Feinstein’s unexpected postpartum blessing

Unusual suspect: The Feinstein Institute is part of a new study shedding light on an unexpected culprit that may be behind many postpartum depression cases.
By GREGORY ZELLER //

The Feinstein Institute for Medical Research has contributed to a potential breakthrough involving postpartum depression, a serious condition affecting hundreds of thousands of new mothers.

Kristina Deligiannidis, an associate professor at the Feinstein Institute and the Hofstra Northwell School of Medicine, joined colleagues at the University of Massachusetts Medical School and Tufts University’s Cummings School of Veterinary Medicine on a study that indicates synthetic oxytocin – a common medication administered during and after labor – contributes to the development of postpartum depression and anxiety.

The findings could help identify postpartum depression and anxiety risk levels in expectant mothers, and ultimately could help curtail the number of new moms suffering mood disorders. The team’s findings were published this month in Depression and Anxiety, the official journal of the Anxiety Disorders Association of America.

The condition, which can be severe and last for several months, affects somewhere between 11 percent and 20 percent of new U.S. mothers annually, according to the Centers for Disease Control. Postpartum Progress, a national 501(C)3 promoting awareness of conditions like postpartum depression, pegs the number of moms with perinatal mood disorders – occurring immediately before or after birth – at one in seven.

Kristina Deligiannidis: Surprising find.

The study explores the common use of a synthesized version of oxytocin, a human peptide hormone and neuropeptide normally produced by the hypothalamus region of the brain. The hormone, discovered in 1952, plays various roles in physiological issues including social bonding, sexual reproduction and childbirth – hence the introduction of synthesized oxytocin during labor.

Deligiannidis, who is also director of Women’s Behavioral Health at Zucker Hillside Hospital in Glen Oaks, is a longtime postpartum depression researcher, focused primarily on understanding how hormonal changes in pregnant women and new moms specifically influence mood disorders.

Along with her colleagues at UMass and the Cummings School, Deligiannidis has identified synthetic oxytocin – commonly administered to induce labor and/or treat postpartum hemorrhaging – as a likely suspect in many postpartum depression and anxiety cases.

That’s “contrary to what we expected,” according to Deligiannidis, especially since the oxytocin hormone is “naturally found in the body during childbirth.”

Nonetheless, the study found that exposure to synthetic oxytocin “was associated with an increase in risk for the development of postpartum depression and anxiety,” Deligiannidis said – and not only in women with a documented history of such conditions.

Deligiannidis and her colleagues at the two Massachusetts universities based their findings on data from the Massachusetts Integrated Clinical Academic Research Database, an enormous informatics platform operated by the University of Massachusetts Medical School.

Reviewing roughly 47,000 births by women ages 15 to 50, the team determined that women with a pre-pregnancy history of depressive or anxiety disorders who were given synthetic oxytocin during or after labor were 36 percent more likely to experience postpartum depression or anxiety than women who didn’t receive the medication.

The team also found that women with no pre-pregnancy history of depressive or anxiety disorders were 32 percent more likely to experience postpartum depression following a synthetic oxytocin treatment.

While once again proving the worth of UMass’ massive medical database – “Our collaboration underscores the value of de-identified clinical data repositories in clinical research,” noted co-author Aimee Kroll-Desrosiers of the UMass Medical School’s Department of Quantitative Health Sciences – the study is especially useful to the roughly 600,000 U.S. mothers who suffer annually through these largely under-explored conditions, according to co-author Benjamin Nephew, an assistant biology professor at the Cummings School.

“Despite the negative impacts to the mother and child, relatively little research has been done to examine the physical mechanisms that lead to postpartum depression,” Nephew said in a statement. “While there may be physiological factors that have a role in the condition, these findings indicate that we need to examine the treatments administered during and post labor.”

Postpartum depression can start anywhere from a few days to six months after birth and can manifest as a variety of symptoms, including prolonged depression, severe mood swings, difficulty bonding with the child and social withdrawal. Suicidal thoughts and deep fears of inadequacy are also common.

And the mother’s symptoms can affect the newborn child’s progress, according to the Feinstein Institute, influencing not only that mother-child bond but such factors as temperament and early-stage cognitive development.

None of the researchers contributing to the new study are advocating for an immediate ban on synthetic oxytocin treatments. But in light of their findings, they are all calling for a deeper exploration of how the manufactured medication “could contribute to the risk of suffering from postpartum depression,” according to Nephew, “or serve as novel predictive factors.”

Deligiannidis – who joined the Feinstein Institute, Zucker Hillside and Hofstra Northwell School of Medicine faculties in September 2016 after directing the Depression Specialty Clinic at UMass Medical School – agreed that the “important and commonly used medicine for peripartum women” shouldn’t immediately be shelved.

But a deeper dive into the potentially harmful effects of synthetic oxytocin, she noted, is required.

“Further research should examine dose, duration, timing and reason for treatment, so that we can better identify which women may be at risk for developing postpartum depression and anxiety,” Deligiannidis said. “Better identification of factors that place women at risk could significantly decrease the number of women who suffer with postpartum depression.”