Affective disorders in the perinatal period and child outcomes

The UPPSAT study was a population-based cohort conducted between 2006 and 2007, at Uppsala University Hospital. The primary aim of the study was to examine maternal, paternal, and infant well-being after childbirth, and it can be considered the foundation for the BASIC study. All women giving birth at the hospital were contacted by their midwife or midwife’s assistant after childbirth and were asked about participation. Information on the participants was retrieved through paper surveys administered at five days, six weeks, and six months postpartum. The surveys included data on socio-demographic characteristics, lifestyle, breastfeeding, partner support, stressful life events, as well as depression.

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

The aim of the BASIC study is to enrich and expand our knowledge on the pathophysiological processes underlying perinatal depression and to pinpoint both epidemiological and biological predictors of the disease in order to improve early detection. BASIC is a mental health population-based cohort of women followed from mid-pregnancy up to one year after childbirth and has so far included more than 6500 pregnancies. All women in Uppsala called for routine ultrasound examination in pregnancy week 16–17 are invited to participate in this study since 2009. During pregnancy and after delivery, women are followed by web-based questionnaires (depression, anxiety and personality assessment tools, early life stress, sleep disorders, socioeconomic factors). Relevant biological material (blood samples, umbilical cord blood samples, umbilical cord samples, placenta samples, amniotic and spinal fluid samples, and microbiota samples) is stored in a biobank. The children of the BASIC participants are followed up in the U-BIRTH study.

The BASIC study data is used in several projects:

• to study the association between the HPA axis and immune system with peripartum depression (PPD)
• to investigate genetic correlates of PPD
• to unravel the complex interplay between breastfeeding and PPD
• to assess the association between personality and attachment and PPD
• to assess the association between delivery complications and PPD
• to investigate if there is seasonality of PPD in Sweden, and examine how the metabolome and inflammatory systems are affected by seasons
• to assess if there are differences in bio-impedance and heart rate variability measurements between depressed and non-depressed women postpartum
• o assess differences in placental gene expression among SSRI-users, depressed and non-depressed pregnant women
• to assess differences in microbiome composition among depressed and non-depressed women during and after pregnancy, and the assess the possible predictive role of the microbiome composition in mid-pregnancy for preterm delivery and postpartum depression
• to identify the best predictive algorithm based on machine learning methods, with data collected up to delivery for the risk for developing postpartum depression, for future application in clinical use.

For more information, visit our website (in Swedish): https://www.basicstudie.se/

Collaborators

Uppsala Biobank of Pregnant Women

Funding

Swedish Research Council, Uppsala University Hospital, Göran Gustafsson Foundation, Swedish Brain Foundation, Marianne and Marcus Wallenberg Foundation, Söderström Königska Foundation, Swedish Society of Medicine, Crime Victim Compensation and Support Authority, P.O. Zetterling Foundation, Swedish Council for Working Life and Social Research, Family Planning Foundation, Fredrik and Ingrid Thuring Foundation, Födelsefonden, General Maternity Hospital Foundation, Gillbergska Foundation, Märta and Nicke Nasvell Foundation, Professor Bror Gadelius Memorial Fund, and Naeslund Scholarship.

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

An in-depth study initiated by Uppsala Children- and Baby Lab, Department of Psychology, studying child development in relation to maternal mood during and after pregnancy. Patients are recruited from the BASIC study and the children followed up with a series of psychological tests.

Funding
Uppsala Children- and Baby Lab (Marianne and Marcus Wallenberg Foundation)

Responsible researcher/contact person
Gustaf Gredebäck, gustaf.gredeback@psyk.uu.se

A follow-up study of the UPPSAT (children at 6 and 11 years of age) and BASIC studies(children at 18 months and 6 years) participants, with focus on maternal mental health and child development.

The aim of the U-BIRTH study is to provide in-depth understanding of how exposure to factors such as maternal depression during fetal and infant life, interact with psychosocial and genetic factors in shaping childrens clinical developmental phenotypes.

