| BACKGROUNDPostpartum depression(PPD)not only affects maternal breastfeeding attitudes and behaviors,but also causes dysfunction of maternal hypothalamic-pituitaryadrenal axis,inhibition of prolactin release,delay of lactation,and decrease of milk yield,leading to changes in the compositions and concentrations of human milk.Human milk is rich in macronutrients,micronutrients,and cytokines.Transforming growth factor-β(TGF-β)is one of the most abundant cytokines in breast milk,which is of great significance for the improvement of immune function and the repair of damaged tissues of infants.However,there is a sparse in the literature on the association between PPD and human milk compositions and concentrations,and no study has been conducted on the association between PPD and the concentrations of TGF-β in human colostrum.OBJECTIVES1.To summarize the evidence on the association between PPD and human milk compositions and concentrations by a systematic review and meta-analysis.2.To assess the associations between PPD and concentrations of different isoforms of TGF-β in human colostrum by a nested cohort study.METHODS1.The systematic review and meta-analysis:Six English and Chinese databases including CINAHL,Embase,PubMed,PsycINFO,CNKI,and Wanfang,were searched from inception to November 30,2021 to collect relevant studies on PPD and human milk compositions and their concentrations.Literature screening,quality assessment and data extraction were independently conducted by two reviewers based on inclusion and exclusion criteria,and meta-analysis was performed using RevMan 5.3 software.2.The nested cohort study:Women were recruited strictly based on inclusion and exclusion criteria in a tertiary general hospital in Guangdong province between December 2020 and September 2021.The Edinburgh Postnatal Depression Scale(EPDS)was used to screen women in the afternoon of the second day following childbirth,with a score of 10 or higher as the cut-off for PPD.Women with PPD were matched with women without PPD in a ratio of 1:1 on maternal age(within five years)and mode of delivery(same).Colostrum samples were collected in the morning of the third day after childbirth.TGF-β concentrations were measured using enzyme-linked immunosorbent assay.Statistical significances between two groups were calculated using t-test or Mann-Whitney U test.Spearman correlation analysis was performed to assess the associations between EPDS scores and TGF-β concentrations.RESULTS1.The systematic review and meta-analysis:Nine studies with a total of 832 women were included in this systematic review.The eligible studies in this review contained the concentrations of fatty acids,TGF-β2 and other compositions in transitional and mature milk of depressed women and non-depressed women.No study has assessed the association between PPD and concentrations of TGF-β in human colostrum,however.Meta-analysis showed that the concentration of TGF-β2 in mature milk of depressed women was significantly higher than that of nondepressed women[mean difference(MD)=250.40,95%confidence interval(CI):14.98-485.83,P=0.04].2.The nested cohort study:A total of 90 women were enrolled and included in the final analysis.The concentrations of TGF-β1,TGF-β2 and TGF-β3 were 684.03(321.22,859.25)pg/mL,(5 116.50±1 747.04)pg/mL and(147.84±48.68)pg/mL in women with PPD,respectively.Corresponding figures in women without PPD were 745.67(596.00,964.22)pg/mL,(4 912.40±1 516.80)pg/mL,and(168.21 ±48.15)pg/mL,respectively.Compared with women without PPD,the concentrations of TGF-β1(P=0.026)and TGF-β3(P=0.049)decreased significantly in women with PPD,and the EPDS scores were negatively associated with the concentrations of TGF-β1(r=-0.23,P=0.03)and TGF-β3(r=-0.25,P=0.02)in colostrum.CONCLUSIONS1.We discovered that the concentration of TGF-β2 in mature milk of depressed women was significantly higher than that of non-depressed women through the systematic review of original studies by searching six English and Chinese databases.However,no study on the concentrations of TGF-β in colostrum of the depressed women was found.2.We demonstrated that PPD was independently associated with significantly decreased concentrations of TGF-β1 and TGF-β3 in colostrum in the nested cohort study.3.We further revealed that there were negative associations of EPDS scores with the concentrations of TGF-β1 and TGF-β3 in women with PPD in the nested cohort study. |
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