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Sundström Poromaa, IngerORCID iD iconorcid.org/0000-0002-2491-2042
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Publications (10 of 179) Show all publications
Skoglund, C., Kallner, H. K., Skalkidou, A., Wikström, A.-K., Lundin, C., Hesselman, S., . . . Sundström Poromaa, I. (2019). Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden. JAMA NETWORK OPEN, 2(10), Article ID e1912463.
Open this publication in new window or tab >>Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden
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2019 (English)In: JAMA NETWORK OPEN, ISSN 2574-3805, Vol. 2, no 10, article id e1912463Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) is associated with a plethora of adverse health outcomes throughout life. While Swedish specialized youth clinics have carefully and successfully targeted risk of unplanned pregnancies in adolescents, important risk groups, such as women and girls with ADHD, might not be identified or appropriately assisted by these interventions. OBJECTIVES To determine whether women and girls with ADHD are associated with increased risk of teenage birth compared with their unaffected peers and to examine the association of ADHD with risk factors for adverse obstetric and perinatal outcomes, such as smoking, underweight or overweight, and substance use disorder. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study included data from 6 national longitudinal population-based registries in Sweden. All nulliparous women and girls who gave birth in Sweden between January 1, 2007, and December 31, 2014, were included. Data analyses were conducted from October 7, 2018, to February 8, 2019. EXPOSURES Women and girls treated with stimulant or nonstimulant medication for ADHD (Anatomic Therapeutic Chemical classification code N06BA) in the Swedish Prescribed Drug Register between July 1, 2005, and December 31, 2014. MAIN OUTCOMES AND MEASURES Maternal age at birth. Secondary outcome measures were body mass index, smoking habits, and psychiatric comorbidities. RESULTS Among 384 103 nulliparous women and girls aged 12 to 50 years who gave birth between 2007 and 2014 included in the study, 6410 (1.7%) (mean [SD] age, 25.0 [5.5] years) were identified as having ADHD. The remaining 377 693 women and girls without ADHD (mean [SD] age, 28.5 [5.1] years) served as the control group. Teenage deliveries were more common among women and girls with ADHD than among women and girls without ADHD (15.3% vs 2.8%; odds ratio [OR], 6.23 [95% CI, 5.80-6.68]). Compared with women and girls without ADHD, those with ADHD were more likely to present with risk factors for adverse obstetric and perinatal outcomes, including smoking during the third trimester (OR, 6.88 [95% CI, 6.45-7.34]), body mass index less than 18.50 (OR, 1.29 [95% CI, 1.12-1.49]), body mass index more than 40.00 (OR, 2.01 [95% CI, 1.60-2.52]), and alcohol and substance use disorder (OR, 20.25 [95% CI, 18.74-21.88]). CONCLUSIONS AND RELEVANCE This study found that women and girls with ADHD were associated with an increased risk of giving birth as teenagers compared with their unaffected peers. The results suggest that standard of care for women and girls with ADHD should include active efforts to prevent teenage pregnancies.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2019
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-400016 (URN)10.1001/jamanetworkopen.2019.12463 (DOI)000497997100014 ()31577361 (PubMedID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2019-12-27Bibliographically approved
Piltonen, T. T., Ruokojärvi, M., Karro, H., Kujanpää, L., Morin-Papunen, L., Tapanainen, J. S., . . . Falah-Hassani, K. (2019). Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe. PLoS ONE, 14(12), Article ID e0226074.
Open this publication in new window or tab >>Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe
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2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0226074Article in journal (Refereed) Published
Abstract [en]

Objective: To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia.

Methods: This cross-sectional survey was conducted among 382 endocrinologists and obstetrician gynaecologists in the Nordic countries and Estonia in 2015-2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS.

Results: Clinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6-8.1) or metformin (OR = 5.0, CI 2.5-10.2), but less frequently OCP (OR = 0.5, CI 0.2-0.9) for non fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1-4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46-55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2-0.8).

