Childhood trauma, emotions, and the eating disorder voice.

Perinatal depression is a significant public health concern and is marked by symptoms such as persistent sadness, restlessness and impaired concentration during pregnancy and in the first months after childbirth [–]. Global estimates suggest that 10–20% of women experience perinatal depression [, ], with approximately 17% of women experiencing symptoms during pregnancy. Among those with prenatal symptoms, approximately 39% of women subsequently develop postpartum depression []. Certain populations face disproportionate risk, with U.S. Hispanic/Latina women experiencing additional vulnerabilities including limited access to mental health services, limited Spanish-speaking mental health care providers, and acculturative stress among immigrant populations [–]. Given this substantial burden and disparities in risk, identifying modifiable factors for prenatal depression represents an urgent priority, particularly among these vulnerable subgroups. Emerging epidemiological and mechanistic evidence implicates ambient air pollution exposure during preconception and early pregnancy as a potential risk factor for prenatal depression. A retrospective cohort of more than 200,000 pregnant women from 19 hospitals across the US showed that preconception and first trimester exposure to ambient pollutants, including nitrogen dioxide (NO) and particulate matter, were associated with increased odds of maternal depression during pregnancy []. A study based in the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) of over 3700 pregnant women further demonstrated that first-trimester particulate matter with aerodynamic diameter less than 2.5 μm (PM) exposure was associated with a 25% increased risk of late-pregnancy depression []. Mechanistically, studies suggest that prenatal exposure to air pollution may contribute to depressive symptoms through activation of the hypothalamic–pituitary–adrenal (HPA) axis, as evidenced by elevated cortisol levels—a pathway linked to stress response and mood dysregulation []. Emerging evidence suggests that the HPA axis undergoes hormonal regulations throughout the menstrual period and early pregnancy [], thus, environmental exposures, including air pollution, during these periods may increase a women’s susceptibility to developing prenatal depression. While existing studies provide important evidence linking air pollution to prenatal depression, primarily examined at a single time point, they overlooked the dynamic nature of depressive symptoms throughout pregnancy. Emerging evidence suggests that the course of maternal depressive symptoms throughout pregnancy exhibit considerable heterogeneity, characterized by diverse patterns of onset, progression, duration, and severity [–], which potentially reflect different underlying etiologies and environmental vulnerabilities []. Environmental exposures like air pollution may differentially affect specific trajectory patterns depending on timing and critical exposure windows, revealing more nuanced relationships than cross-sectional analyses are able to discern. Recent advances in trajectory analysis, such as latent class trajectory modeling (LTCM) methods, allow investigation of patterns of depressive symptoms throughout the perinatal period and thus identify factors that may predict these patterns [].