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CSF Inflammatory Cytokines Linked to Perinatal Depression

CSF Inflammatory Cytokines Linked to Perinatal Depression

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DALLAS — Increased levels of certain cerebrospinal fluid (CSF) inflammatory cytokines were associated with an increased risk of perinatal depression, a researcher said here.

While there was a lack of a strong correlation between plasma and cerebrospinal fluid inflammatory cytokines, CSF levels of IL-1β, IL-23 and IL-33 were significantly associated with increased odds of perinatal depression, reported Emily S. Miller, MD, of Northwestern University in Evanston, Illinois.

At a presentation at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting, she said that while several studies have explored the role of CSF cytokines outside of pregnancy, but the results are conflicting due to heterogeneous inclusion criteria, and that pregnancy complicates these inflammatory changes.

They hypothesized that similar to depression outside of pregnancy, perinatal depression may be associated with CSF cytokines.

David Hackney, MD, division chief, maternal fetal medicine at University Hospitals Cleveland Medical Center in Cleveland, who was not involved with the research, said that this study provided potential mechanistic insights and directions for future research, though there were no clinical applications at this time.

“Minimal research has previously been conducted in this area and thus the results are novel,” he told MedPage Today. “This could be a fruitful area for future research since small quantities of CSF fluid are routinely generated in patients undergoing spinal anesthesia for Cesarean delivery.”

Miller’s study examined a cohort of women undergoing a planned cesarean delivery with a gestational age of >37 weeks, due to the potential for labor to alter markers of inflammation. Women were screened for depression, and the decision was made to include 1 screen-negative woman for every 2 screen-positive women. The Mini-International Neuropsychiatric Interview (MINI) was administered to participants to confirm a diagnosis of perinatal depression, and maternal plasma and CSF were collected preoperatively.

There were 117 women included in the study — 41 who screened negative and 76 who screened positive. Fifteen women in the screen-positive cohort had a clinically confirmed diagnosis of perinatal depression.

No significant associations were observed between any plasma cytokines and perinatal depression, and there was not a strong correlation between plasma and CSF cytokine levels.

After adjusting for confounders, higher IL-1β (adjusted OR 32.2, 95% CI 1.8-571.5), IL-23 (adjusted OR 24.8, 95% CI 1.6-377.9) and IL-33 (adjusted OR 1.6, 95% CI 1.1-2.4) levels were associated with increased odds of perinatal depression — albeit with widely varying confidence intervals. At the presentation, Miller reported that these results support a neuroinflammatory mechanism for perinatal depression.

Miller’s team also performed a post-partum follow-up with the participants, 90 of which completed a post-partum screen. About half screened negative, with 38% having mild post-partum depression, 10% having moderate post-partum depression and 1% severe post-partum depression.

This study was supported by the Friends of Prentice Foundation, Northwestern and NICHD funding.

2018-02-05T10:45:00-0500

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