Conclusion: Despite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-407645 (URN)10.1371/journal.pone.0226074 (DOI)000515084600013 ()31877155 (PubMedID)
Funder
Academy of Finland, 321763
Available from: 2020-03-31 Created: 2020-03-31 Last updated: 2020-03-31Bibliographically approved
Henriksson, H. E., Malavaki, C., Bränn, E., Drainas, V., Lager, S., Iliadis, S. I., . . . Skalkidou, A. (2019). Blood plasma metabolic profiling of pregnant women with antenatal depressive symptoms. Translational Psychiatry, 9, Article ID 204.
Open this publication in new window or tab >>Blood plasma metabolic profiling of pregnant women with antenatal depressive symptoms
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2019 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 9, article id 204Article in journal (Refereed) Published
Abstract [en]

Antenatal depression affects similar to 9-19% of pregnant women and can exert persistent adverse effects on both mother and child. There is a need for a deeper understanding of antenatal depression mechanisms and the development of tools for reliable diagnosis and early identification of women at high risk. As the use of untargeted blood metabolomics in the investigation of psychiatric and neurological diseases has increased substantially, the main objective of this study was to investigate whether untargeted gas chromatography-mass spectrometry (GC-MS) plasma metabolomics in 45 women in late pregnancy, residing in Uppsala, Sweden, could indicate metabolic differences between women with and without depressive symptoms. Furthermore, seasonal differences in the metabolic profiles were explored. When comparing the profiles of cases with controls, independently of season, no differences were observed. However, seasonal differences were observed in the metabolic profiles of control samples, suggesting a favorable cardiometabolic profile in the summer vs. winter, as indicated by lower glucose and sugar acid concentrations and lactate to pyruvate ratio, and higher abundance of arginine and phosphate. Similar differences were identified between cases and controls among summer pregnancies, indicating an association between a stressed metabolism and depressive symptoms. No depression-specific differences were apparent among depressed and non-depressed women, in the winter pregnancies; this could be attributed to an already stressed metabolism due to the winter living conditions. Our results provide new insights into the pathophysiology of antenatal depression, and warrant further investigation of the use of metabolomics in antenatal depression in larger cohorts.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-381425 (URN)10.1038/s41398-019-0546-y (DOI)000483953900001 ()31444321 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Society of Medicine, SLS-250581Marianne and Marcus Wallenberg Foundation, MMW2011.0115
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-10-09Bibliographically approved
Skírnisdottir, I., Åkerud, H., Seidal, T. & Sundström-Poromaa, I. (2019). Cell Cycle Regulator p27 Mediates Body Mass IndexEffects in Ovarian Cancer in FIGO-stages I-II. Cancer Genomics & Proteomics, 16(6), 443-450
Open this publication in new window or tab >>Cell Cycle Regulator p27 Mediates Body Mass IndexEffects in Ovarian Cancer in FIGO-stages I-II
2019 (English)In: Cancer Genomics & Proteomics, ISSN 1109-6535, E-ISSN 1790-6245, Vol. 16, no 6, p. 443-450Article in journal (Refereed) Published
Abstract [en]

Background/Aim: The aim of the present study was to evaluate the association between body mass index (BMI), the biomarker p27, and the clinical factors in FIGO-stages I-II ovarian cancer. Patients and Methods: A total of 128 patients with ovarian cancer were included in the study. For testing differences in univariate analyzes we used the Pearson's Chi-square test and the log-rank test. For multivariate analyses the logistic regression and Cox regression models were used with recurrent disease and disease free survival as endpoints, respectively. Results: Patients with BMI <= 25 kg/m(2) had a significantly better 5-year disease free survival compared with patients with BMI >25 kg/m(2) in the total series of patients (p=0.008), and in the series of patients (n=77) with non-serous tumors (p=0.047). Patients with p27-positive non-serous tumors had higher survival compared to patients with p27-negative non-serous tumors (p=0.020). Conclusion: The cell cycle regulator p27 mediates BMI effects in ovarian cancer in FIGO-stages I-II.

