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1.  Vitamin D levels and perinatal depressive symptoms in women at risk: a secondary analysis of the mothers, omega-3, and mental health study 
Vitamin D insufficiency may be associated with depressive symptoms in non-pregnant adults. We performed this study to evaluate whether low maternal vitamin D levels are associated with depressive symptoms in pregnancy.
This study was a secondary analysis of a randomized trial designed to assess whether prenatal omega-3 fatty acid supplementation would prevent depressive symptoms. Pregnant women from Michigan who were at risk for depression based on Edinburgh Postnatal Depression Scale Score or history of depression were enrolled. Participants completed the Beck Depression Inventory (BDI) and Mini International Neuropsychiatric Interview at 12–20 weeks, 26–28 weeks, 34–36 weeks, and 6–8 weeks postpartum. Vitamin D levels were measured at 12–20 weeks (N = 117) and 34–36 weeks (N = 112). Complete datasets were available on 105 subjects. Using regression analyses, we evaluated the relationship between vitamin D levels with BDI scores as well as with MINI diagnoses of major depressive disorder and generalized anxiety disorder. Our primary outcome measure was the association of maternal vitamin D levels with BDI scores during early and late pregnancy and postpartum.
We found that vitamin D levels at 12–20 weeks were inversely associated with BDI scores both at 12—20 and at 34–36 weeks’ gestation (P < 0.05, both). For every one unit increase in vitamin D in early pregnancy, the average decrease in the mean BDI score was .14 units. Vitamin D levels were not associated with diagnoses of major depressive disorder or generalized anxiety disorder.
In women at risk for depression, early pregnancy low vitamin D levels are associated with higher depressive symptom scores in early and late pregnancy. Future investigations should study whether vitamin D supplementation in early pregnancy may prevent perinatal depressive symptoms.
Trial registration Registration Number: NCT00711971
PMCID: PMC4971719  PMID: 27485050
Depression; Pregnancy; Vitamin D
2.  Total Serum Fatty Acid Analysis by GC-MS: Assay Validation and Serum Sample Stability 
Current pharmaceutical analysis  2013;9(4):331-339.
Analysis of n3 fatty acids in serum samples has clinical applications in supplementation trials, but the analysis can be challenging due to low levels, stability issues and intra-individual variation. This study presents the single laboratory validation of a gas chromatographic-mass spectral (GC-MS) assay for analysis of fatty acid methyl esters (FAME) using sensitive single ion monitoring and provides data on fatty acid stability under different sample handling conditions. Recovery of total fatty acids from serum with Folch extraction was optimized and parallelism tests with spiked samples indicated that the serum matrix did not interfere with mass spectral quantitation. Precision and accuracy of the assay at the lowest limit of quantitation and at low, medium and high levels met with accepted guidelines for single laboratory validation. Several storage conditions that can be encountered with clinical samples also were evaluated for impact on fatty acid levels in serum. Serum from blood that was stored refrigerated for 3 days yielded similar results as serum that was prepared and frozen at −80°C immediately. Serum storage at room temperature for 3–24 hours and serum subjected to one freeze/thaw cycle had minimal effects on fatty acid levels. The intra-individual variability in pregnant women was reasonably small, with significant correlation coefficients ranging from 0.35 to 0.76 for blood drawn between 12–20 weeks versus 34–36 weeks of gestation. These results indicate that GC-MS with single ion monitoring is valid for the analysis of total fatty acids in clinical samples, even when blood processing cannot be performed in a timely manner.
PMCID: PMC4123757  PMID: 25110470
Fatty acids; fatty acid methyl esters; GC-MS; fish oils; pregnancy; blood levels
3.  The Mothers, Omega-3, and Mental Health Study: a double-blind, randomized controlled trial 
Maternal deficiency of the omega-3 fatty acid, docosahexaenoic acid (DHA), has been associated with perinatal depression, but there is evidence that supplementation with eicosapentaenoic acid (EPA) may be more effective than DHA in treating depressive symptoms. This trial tested the relative effects of EPA- and DHA-rich fish oils on prevention of depressive symptoms among pregnant women at an increased risk of depression.
We enrolled 126 pregnant women at risk for depression (Edinburgh Postnatal Depression Scale score 9–19 or a history of depression) in early pregnancy and randomly assigned them to receive EPA-rich fish oil (1060 mg EPA plus 274 mg DHA), DHA-rich fish oil (900 mg DHA plus 180 mg EPA), or soy oil placebo. Subjects completed the Beck Depression Inventory (BDI) and Mini-International Neuropsychiatric Interview at enrollment, 26–28 weeks, 34–36 weeks, and at 6–8 weeks’ postpartum. Serum fatty acids were analyzed at entry and at 34–36 weeks’ gestation.
