Abstract
Vitamin D deficiency and elevated pro-inflammatory cytokines have each been associated individually with postpartum depression (PPD). African American women are at increased risk for prenatal vitamin D deficiency, inflammation, and prenatal and postpartum depressive symptoms, but biological risk factors for PPD in this population have rarely been tested. This prospective study tested whether low prenatal vitamin D status (serum 25-hydroxyvitamin D, 25[OH]D) predicted PPD symptomatology in pregnant African American women and whether high levels of prenatal inflammatory cytokines interacted with low 25(OH)D in effects on PPD symptoms. Vitamin D status was measured in the first trimester in a sample of 91 African American pregnant women who had a second trimester blood sample assayed for inflammatory markers. Depressive symptoms were assessed at a postpartum visit. An inverse association between prenatal log 25(OH)D and PPD symptomatology approached significance (β = −0.209, p = 0.058), and interleukin-6 and IL-6/IL-10 ratio significantly moderated the effect. Among women with higher levels of inflammatory markers, lower prenatal log 25(OH)D was associated with significantly higher PPD symptoms (p < 0.05). These preliminary results are intriguing because, if replicable, easy translational opportunities, such as increasing vitamin D status in pregnant women with elevated pro-inflammatory cytokines, may reduce PPD symptoms.
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Notes
Approximately 0.5 MED of UVB radiation would be absorbed after an average of 5 to 10 min of exposure of the arms and legs to direct sunlight depending on the time of day, season, latitude, and skin sensitivity (Zhang and Naughton 2010).
The other vitamin cutoffs we considered were vitamin D ≤ 15 ng/ml for risk of cardiovascular disease (Wang et al. 2008) and vitamin D ≤ 10 ng/ml used for risk for all-cause mortality (Dobnig et al. 2008). Analyses showed that 69 % of our sample (63 women) met the cardiovascular risk cutoff, and 48 % (44 women) were at risk of all-cause mortality.
A table displaying the Spearman correlation coefficients among the main study variables, including vitamin D status and each inflammatory marker can be provided by the authors.
History of depression was abstracted from the electronic medical record. We do not know if any women sought out psychological or complementary treatments for depression nor how long ago a previous episode occurred. One woman in our study reported taking antidepressants (Zoloft) during her postpartum visit, and removing her from analyses did not change our results.
IU refers to international units, which equal 25 ng. Vitamin D supplements were prescribed to 87 % of the women with 74 % reporting use of the supplement at a prenatal care visit. Most vitamin D supplements prescribed were 50,000 IU, taken once weekly.
Bonferroni critical p of 0.0125 (IL-6 p = 0.025; IL-6/IL-10 p = 0.016).
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Acknowledgments
R.M.P. and A.C.B. conducted the study. E.E.A. developed the research questions for secondary analyses, analyzed the data, and wrote the article. C.D.S, A.C.B., and R.M.P. assisted in writing. All authors contributed to the study design, interpretation of data, and approved the final manuscript. The authors have no financial gain related to the outcome of this research, and there are no potential conflicts of interest. This project was supported by funding from the Institute for Population Sciences, Health Assessment, Administration, Services, and Economics (INPHAASE) to A.C.B. and R.M.P. and National Institutes of Mental Health (T32MHI5750) postdoctoral fellowship to E.E.A. We thank the participants in this study for contributing to this research and increasing our knowledge about the experiences of African American pregnant women. We acknowledge the support of the research team members, Dayna Johnson, Project Manager, Henry Ford Hospital Department of Public Health Sciences and Christine Wells, Ph.D., Statistician, UCLA Statistical Consulting Group. We also thank Judith E. Carroll, Ph.D. of the UCLA Semel Institute for Neuroscience and Human Behavior and the Dunkel Schetter lab for consultation in this work.
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Accortt, E.E., Schetter, C.D., Peters, R.M. et al. Lower prenatal vitamin D status and postpartum depressive symptomatology in African American women: Preliminary evidence for moderation by inflammatory cytokines. Arch Womens Ment Health 19, 373–383 (2016). https://doi.org/10.1007/s00737-015-0585-1
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DOI: https://doi.org/10.1007/s00737-015-0585-1