of salivary alpha amylase (sAA) in pregnant women have not previously been described. The current study employed ecological momentary assessment to examine the association between the diurnal sAA, obstetric history, maternal demographics, and mood during pregnancy. Saliva was self-collected by 83 pregnant women (89% White, age 25.3-43.0 years; mean gestational age 21.9 weeks, range 6-37 weeks; gravida 1-6) at home over three days. Results indicated that current pregnancy (gestational age and fetal sex) and maternal demographics were not related to diurnal sAA. In contrast, a history of previous miscarriage (Parameter = -.17; SE = .05; p < .05) was associated with an atypical diurnal pattern. Even after accounting for obstetric history, trait anxiety (Parameter = .16; SE = .04; p < .001) was associated with increased sAA over the day while chronic levels of fatigue (Parameter = -.06; SE = .03; p < .05) were associated with decreased sAA. In a separate model, we also tested the time varying covariation of sAA and mood. The effects of momentary mood were in contrast to those for trait mood. Both momentary depression (Parameter = .22; SE = .09; p < .01) and vigour/positive mood (Parameter = .12; SE = .04; p < .001) were associated with momentary increases in sAA while momentary anxiety and fatigue were not related to sAA. The findings suggest that basal sAA during pregnancy is sensitive to emotional arousal. Evaluating diurnal patterns of sAA holds promise for advancing understanding of how emotional arousal during pregnancy may affect fetal development.YesThis research was supported in part by funding from Alberta Innovates Health Solutions, the Alberta Children’s Hospital Research Institute, and the Department of Paediatrics, University of Calgary. The authors thank the participants of the Pregnancy Mood and Cortisol study for the time and effort they contributed to this research and Claudia Buss for helpful comments on a previous draft of this paper

Effective Social Support Buffers Hypothalamic-Pituitary Adrenal Axis Function During Pregnancy

Articles that are published open access will be freely available to read, download and share from the time of publication. Articles are published under the terms of the Creative Commons License Attribution-NonCommerical No Derivative 4.0, which allows readers to disseminate and reuse the article, as well as share and reuse of the scientific material. It does not permit commercial exploitation or the creation of derivative works without specific permission. To view a copy of this license visit: http://creativecommons.org/licenses/by-nc-nd/4.0 (see also http://journals.lww.com/psychosomaticmedicine/_layouts/oaks.journals/OpenAccess.aspx)Objective: Recent studies suggest that effective social support during pregnancy may buffer adverse effects of maternal psychological distress on fetal development. The mechanisms whereby social support confers this protective advantage, however, remain to be clarified. The aim of this study was to assess whether individual differences in social support alter the co-variation of psychological distress and cortisol during pregnancy. Methods: Eighty two pregnant women’s psychological distress and cortisol were prospectively assessed in all three trimesters using an ecological momentary assessment strategy. Appraisal of partner social support was assessed in each trimester via the Social Support Effectiveness questionnaire. Results: In multilevel analysis, ambulatory assessments of psychological distress during pregnancy were associated with elevated cortisol levels, unstandardized β = .023, p < .001. Consistent with the stress buffering hypothesis, social support moderated the association between psychological distress and cortisol, unstandardized β = -.001, p = .039, such that the co-variation of psychological distress and cortisol increased with decreases in effective social support. The effect of social support for women with the most effective social support was a 50.4% reduction in the mean effect of distress on cortisol and a 2.3 fold increase in this effect for women with the least effective social support scores. Conclusions: Pregnant women receiving inadequate social support secrete higher levels of cortisol in response to psychological distress as compared to women receiving effective social support. Social support during pregnancy may be beneficial because it decreases biological sensitivity to psychological distress, potentially shielding the fetus from the harmful effects of stress-related increases in cortisol.YesThis research was supported by funding from Alberta Innovates Health Solutions (awarded to B. Kaplan) and the Alberta Children’s Hospital Research Institute for Child and Maternal Health (awarded to G. Giesbrecht, B. Kaplan, N. Letourneau, & T. Campbell). The sponsors had no influence over study design, data collection, data analysis or interpretation of the results, in writing this report, or in the decision to submit this article for publication

Both Mother and Infant Require a Vitamin D Supplement to Ensure That Infants’ Vitamin D Status Meets Current Guidelines

We examined the association between maternal vitamin D intake during breastfeeding with their infants’ vitamin D status in infants who did or did not receive vitamin D supplements to determine whether infant supplementation was sufficient. Using plasma from a subset of breastfed infants in the APrON (Alberta Pregnant Outcomes and Nutrition) cohort, vitamin D status was measured by liquid chromatography-tandem mass spectrometry. Maternal and infants’ dietary data were obtained from APrON’s dietary questionnaires. The median maternal vitamin D intake was 665 International Units (IU)/day, while 25% reported intakes below the recommended 400 IU/day. Of the 224 infants in the cohort, 72% were exclusively breastfed, and 90% were receiving vitamin D supplements. Infants’ median 25(OH)D was 96.0 nmol/L (interquartile ranges (IQR) 77.6–116.2), and 25% had 25(OH)D &lt; 75 nmol/L. An adjusted linear regression model showed that, with a 100 IU increase in maternal vitamin D intake, infants’ 25(OH)D increased by 0.9 nmol/L controlling for race, season, mid-pregnancy maternal 25(OH)D, birthweight, and whether the infant received daily vitamin D supplement (β = 0.008, 95% confidence interval (CI) 0.002, 0.13). These results suggest that, to ensure infant optimal vitamin D status, not only do infants require a supplement, but women also need to meet current recommended vitamin D intake during breastfeeding

Advancing gestation does not attenuate biobehavioural coherence between psychological distress and cortisol

Background Despite little evidence to suggest that HPA axis responses to psychological provocation are attenuated during pregnancy, it is widely held that dampening of the HPA axis response to psychological distress serves a protective function for the mother and fetus. The current study was designed to assess changes in biobehavioral coherence between psychological distress and cortisol over the course of pregnancy. Methods Ambulatory assessment of ecologically relevant psychological distress and salivary cortisol were repeated in all three trimesters for 82 pregnant women. Samples were collected 5 times per day over the course of 2 days in each trimester. Results Psychological distress and cortisol were positively associated, β = .024, p < .01, indicating that increases in psychological distress were associated with increases in cortisol. Gestational age did not moderate this association, β = .0009, p = .13, suggesting that negative psychological experiences remain potent stimuli for the HPA axis during pregnancy. Conclusion Biobehavioral coherence between ecologically relevant experiences of psychological distress and cortisol is not attenuated with advancing gestation. Highlights ► We assess changes in the association between psychological distress and cortisol over the course of pregnancy. ► Psychological distress was associated with cortisol throughout pregnancy. ► Psychological experiences remain potent stimuli for the HPA axis during pregnancy. ► Advancing gestation does not protect the mother or fetus from the psychobiological effects of distress. Keywords: Psychological distress, Salivary cortisol, Pregnancy, Stress response, HPA axis, Biobehavioural coherenc