Pregnant women who will deliver by planned caesarian. Participants enrolled in the study that are not eligible for the imaging subgroup.
All participants start in the basic program. Includes collection of blood, cerebrospinal fluid, saliva, hair, placenta tissues, umbilical cord blood and psychometrics.

A subgroup of 70 pregnant women who will deliver by planned caesarian selected towards either high (N=35) or low (N=35) risk for perinatal depression will undergo brain imaging in addition to the elements of the basic program. The extended imaging program includes functional and structural magnetic resonance imaging, positron emission tomography (PET) and a semistructured interview for depression symptoms (HAM-D17).

Major Depressive Disorder

Perinatal Depression

Peripartum transition from pregnant to postpartum state

Pregnancy

Rigshospitalet

The Role of Sex Steroids and Serotonin Brain Dynamics in Perinatal Mental Health

Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Total group

Score on the Hamilton 17-item depression scale. Score range: 0-52. Higher scores indicate more depressive symptoms. Assessed in imaging group

116 a priori defined gene transcripts, which where differentially expressed in third trimester of women who later developed perinatal depression with postpartum onset relative to pregnant women who did not and to other depressed (reference Mehta et al, 2014, Psychological Medicine) and confirmed to be coupled to estrogen fluctuations (Mehtaet al. 2018 British Journal of Psychiatry) will be evaluated in the total group.
Also DNA methylation of the genes of these transcripts will be determined and analysed in terms of their predictive value (above chance) for perinatal depression.

Latent variable construct of brain 5-HT4R level based on quantification of 5-HT4R binding from 11C-SB207145 positron emission tomography in primary volumes of interest; neocortex, nucleus caudatus, putamen and hippocampus. Assessed in imaging group.

Cortisol awakening response, area under the curve with respect to baseline from 0 to 60 minutes from awakening.

Provides an estimate of cortisol exposure up to 6 months prior to delivery, total group

Provides an estimate of fetal cortisol exposure, infants from total group

Hippocampal brain volume (including hippocampus) from structural MRI, imaging group.

fMRI (BOLD response) based assessment of brain activity in response to reward, relative to non-reward, stimuli. Assessed in imaging cohort

rsfMRI based spontaneous co-fluctuations in low frequency BOLD signal, (functional connectivity). Assessed with rsfMRI scan in the resting state, i.e. non-goal oriented spontaneous thought and awake. Assessed in imaging group.

Change in epigenetic SERT status from late pregnancy to postpartum week 3-6.

Composite measure of hsCRP, TNF-α, IL-6, IL-18 and IL-10 levels, total group

fMRI (BOLD response) based assessment of brain activity to emotionally salient, relative to neutral, stimuli. Assessed in imaging cohort.

Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Assessed in total group

Edinburgh Postnatal Depression Scale. Score range: 0-30. Higher scores indicate more symptoms of postpartum depression. Assessed in all

Composite measure of IFN-c, IFN-alfa TNF-alfa og IL-6, in total group

Estradiol level in peripheral blood, total group

Estradiol level peripheral blood, total group

Estradiol change pre- to postpartum, peripheral blood total group

Progesterone change pre- to postpartum, peripheral blood total group

Allopregnanolone level in peripheral blood

Change in allopregnanolone level in peripheral blood

Cortisol change pre- to postpartum, peripheral blood total group

Change in cortisol awakening response, from caesarean section to 3-6 weeks postpartum.

Methylation status for the SERT gene, total group

DNA Methylation status for the SERT gene, total group

Methylation status for the FK506-binding protein 51 (FKBP5) gene, total group

Change in methylation status for the FK506-binding protein 51 (FKBP5) gene from late pregnancy to postpartum week 3-6.

Methylation status for the glucocorticoid receptor gene, total group

Change in methylation status for the glucocorticoid receptor gene from late pregnancy to postpartum week 3-6.

Methylation status for the COMT gene, total group

Change in methylation status for the COMT gene from just before delivery to 3-6 weeks postpartum

Methylation status for the MAO-A gene, total group

Change in methylation status for the MAO-A gene, total group

Methylation status for the oxytocin receptor gene, total group

Change in methylation status for the oxytocin receptor gene, total group

Methylation status for the oxytocin gene, total group

Change methylation status for the oxytocin gene, total group

Change in composite measure of hsCRP, TNF-α, IL-6, IL-18 and IL-10 levels, total group

Family History Assessment Module (OS-FHAM). Number of first degree relatives with a history of depressive episodes or bipolar disorder. Total group.