Place, publisher, year, edition, pages
International Institute of Anticancer Research, 2019
Keywords
BMI, p27, non-serous tumors, ovarian cancer, FIGOstages I-II.
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-396005 (URN)10.21873/cgp.20148 (DOI)000493397500004 ()31659099 (PubMedID)
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-11-18Bibliographically approved
Piltonen, T. T., Giacobini, P., Edvinsson, Å., Hustad, S., Lager, S., Morin-Papunen, L., . . . Arffman, R. K. (2019). Circulating antimüllerian hormone and steroid hormone levels remain high in pregnant women with polycystic ovary syndrome at term. Fertility and Sterility, 111(3), 588-596.e1
Open this publication in new window or tab >>Circulating antimüllerian hormone and steroid hormone levels remain high in pregnant women with polycystic ovary syndrome at term
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2019 (English)In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 111, no 3, p. 588-596.e1Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate plasma antimullerian hormone (AMH) concentration and its relation to steroid hormone levels in pregnant women with polycystic ovary syndrome (PCOS) and controls at term.

Design: Case-control study.

Setting: University-affiliated hospital.

Patient(s): A total of 74 pregnant women at term: 25 women with PCOS (aged 31.6 ± 3.9 years [mean ± standard deviation], body mass index 24.0 ± 3.9 kg/m2, mean gestational length 279 ± 9 days) and 49 controls (aged 31.7 ± 3.3 years, body mass index 24.0 ± 3.3 kg/m2, mean gestational length 281 ± 9 days).

Intervention(s): None.

Main Outcome Measure(s): Plasma AMH and steroid hormone levels.

Result(s): Antimullerian hormone, T, and androstenedione levels were higher in women with PCOS at term compared with controls, whereas estrogen and P levels were similar. The differences were pronounced in women carrying a female fetus. Testosterone and AMH levels correlated positively in both groups, but E2 levels only in women with PCOS.

Conclusion(s): Pregnant women with PCOS present with elevated AMH and androgen levels even at term, suggesting a hormonal imbalance during PCOS pregnancy. Differences were detected especially in pregnancies with a female fetus, raising the question of whether female pregnancies are more susceptible to AMH and steroid hormone actions.

Keywords
Antimullerian hormone, androgens, polycystic ovary syndrome, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-379340 (URN)10.1016/j.fertnstert.2018.11.028 (DOI)000460037400031 ()30630591 (PubMedID)
Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-03-15Bibliographically approved
Axfors, C., Bränn, E., Henriksson, H. E., Hellgren, C., Kallak, T. K., Fransson, E., . . . Skalkidou, A. (2019). Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort. BMJ Open, 9(10), Article ID e031514.
Open this publication in new window or tab >>Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 10, article id e031514Article in journal (Refereed) Published
Abstract [en]

PURPOSE: With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

PARTICIPANTS: From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16-18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

FINDINGS TO DATE: In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case-control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic-pituitary-adrenal axis and immune system.

FUTURE PLANS: In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
cohort study, mother-child relations, pituitary-adrenal system, postpartum depression, pregnancy, psychoneuroimmunology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-404667 (URN)10.1136/bmjopen-2019-031514 (DOI)31641004 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Research Council, 523-2014-07605Swedish Research Council, 521-2013-2339Göran Gustafsson Foundation for promotion of scientific research at Uppala University and Royal Institute of TechnologyMarianne and Marcus Wallenberg FoundationStiftelsen Söderström - Königska sjukhemmetSwedish Society of MedicineForte, Swedish Research Council for Health, Working Life and WelfareFredrik och Ingrid Thurings Stiftelse
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-03-27Bibliographically approved
Comasco, E., Schijven, D., de Maeyer, H., Vrettou, M., Nylander, I., Sundström-Poromaa, I. & Olivier, J. D. A. (2019). Constitutive serotonin transporter reduction resembles maternal separation with regard to stress-related gene expression. ACS Chemical Neuroscience, 10(7), 3132-3142
Open this publication in new window or tab >>Constitutive serotonin transporter reduction resembles maternal separation with regard to stress-related gene expression
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2019 (English)In: ACS Chemical Neuroscience, ISSN 1948-7193, E-ISSN 1948-7193, Vol. 10, no 7, p. 3132-3142Article in journal (Refereed) Published
Abstract [en]