One hundred eighteen women completed the trial. There were no differences between groups in BDI scores or other depression endpoints at any of the 3 time points after supplementation. The EPA-and DHA-rich fish oil groups exhibited significantly increased post-supplementation concentrations of serum EPA and serum DHA respectively. Serum DHA- concentrations at 34–36 weeks were inversely related to BDI scores in late pregnancy.
EPA-rich fish oil and DHA-rich fish oil supplementation did not prevent depressive symptoms during pregnancy or postpartum.
PMCID: PMC4010222  PMID: 23531328
depression; docosahexaenoic acid; eicosapentaenoic acid; fish oil; supplementation
4.  Developmental programming for allergy: a secondary analysis of the Mothers, Omega-3, & Mental Health Study 
Fetal dysregulation of T helper (Th) cell pathways may predispose to allergy, as high cord blood Th2/Th1 ratios have been shown to precede development of allergic diseases. We aimed to determine whether prenatal eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation reduces Th2 to Th1-associated chemokine ratios. We also explored the effect of mode of delivery on Th2/Th1 ratios.
Study design
We conducted a secondary analysis of a randomized placebo controlled trial initially performed to assess the effects of DHA or EPA supplementation on pregnancy-related depressive symptoms among 126 participants. Cord plasma specimens from 98 newborns were assayed for chemokines associated with Th2 [TARC (CCL17), MDC (CCL22), Eotaxin (CCL 11)] and Th1 [IP10 (CXCL 10)] by ELISA and Multiplex immunoassays. Ratios of log-transformed chemokines MDC/IP10 and TARC/IP10 were compared between groups by ANOVA. Multiple linear regression was performed to examine associations between treatments and chemokine ratios, adjusting for covariates.
After adjusting for gestational age at delivery, birth weight and mode of delivery, both omega-3 supplementation groups were associated with lower MDC/IP10 ratios than placebo [EPA: coefficient −1.8 (95% CI −3.6, −0.05), p=0.04; DHA: −2.0 (95% CI −3.9, −0.07), p=0.04]. Similar associations were found for TARC/IP10 [EPA: −1.5 (95% CI −3.0 0.06), p=0.06; DHA −2.2 (95% CI −3.8,−0.52), p=0.01]. Cesarean delivery was associated with higher MDC/IP10 [1.6 (95% CI 0.01, 3.3), p=0.049] and TARC/IP10 [1.5, (95%CI 0.1, 2.9), p=0.042] ratios than vaginal delivery.
Prenatal supplementation with EPA and DHA resulted in decreased cord blood Th2/Th1 chemokine ratios. Cesarean delivery was associated with a pronounced Th2 deviation at birth.
PMCID: PMC3610088  PMID: 23531329
fetal; programming; chemokines; allergy; omega-3
5.  Sex Differences in Subclinical Atherosclerosis by Race/Ethnicity in the Multi-Ethnic Study of Atherosclerosis 
American Journal of Epidemiology  2011;174(2):165-172.
Sex differences in cardiovascular disease mortality are more pronounced among non-Hispanic whites than other racial/ethnic groups, but it is unknown whether this variation is present in the earlier subclinical stages of disease. The authors examined racial/ethnic variation in sex differences in coronary artery calcification (CAC) and carotid intimal media thickness at baseline in 2000–2002 among participants (n = 6,726) in the Multi-Ethnic Study of Atherosclerosis using binomial and linear regression. Models adjusted for risk factors in several stages: age, traditional cardiovascular disease risk factors, behavioral risk factors, psychosocial factors, and adult socioeconomic position. Women had a lower prevalence of any CAC and smaller amounts of CAC when present than men in all racial/ethnic groups. Sex differences in the prevalence of CAC were more pronounced in non-Hispanic whites than in African Americans and Chinese Americans after adjustment for traditional cardiovascular disease risk factors, and further adjustment for behavioral factors, psychosocial factors, and socioeconomic position did not modify these results (for race/sex, Pinteraction = 0.047). Similar patterns were observed for amount of CAC among adults with CAC. Racial/ethnic variation in sex differences for carotid intimal media thickness was less pronounced. In conclusion, coronary artery calcification is differentially patterned by sex across racial/ethnic groups.
PMCID: PMC3167681  PMID: 21685409
calcification, physiologic; continental population groups; coronary vessels; sex; social class

Results 1-5 (5)