THE ASSOCIATION OF PLASMINOGEN ACTIVATOR INHIBITOR-1 AND ANTEPARTUM DEPRESSIVE SYMPTOMS: CONSEQUENCES FOR CARDIOVASCULAR HEALTH

Abstract

Major Depressive Disorder (MDD) is one of the most common psychiatric conditions affecting adults and afflicts approximately 5% of the world's population. MDD is highly co-morbid with cardiovascular disease, a major source of morbidity and mortality. Although a number of pathological changes observed in MDD may impact cardiovascular health, no single mechanism has been identified that can explain this association. Both MDD and CVD are more common in women, and pregnancy may represent a period of elevated risk for both depression and changes in cardiovascular health that may never fully resolve in the years following pregnancy. This study of 61 pregnant women during their third trimester of pregnancy investigated whether depressive symptoms (as measured by the Edinburgh Postnatal Depression Scale, or EPDS) are associated with decreased heart rate variability, a well-known marker of cardiovascular risk. Additionally, this study will investigate whether Plasminogen Activator Inhibitor-1 and 2 (PAI-1 and PAI-2) mediate this association. These pro-thrombotic proteins have long been linked to the presence and severity of cardiovascular disease, and an emerging body of evidence suggests that plasma concentrations of these proteins may also be elevated in Major Depressive Disorder. Heart rate variability was significantly reduced among participants who had clinically significant depressive symptoms during the third trimester (EPDS >14), although adjustment for age, body mass index, smoking, education level and use of psychiatric medication fully attenuated this relationship. PAI-1 and PAI-2 measured via ELISA assay in a subset of the study population (n=23) was found to not mediate this association. This study is the first of its kind to evaluate the role of PAI-1 in psychiatric illness during pregnancy, and may serve as the impetus for further research aimed at elucidating the relationship between mental health and cardiovascular risk during gestation.