Interactive effects between allelic variants of the serotonin transporter (5-HTT) promoter-linked polymorphic region (5-HTTLPR) and stressors on depression symptoms have been documented, as well as questioned, by meta-analyses. Translational models of constitutive 5-htt reduction and experimentally controlled stressors often led to inconsistent behavioral and molecular findings and often did not include females. The present study sought to investigate the effect of 5-htt genotype, maternal separation, and sex on the expression of stress-related candidate genes in the rat hippocampus and frontal cortex. The mRNA expression levels of Avp, Pomc, Crh, Crhbp, Crhr1, Bdnf, Ntrk2, Maoa, Maob, and Comt were assessed in the hippocampus and frontal cortex of 5-htt± and 5-htt+/+ male and female adult rats exposed, or not, to daily maternal separation for 180 min during the first 2 postnatal weeks. Gene- and brain region-dependent, but sex-independent, interactions between 5-htt genotype and maternal separation were found. Gene expression levels were higher in 5-htt+/+ rats not exposed to maternal separation compared with the other experimental groups. Maternal separation and 5-htt+/− genotype did not yield additive effects on gene expression. Correlative relationships, mainly positive, were observed within, but not across, brain regions in all groups except in non-maternally separated 5-htt+/+ rats. Gene expression patterns in the hippocampus and frontal cortex of rats exposed to maternal separation resembled the ones observed in rats with reduced 5-htt expression regardless of sex. These results suggest that floor effects of 5-htt reduction and maternal separation might explain inconsistent findings in humans and rodents.

Keywords
Frontal cortex, hippocampus, maternal separation, serotonin transporter, gene expression
National Category
Neurosciences Biochemistry and Molecular Biology
Identifiers
urn:nbn:se:uu:diva-381818 (URN)10.1021/acschemneuro.8b00595 (DOI)000476685400012 ()30614673 (PubMedID)
Funder
Swedish Society of Medicine, SLS-411161Fredrik och Ingrid Thurings StiftelseLars Hierta Memorial FoundationSwedish Research Council, K2012-61X-22090-01-3Swedish Research Council, VR: 2015-00495EU, FP7, Seventh Framework Programme, INCA 600398Science for Life Laboratory - a national resource center for high-throughput molecular bioscience
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2019-09-20Bibliographically approved
Persson, S., Elenis, E., Turkmen, S., Kramer, M. S., Yong, E.-L. & Sundström Poromaa, I. (2019). Fecundity among women with polycystic ovary syndrome (PCOS)-a population-based study. Human Reproduction, 34(10), 2052-2060
Open this publication in new window or tab >>Fecundity among women with polycystic ovary syndrome (PCOS)-a population-based study
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2019 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 34, no 10, p. 2052-2060Article in journal (Refereed) Published
Abstract [en]

STUDY QUESTION: Does the long-term fecundity of women with polycystic ovary syndrome (PCOS) differ from those without PCOS?

SUMMARY ANSWER: Cumulative probability of childbirth is similar between women with and without PCOS.

WHAT IS KNOWN ALREADY: PCOS is the main cause of anovulatory infertility in women after menarche. Previous studies indirectly suggest that fecundity in women with PCOS over the longer term may not be lower than in women PCOS.

STUDY DESIGN, SIZE, DURATION: This is a population-based study using four linked Swedish national registries. A total of 45 395 women with PCOS and 217 049 non-PCOS women were included. Follow-up began at the age of 18 years and continued for a maximum of 26 years, from 1989 to the end of 2015. Childbirth was the main outcome, as identified from the Medical Birth Register.

