[Frontiers in Bioscience, Landmark, 25, 1433-1461, March 1, 2020]

Psychiatric disorders and changes in immune response in labor and postpartum

Magdalena Maria Dutsch-Wicherek1, Agnieszka Lewandowska2, Magdalena Zgliczynska2, Sebastian Szubert2, Michal Lew-Starowicz1

1Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland, 22nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Immunological dysregulation in psychiatric disorders
4. Psychiatric disorders in postpartum – epidemiology
5. Psychiatric disorders in postpartum – pathogenesis
6. Evidence of immune system dysregulation in postpartum psychiatric disorders
7. The Immune response dysregulation in pregnancy and labor complications
8. Perspectives
9. Acknowledgments
10. References

1. ABSTRACT

Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.

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Abbreviations: DSM-V: Diagnostic and Statistical Manual of Mental Disorders, ICD-10: international statistical classification of diseases and related health problems, PROM - premature rupture of membranes , PTSD: post-traumatic stress disorder, CSF: cerebro-spinal fluid, PET: positron emission tomography , MHC: Major histocompatibility complex, Tregs: regulatory T cells , SNP: single nucleotide polymorphisms , PSMB4: Proteasome subunit beta type-4, TBX21: T-box transcription factor TBX21, STAT3 -signal transducer and activator of transcription 3 , CD3E: CD3e Antigen, Epsilon Polypeptide, CXCR1: C-X-C motif chemokine receptor 1, PRKCH: Protein kinase C eta type, PSMD9: 26S proteasome non-ATPase regulatory subunit 9, Il: interleuin, INF: interferon, FAS: FasR, apoptosis antigen 1 (APO-1 or APT), HIV: human immunodeficiency virus, TGF: Transforming growth factor, TLR: toll-like receptor , CRP - C-reactive protein, OCD: obsessive-compulsive disorder , SSRI: selective serotonin-reuptake inhibitors , ABGA: anti-basal ganglia antibodies , CB-PTSD: postpartum childbirth-related post-traumatic stress disorder , HDP: hypertensive disorder of pregnancy , HELLP: hemolysis, elevated liver enzymes, and low platelet count, STAM-BP: STAM-binding protein (AMSH), ST1A1: Sulfotransferase 1A1, NMDA: N-methyl D-aspartate , PP: postpartum psychosis , HLA: Human Leukocyte Antigen, IDO: indoleamine dioxygenase , CTLA-4: cytotoxic T cell antigen 4, CD: cluster of differentiation, KIR: Killer-cell immunoglobulin-like receptor, VEGF - vascular-endothelial growth factor, MMP: metalloproteinase, APC: Antigen-presenting cells

Key Words: Immune system, Inflammation, Placenta, Pregnancy, Labor, Peripartum depression, Perinatal mental health, Postpartum psychosis, Review

Send correspondence to: Sebastian Szubert, 2nd Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland, Bielanski Hospital, Ceglowska 80 St., 01-809 Warsaw, Poland, Tel: 22-56-90-274, Fax: 22-56-90-274, E-mail: szuberts@o2.pl