Approximately 60% of BASIC and 30% of UPPSAT mothers are included in this follow-up, via web-based questionnaires, and we expect to include 2800 mother-offspring pairs from the BASIC study and 800 pairs in the UPPSAT study. Thus far, about 65% these have already been recruited. An epigenome-wide association study (EWAS) among children with psycho-emotional problems and controls is being conducted. For more information, visit our website https://www.ubirth.se

Collaborators
FinnBrain study

Funding
Göran Gustafsson Foundation, Swedish Brain Foundation, and the Swedish Medical Association

Responsible researcher/contact person
Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

(same page) U-BIRTH Sub-studies:

Inflammatory markers during pregnancy and offspring´s outcome: more to learn from the Swedish population focused U-BIRTH cohort.

The aim of the U-BIRTH study is to provide an in-depth understanding of how exposure to factors such as peripartum depression during fetal and infant life interacts with psychosocial, genetic factors in the design of children's clinical developmental and metabolic phenotypes. The maternal environment during gestation critically influences fetal development and future offspring health. While much research has investigated developmental programming in response to maternal nutrition, there is currently growing interest in the role of the maternal immune system as an influence on fetal development and long-term outcomes. Being born too early, too small, or too large is associated with impaired development and chronic diseases later in life. Infants of similar weight often differ in adiposity, and given the increasing trend of childhood obesity globally, investigation of infant adiposity is crucial in order to understand the early-life determinants of metabolic health.

Funding

Gillbergska stiftelsen

Responsible researcher / contact person

Alkistis Skalkidou, alkistis.skalkidou@uu.se

Alexandra Gkourogianni, alexandra.gkourogianni@uu.se

In the PACT study, interactions between genetics and environment is investigated in order to increase our understanding of the causes of postpartum depression and postpartum psychosis. An increased understanding is important in order to develop new and better treatments of these conditions, as well as improve prediction of which women are at risk of postpartum depression. PACT is an international study, recruiting women in several countries around the world. So far, more than 11,000 women have been included in the PACT study in Australia, Canada, and the US. Recruitment in Sweden will begin shortly.

For more information, visit our website (in Swedish): https://www.pactstudie.se/

Collaborators

Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (http://www.pactforthecure.com/)

Funding

Swedish federal government under the ALF agreement

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

To promote perinatal mental health, midwives and obstetricians are key actors in screening and referring women with PPD to mental health services. However, there are many factors that may reduce the commitment to prevention and intervention by both mothers and health professionals. In this study, parents’ and healthcare staffs’ knowledge of and attitudes towards PPD, as well as their perception of underlying processes (causal attribution) are investigate anonymously. The study is part of a larger research project that will study these research questions in 11 countries (France, the Netherlands, Italy, Spain, Portugal, Estonia, Norway, Bulgaria, Poland, Greece, Cyprus and Sweden). The hypothesis is that a higher level of knowledge about perinatal depression is associated with more positive attitudes towards women with PPD among both parents and healthcare professionals. Thereby, the conditions are created to give mothers a positive care experience, and to enable them to seek help when needed, in order to improve the quality of perinatal care.

Study duration

2024-2026

Collaborations

Foundation FondaMental (France); lead institution for this international project, responsible for coordination, data collection, data management, analyses and reports regarding the overall comparison between the 11 participating countries.

Funding

-

Principal investigator/contact person

Alkistis Skalkidou, alkistis.skalkidou@uu.se

Depression after childbirth often includes feelings of inadequacy in mothering and feelings of shame or guilt, and can also affect her ability to bond with her child, perpetuating symptoms of depression. Ultimately, insecure mother-child attachment can lead to behavioural problems in the child such as aggression and avoidance, anxiety and depression in adolescence, negative effects on cognitive development and trust issues in close relationships.

Baby swimming is a structured form of social interaction that aims to teach the child essential life skills and to stimulate the child's social, intellectual and motor development. The mother participates actively and is encouraged to perform various exercises. In the BIDAP project, we want to investigate whether baby swimming can be used as an intervention to reduce depressive symptoms in new mothers and also strengthen the mother-infant bond.