PARTICIPANTS/MATERIALS, SETTING, METHODS: All women born between 1971 and 1997 who were identified with a PCOS diagnosis in the Swedish Patient Registry between I January 2001 and 31 December 2016 were included in the study population. Five controls per women with PCOS were randomly drawn from the Total Population Registry. The control women were born in the same year and living in the same municipality as the patient. The fecundity ratio (FR) was calculated by clustered Cox regression using a robust variance, adjusted for maternal birth period, country of birth and level of education.

MAIN RESULTS AND THE ROLE OF CHANCE: The cumulative probability of childbirth was 80.2% (95% CI, 79.5-80.9%) in women with PCOS and 78.2% (95% CI, 77.9-78.5%) in those without PCOS. Adjusted FR was 0.81 (95% CI, 0.80-0.82) for first childbirth and 0.58 (95% CI, 0.57-0.60) for first childbirth following a spontaneous pregnancy. The FR for second childbirth was 0.79 (95% CI, 0.77-0.80). Women with PCOS had more than one child less frequently than the comparison group. Within the PCOS group, early age at diagnosis, later birth year, Nordic country of origin and low educational level positively influenced the FR.

LIMITATIONS, REASONS FOR CAUTION: Results are not adjusted for BMI, and time from intention to conceive to first childbirth could not be captured. Data on pregnancies, miscarriages or abortions and fertility treatment are unknown for women who did not give birth during the study period. Women with PCOS who did not seek medical assistance might have been incorrectly classified as not having the disease. Such misclassification would lead to an underestimation of the true association between PCOS and outcomes.

WIDER IMPLICATIONS OF THE FINDINGS: While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth. Women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS. Early diagnosis of and information about PCOS may improve affected women's reproductive potential.

STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Swedish Society of Medicine. Inger Sundstrom Poromaa has, over the past 3 years, received compensation as a consultant and lecturer for Bayer Schering Pharma, MSD, Gedeon Richter, Peptonics and Lundbeck A/S. The other authors declare no competing interests.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2019
Keywords
PCOS, fecundity, childbirth rate, fertility, reproduction, fecundity ratio
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-397790 (URN)10.1093/humrep/dez159 (DOI)000493485900022 ()31504532 (PubMedID)
Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2019-11-28Bibliographically approved
Breedh, J., Comasco, E., Hellgren, C., Papadopoulos, F. C., Skalkidou, A. & Sundström Poromaa, I. (2019). Hypothalamic-pituitary-adrenal axis responsiveness, startle response, and sensorimotor gating in late pregnancy. Psychoneuroendocrinology, 106, 1-8
Open this publication in new window or tab >>Hypothalamic-pituitary-adrenal axis responsiveness, startle response, and sensorimotor gating in late pregnancy
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2019 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 106, p. 1-8Article in journal (Refereed) Published
Abstract [en]

During pregnancy, the hypothalamic-pituitary-adrenal (HPA) axis, the main regulator of the stress response, undergoes dramatic changes. The acoustic startle response (ASR) and the prepulse inhibition (PPI) of the startle response are neurophysiological research tools and objective measures of an individual's response to an emotional context or stressor. The ASR and PPI are influenced by psychiatric diseases characterized by anxiety symptoms and are sensitive to cortisol. Hence, the ASR and the PPI can be used to investigate the effects of pregnancy-induced endocrine changes and their contribution to affective disorders. The present study sought to investigate the association between measures of HPA-axis responsiveness, startle reactivity and sensorimotor gating during pregnancy that to date remains unknown. The eye-blink component of the ASR, and its prepulse inhibition, were measured in 107 late third trimester pregnant women. Saliva samples were collected to assess the cortisol awakening response (CAR), a measure of HPA-axis activity. Blood was sampled to measure serum levels of cortisol, cortisone and the cortisone to cortisol ratio. Ongoing anxiety disorders, sleep duration, smoking, and age were considered as potential confounders in the statistical analyses. CAR reactivity, measured as area under the curve (AUC) increase and above baseline, was positively associated with baseline startle magnitude [Cohen's d = 0.27; F (1, 105) = 4.99; p = 0.028, and Cohen's d = 0.30; F (1, 105) = 6.25; p = 0.014, respectively] as well as PPI at 86 dB [Cohen's d = 0.29; F (1, 105) = 5.93; p = 0.017; and Cohen's d = 0.34; F (1, 105) = 8.38; p = 0.005, respectively]. The observed positive correlation between startle magnitude in pregnant women and greater increase in cortisol during the awakening response may be interpreted as heightened neurophysiological reactivity, likely associated with dysregulation of the stress system.

