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Title: Antenatal depression and developmental programming of offspring hypothalamic-pituitary-adrenal axis in the first year of life
Author: Osborne, Sarah Ann
ISNI:       0000 0004 5918 7041
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2016
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Background: Research in humans demonstrates a link between an adverse environment during development and unfavourable health outcomes in adulthood. Animal research used to understand this phenomenon reveals that exposure to prenatal stress and to glucocorticoids may programme offspring hypothalamic-pituitary-adrenal (HPA) axis, which is in turn hypothesised to mediate disease risk. Extension of these findings in human research is at a less advanced stage, although synthesis of a number of lines of evidence suggests that similar HPA axis programming exists. Glucocorticoids are hypothesised as the final mediator in the pathway from adverse antenatal environment to programming effects, including altered offspring HPA axis activity, although molecular mechanisms underlying this hypothesis are yet to be elucidated. Depression in pregnancy is a paradigm by which mechanisms for developmental programming may be further studied. Methodology: A prospective longitudinal observational study of 82 pregnant women from the second trimester of pregnancy, and their offspring to 1 year postnatal is described. A cases group with DSM-IV major depressive disorder (MDD) was compared with a non-depressed control group. Maternal mood, antenatal HPA axis, obstetric outcomes and infant basal HPA axis activity and cortisol response to pain stress were assessed. Results: Compared with the control group, women with MDD in pregnancy had overactivity of the HPA axis in the third trimester of pregnancy, a shorter length of gestation, infants with larger cortisol response to pain stress at 8 weeks and 1 year postnatal and higher evening cortisol at 1 year of age. Furthermore, associations were found between antenatal depression, maternal antenatal HPA axis and infant HPA axis. The findings were independent of socio-demographic and obstetric factors and maternal postnatal mood. Conclusions: The associations between maternal antenatal depression and altered maternal and infant HPA axis activity suggest programming effects and add to the important literature on developmental programming in humans. Furthermore, the findings have clinical relevance in the fields of obstetrics, psychiatry and paediatrics.
Supervisor: Pariante, Carmine Maria ; Pawlby, Susan Jennifer Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available