Depressive symptoms predict exaggerated inflammatory responses to an in vivo immune challenge among pregnant women

Abstract

Objective: Stress and depressive symptoms predict exaggerated inflammatory responses to a biological challenge in nonpregnant humans and animals. The extent to which these findings generalize to pregnancy is unknown because the immune system exhibits substantial changes to support pregnancy. Notably, inflammatory responses to infectious agents play a causal role in the development of gestational hypertension as well as risk for preterm birth. Thus, depressive symptoms may increase susceptibility to these outcomes via sensitization of inflammatory processes. The current study was designed to test the hypothesis that depressive symptoms would predict an exaggerated proinflammatory response to an in vivo antigen challenge, influenza virus vaccination, among pregnant women.

Method: Twenty-two pregnant women completed two study visits: baseline and 1week after receiving influenza virus vaccination. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline. Serum levels of macrophage migration inhibitory factor (MIF) were determined using a high sensitivity immunoassay at both study visits.

Outcomes: Analyses demonstrated that, as compared to those in the lowest tertile of CES-D scores, those in the highest tertile exhibited significantly higher levels of MIF 1week after influenza virus vaccination (p=.035).

Conclusions: Depressive symptoms predicted exaggerated MIF production following influenza virus vaccination during pregnancy. These data support the hypothesis that depressive symptoms are associated with sensitization of the inflammatory response during pregnancy. Thus, women with greater depressive symptoms may be more vulnerable to negative sequelae of infectious illness during pregnancy.

Figure 1. Macrophage migration inhibitory factor (MIF) levels prior to and one week post-influenza virus vaccination

As compared to women in the lowest tertile of CES-D scores (n=8), those in the highest tertile (n=6) exhibited significantly higher levels macrophage MIF at one week after vaccination (p=.035).