Barratt Impulsiveness Scale (BIS-11), self-reported. Range: 30-120. Total group.

NEO-PI-R - Revised NEO Personality Inventory, self-reported. Participants may score 20-80 for each of the personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism. The higher the score, the more prominent is the personality trait. Total group.

Parental bonding instrument (PBI), both parents, self-reported. Total group.

Perceived Stress Scale (PSS), range 0-40, a score of 0 indicates no perceived stress. Total group.

Change in Perceived Stress Scale (PSS), range 0-40, a score of 0 indicates no perceived stress. Total group.

Snaith-Hamilton Pleasure Scale (SHAPS), range 0-14, a score of 0 indicates no self-reported anhedonia. Total group.

Change in Snaith-Hamilton Pleasure Scale (SHAPS) score, range 0-14, a score of 0 indicates no self-reported anhedonia. Total group.

Rumination Response Scale (RRS), range 22-88, a score of 22 indicates no ruminative symptoms. Total group.

Change in Rumination Response Scale (RRS) score, range 22-88, a score of 22 indicates no ruminative symptoms. Total group.

Profile of Mood States (POMS), range 0-260, a score of 0 indicates no mood disturbance. Total group.

Change in Profile of Mood States (POMS) score, range 0-260, a score of 0 indicates no mood disturbance. Total group.

Pittsburgh Sleep Quality Index (PSQI), range 0-21, a score of 0 indicates a healthy sleep quality. Total group.

Change in Pittsburgh Sleep Quality Index (PSQI), range 0-21, a score of 0 indicates a healthy sleep quality. Total group.

Brief symptom Inventory-53 item (BSI-53), range 0-212, increasing score means worsening of symptoms.Total group.

Change in Brief symptom Inventory-53 item (BSI-53) score, range 0-212, increasing score means worsening of symptoms.Total group.

WHO-5 well-being index, range 0-100, low score means less well-being. Total group.

Change in WHO-5 well-being index, range 0-100, low score means less well-being. Total group.

State Trait Anxiety Inventory (STAI-AD-D), state and trait subscales each have a range of 20-80, 20 means no anxiety. Total group.

State Trait Anxiety Inventory (STAI-AD-D), state subscale range 20-80, 20 means no anxiety. Total group.

Change in State Trait Anxiety Inventory (STAI-AD-D) score, state subscale range 20-80, 20 means no anxiety. Total group.

Obsessive-Compulsive Inventory (OCI) score, self-reported, range 0-72, higher scores indicate more symptoms. Total group.

Change in Obsessive-Compulsive Inventory (OCI) score, self-reported, range 0-72, higher scores indicate more symptoms. Total group.

Performance on Simple Reaction Time, in imaging cohort.

Gray matter brain volume prefrontal cortex and anterior cingulate cortex

Composite measure of serotonin, tryptophan og tryptofan hydroxylase levels relative to 5-HIAA, in placenta sample. Infants from total group

11-beta-hydroxysteroid dehydrogenase type 2 activity in placenta. Infants from total group

Composite measure of methylation status for the FKBP5, glucocorticoid receptor, 11-beta hydroxysteroid dehydrogenase type 2 genes. Infants from total group

Composite measure of the methylation status for monoamine oxidase, serotonin receptor and serotonin transporter genes. Infants from total group

Composite measure of methylation status and gene transcript profiles of Glucocorticoid receptor, FKBP5, oxytocin and oxytocin receptors, Brain-derived neurotrophic factor (BDNF) genes. Assessed in blood from umbilical cord blood sample from infants, total group.

val158met (rs4680) status, binary variable, i.e. "val/val, val/met" vs "met/met" variants

BDNF val66met (rs6265) status, binary variable, i.e. "val/val" versus "met-carrier" status

5-HTTLPR genotype status (binary), i.e. high-expressing LALA vs low-expressing (S or LG) variants, based on SLC6A4, i.e. L or S variants, and further subtyping on rs25531 haplotype L(A)L(A) vs LGLA, LGLG or variants containing as S as specified above.

In house interview based on Kennerley Maternity Blues Questionnaire, range: 0-28, higher score indicates more severe postpartum blues symptoms. High blues score is associated with greater risk for perinatal depression at week 3-6.

Via database of Center for Integrated Molecular Brain Imaging (Knudsen et al 2016, NeuroImage) data will be available for neuroscience research community contingent on approval by scientific board.

breech presentation/seratonin

The Role of Sex Steroids and Serotonin Brain Dynamics in Perinatal Mental Health

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