Keywords
AUC, CAR, Cortisol, Pregnancy, Sensorimotor gating, Startle response
National Category
Endocrinology and Diabetes Neurosciences Psychiatry
Identifiers
urn:nbn:se:uu:diva-381815 (URN)10.1016/j.psyneuen.2019.03.008 (DOI)000474678300001 ()30927623 (PubMedID)
Funder
Swedish Research Council, 521-2013-2339Marianne and Marcus Wallenberg Foundation, MMW2011.0115The Swedish Medical Association, SLS-250581Swedish Society of Medicine, SLS-331991Swedish Research Council, 2015-00495EU, FP7, Seventh Framework Programme, INCA 600398
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2019-08-16Bibliographically approved
Bränn, E., Edvinsson, Å., Rostedt Punga, A., Sundström Poromaa, I. & Skalkidou, A. (2019). Inflammatory and anti-inflammatory markers in plasma: from late pregnancy to early postpartum. Scientific Reports, 9, Article ID 1863.
Open this publication in new window or tab >>Inflammatory and anti-inflammatory markers in plasma: from late pregnancy to early postpartum
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 1863Article in journal (Refereed) Published
Abstract [en]

During pregnancy, the woman's body undergoes tremendous changes in immune system adaptation. The immunological shifts that occur in pregnancy can partially be explained by alterations in hormonal levels. Furthermore, during pregnancy, many autoimmune diseases go into remission, only to flare again in the early postpartum period. Given these important changes in the clinical course of a number of autoimmune disorders, surprisingly little has been done to investigate the inflammatory profile changes across pregnancy and the postpartum period. Thus, the aim of this study was to describe how inflammatory and anti-inflammatory markers change from late pregnancy to the early postpartum period, using a multiplexed assay consisting of both well-known as well as exploratory proteins. Two-hundred-and-ninety women were included in this study and donated a total of 312 blood samples; 198 in late pregnancy (similar to gw38) and 114 in the postpartum period (similar to w8). The plasma blood samples were analyzed for 92 immune system related protein markers using Proseek Multiplex Inflammation I panel, a high-sensitivity assay based on proximity extension assay technology. Fifty-six inflammatory and anti-inflammatory markers were significantly different between pregnancy and the postpartum, of which 50 survived corrections for multiple comparisons. Out of these 50 markers, 41 decreased from pregnancy to postpartum, while the remaining 9 increased in the postpartum period. The top five markers with the greatest decrease in the postpartum period were Leukemia inhibitory factor receptor (LIF-R), Latency-associated peptide Transforming growth factor beta-1 (LAP TGF-beta-1), C-C motif chemokine 28 (CCL28), Oncostatin M (OSM) and Fibroblast growth factor 21 (FGF21). Top three markers that increased in the postpartum period were Tumor necrosis factor ligand superfamily member 11 (TRANCE), Tumor necrosis factor ligand superfamily member 12 (TWEAK), and C-C motif chemokine/Eotaxin (CCL11). This study revealed that the majority of the markers decreased from pregnancy to postpartum, and only a few increased. Several of the top proteins that were higher in pregnancy than postpartum have anti-inflammatory and immune modulatory properties promoting pregnancy progress. These results clearly reflect the tremendous change in the immune system in the pregnancy to postpartum transition.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-378379 (URN)10.1038/s41598-018-38304-w (DOI)000458401500066 ()30755659 (PubMedID)
Funder
Swedish Research Council, VR:521-2013-2339Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-03-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2491-2042

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