Collaborations

Region Uppsala

Principal investigator/contact person

Alkistis Skalkidou, alkistis.skalkidou@uu.se

Sara Sylvén

Ludmilla Rosengren

Pregnancy- And Childbirth related Media Use to support Maternal mental health, or ‘Project PACMUM’ for short, is a project situated on the crossroads of women’s health and media psychology. In project PACMUM, we study how exposure to pregnancy- and childbirth-related content on the popular social media platform YouTube can play a role in pregnancy-related anxiety.

Not only can pregnancy-related anxiety have long-lasting negative consequences for both mother and child, maternal mental health struggles are also still highly stigmatized and not easily discussed with healthcare professionals or friends. This makes it especially important to study how maternal mental health can be supported through non-traditional methods, such as via social media. This project aims to improve our understanding of how YouTube can be strategically used to improve maternal mental health, but also of how content creators can informally and often unintentionally play a role in their followers’ health behaviors and experiences.

Funding: Marie Skłodowska-Curie Actions - Postdoktoralt stipendium till Femke Geusens

Collaboration: Reproduction and Lifestyle for Healthier Families Research Group, KU Leuven (Belgium)

Responsible researcher: Femke Geusens (femke.Geusens@uu.se)

The aim of 3PAD is to try to predict which women are at higher risk of postpartum depression (PPD) through two neurophysiological measurements. By measuring pupil dilation (PD) and heart rate variability (HRV) at rest and during concentration, we calculate how the body responds to stress and relaxation, which is important for the risk of developing symptoms of anxiety and depression.

Participating researchers

Emma Fransson,

emma.fransson@kbh.uu.se

Allison Eriksson

allison.eriksson@kbh.uu.se

Collaborations

Department of Psychology and Department of Neuroscience, Uppsala University
University of Zurich, Schweiz

Funding

Project funding from the Swedish Research Council (VR) Dnr 2023-01928; Women's Mental Health during the Reproductive Lifespan https://uu.se/forskning/womher/

Principal investigator/contact person

Emma Fransson,
emma.fransson@kbh.uu.se
Allison Eriksson
allison.eriksson@kbh.uu.se

Information for participants
https://www.kbh.uu.se/forskning/obstetrisk-och-reproduktiv-halsoforskning/huvudforskningsomraden-och-projekt/3pad/

Healthcare today is largely focused on treating symptoms, rather than preventing, mental illness. One goal of RE-MEND is to develop better strategies to prevent vulnerable individuals from developing mental illness during sensitive phases of life. Another is to reduce stigma associated with mental health problems.

Through an interdisciplinary approach, the project will deal with knowledge gaps and challenges by:

1. Focus on four critical and particularly sensitive phases of life where an individual's susceptibility to developing mental illness is strongly influenced by changes in hormonal balance; the forster stage/early development, puberty, pregnancy/childbirth and transition when you get older.
2. Compile and compare data from several large population-based studies around Europe, in order to detect early risks and protective factors that influence mental health conditions in the population during these four life stages.
3. Examine how biological, medical and social aspects interact. For example, the findings from the population-based and clinical studies will be supplemented with experimental studies to find causal relationships between biological mechanisms, environmental factors and mental illness.
4. Using biostatistics, machine learning and artificial intelligence for the identification of possible biomarkers to assess a person's mental health, the person's susceptibility to disease, personalized interventions and drug development.
5. Investigate how the project's results can be used to change medical practice and reduce stigmatization of affected individuals using communication research.

Collaborations:

• Uppsala universitet, Sverige (koordinator)
• Fondazione Telethon, Italien
• Helsingfors Universitet, Finland
• International Centre for Diarrhoeal Disease Research, Bangladesh
• Karlstads universitet, Sverige
• Karolinska Institutet, Sverige
• Max Planck für Psychiatrie, Tyskland
• Mount Sinai School of Medicine, USA
• Stockholms universitet, Sverige
• Ulster University, Nordirland
• Umeå universitet, Sverige
• Università degli Studi di Milano, Italien
• University of Rochester School of Medicine and Dentistry, USA
• Universität Bielefeld, Tyskland
• Universität zu Köln , Tyskland
• Vetenskap & Allmänhet, Sverige

Finansiering: forsknings- och innovationsprogrammet Horizon Europe GA No. 101057604