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Sex-specific impact of maternal–fetal risk factors on depression and cardiovascular risk 40 years later

Published online by Cambridge University Press:  04 November 2011

J. M. Goldstein ,
S. Cherkerzian ,
S. L. Buka ,
G. Fitzmaurice ,
M. Hornig ,
M. Gillman ,
S. O'Toole  and
R. P. Sloan
J. M. Goldstein*
Affiliation:
Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA Division of Psychiatric Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
S. Cherkerzian
Affiliation:
Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA
S. L. Buka
Affiliation:
Department of Epidemiology, Brown University, Providence, RI, USA
G. Fitzmaurice
Affiliation:
Department of Psychiatry, Harvard Medical School at McLean Hospital, Belmont, MA, USA
M. Hornig
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
M. Gillman
Affiliation:
Department of Population Health, Harvard Medical School, Harvard Pilgrim Community Health
S. O'Toole
Affiliation:
Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
R. P. Sloan
Affiliation:
Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
*
*Address for correspondence: Dr J. M. Goldstein, Division of Women's Health, Brigham and Women's Hospital, One Brigham Circle, 3rd Floor, 1620 Tremont St., Boston, MA 02120, USA. (Email [email protected])
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Abstract

Major depressive disorder (MDD) and cardiovascular disease (CVD) represent leading causes of morbidity and mortality worldwide. We tested the hypothesis that growth restriction and preeclampsia (referred to as fetal risk) are significant predictors of these conditions, with women at higher risk in adulthood. Adult offspring exposed to fetal risk factors and their discordant siblings were from two prenatal cohorts, whose mothers were followed through pregnancy and whom we recruited as adults 40 years later (n = 538; 250 males and 288 females). Subjects were psychiatrically diagnosed and underwent a stress challenge during which parasympathetic regulation was assessed by electrocardiogram, operationalized as high-frequency R-R interval variability (HF-RRV). Linear mixed models and generalized estimating equations were used to examine the relationship of fetal risk on HF-RRV, MDD and comorbidity of low HF-RRV (lowest 25th percentile) and MDD, including interactions with sex and socioeconomic status (SES). Fetal risk was significantly associated with low HF-RRV response (F = 3.64, P = 0.05), particularly among low SES (interaction: F = 4.31, P < 0.04). When stratified by MDD, the fetal risk impact was three times greater among MDD compared with non-MDD subjects (effect size: 0.21 v. 0.06). Females had a significantly higher risk for the comorbidity of MDD and low HF-RRV than males (relative risk (RR) = 1.36, 95% CI: 1.07–1.73), an association only seen among those exposed to fetal risk (RR = 1.38, 95% CI: 1.04–1.83). Findings suggest that these are shared fetal antecedents to the comorbidity of MDD and CVD risk 40 years later, an association stronger in females than in males.

Keywords

autonomic nervous systemcardiovascular diseasedepressionfetal programmingfetal risksex differences
Type
Original Articles
Information
Journal of Developmental Origins of Health and Disease , Volume 2 , Special Issue 6: The Early Determinants of Adult Health Study , December 2011 , pp. 353 - 364
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2011

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