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Høgh S, Lange EØ, Høgsted ES, Larsen K, Hegaard HK, Borgsted C, Frokjaer VG. The cortisol awakening response is blunted in healthy women early postpartum. Psychoneuroendocrinology 2024; 165:107048. [PMID: 38657341 DOI: 10.1016/j.psyneuen.2024.107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/01/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The dynamic capacity of the hypothalamic-pituitary-adrenal (HPA) axis supports healthy adaptions to stress and play a key role in maintaining mental health. Perinatal adaptations in the HPA-axis dynamics in terms of the Cortisol Awakening Response (CAR), may be involved in dysregulation of perinatal mental health. We aimed to determine if CAR and absolute evening cortisol early postpartum differed from non-perinatal women and evaluate the association between the CAR and maternal mental well-being. METHODS The CAR was computed as the area under the curve with respect to increase from baseline from serial home-sampling of saliva across 0-60 minutes from awakening. We evaluated differences in CAR and absolute evening cortisol between postpartum women (N=50, mean postpartum days: 38, SD: ±11) and non-perinatal women (N=91) in a multiple linear regression model. We also evaluated the association between CAR and maternal mental well-being in a multiple linear regression model. RESULTS We found that healthy postpartum women had a blunted CAR (p<0.001) corresponding to 84% reduction and 80% lower absolute evening cortisol (p<0.001) relative to non-perinatal healthy women. In the postpartum group, there was a trend-level association between lower CAR and higher scores on the WHO Well-Being Index (WHO-5) (p=0.048) and lower Edinburgh Postnatal Depression Scale (EPDS) scores (p=0.04). CONCLUSION Our data emphasize the unique hormonal landscape during the postpartum period in terms of blunted CAR and lower absolute evening cortisol in healthy women early postpartum compared to non-perinatal. Our findings show a potential association between a reduced CAR and improved mental well-being during early motherhood, which suggests that reduced CAR might reflect healthy adjustment to early motherhood.
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Affiliation(s)
- Stinne Høgh
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emilie Ø Lange
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emma S Høgsted
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Larsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Hanne K Hegaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Camilla Borgsted
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Denmark.
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Amiel Castro RT, Pinard Anderman C, O'Connor TG, Glover V, Kammerer M. Maternal and paternal postpartum early mood and bonding. J Reprod Infant Psychol 2024; 42:741-752. [PMID: 36593232 DOI: 10.1080/02646838.2022.2159351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Whereas the maternal 'blues' has been widely researched, comparatively less is known about the "highs" following childbirth, and the relation between mothers and fathers' mood in this early period. We aimed to investigate the association between maternal 'blues' and 'highs' with paternal postpartum mood (here described as 'lows' and 'highs') in the early postpartum and their associations with the quality of child bonding. METHODS Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data. RESULTS The 'blues' scores were higher in mothers, whereas 'highs' and bonding were higher in fathers. Maternal 'blues' were significantly correlated with paternal 'lows' (rs = .23, p < .05) and maternal 'highs' were also associated with paternal 'highs' (rs = .22, p < .05). Parental 'highs' were significantly associated with better baby bonding (B = .13, p = .02). CONCLUSIONS Our study demonstrates moderate associations between both 'blues/lows' and 'highs' in mothers and fathers shortly after the birth of the child. Associations between mood, particularly 'highs', and bonding were similar for mothers and fathers. Greater consideration of 'blues/lows' and 'highs' in both parents is needed to promote adjustment in the postpartum period.
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Affiliation(s)
- Rita T Amiel Castro
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Claudia Pinard Anderman
- Department of Applied Psychology, Zurich University of Applied Sciences, ZHAW, Zürich, Switzerland
| | - Thomas G O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Vivette Glover
- Imperial College London, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction Hammersmith Hospital Campus, London, UK
| | - Martin Kammerer
- Imperial College London, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction Hammersmith Hospital Campus, London, UK
- Outpatient Service, Alpine Health AG, Altendorf, Switzerland
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Weiss SJ, Xu L. Postpartum symptoms of anxiety, depression and stress: differential relationships to women's cortisol profiles. Arch Womens Ment Health 2024; 27:435-445. [PMID: 38214755 PMCID: PMC11116185 DOI: 10.1007/s00737-024-01421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE Women are at high risk of stress, anxiety, and depression during the postpartum but the ways in which these different types of psychological distress are related to cortisol regulation is not clear. We examined the distinct association of each type of distress with women's average cortisol level, cortisol awakening response (CAR), cortisol decline across the day (diurnal slope), and overall amount of cortisol secretion across the day (AUCG). METHODS At 6 months postpartum, a diverse group of 58 women completed measures of depression, anxiety, perceived stress, and life stressors. Each woman provided 4 salivary samples for cortisol assay from waking to bedtime on each of 2 consecutive days. Linear regressions were used to examine associations of stress, anxiety and depression to each of the 4 cortisol measures, controlling for number of stressful life events. RESULTS Depressive symptoms were associated with less of a rise in the CAR (β = -.46, p = 0.01), steeper diurnal slope (β = .51, p = 0.006), and higher average cortisol level (β = .42, p = .01). Women who met the clinical cutoff for an anxiety disorder had lower overall cortisol output (β = -.29, p = 0.03). Stress was not related to any cortisol metric. CONCLUSIONS Findings suggest that stress is less associated with cortisol alterations in the postpartum than are more severe types of psychological distress. Anxiety and depression may have distinct and opposite profiles of cortisol dysregulation. Results indicate that mental health assessment is critical even in the later postpartum so that interventions can be initiated to reduce emotional suffering and the risk of impaired cortisol regulation.
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Affiliation(s)
- Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco, CA, USA.
| | - Ling Xu
- Department of Community Health Systems, University of California, San Francisco, CA, USA
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Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
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Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
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Hantsoo L, Jagodnik KM, Novick AM, Baweja R, di Scalea TL, Ozerdem A, McGlade EC, Simeonova DI, Dekel S, Kornfield SL, Nazareth M, Weiss SJ. The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions. Front Endocrinol (Lausanne) 2023; 14:1295261. [PMID: 38149098 PMCID: PMC10750128 DOI: 10.3389/fendo.2023.1295261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023] Open
Abstract
The aim of this narrative review is to consolidate knowledge on the role of the hypothalamic-pituitary-adrenal (HPA) axis in depression pathophysiology at different reproductive stages across the female lifespan. Despite growing evidence about the impact of gonadal hormones on mood disorders, no previous review has examined the interaction between such hormonal changes and the HPA axis within the context of depressive disorders in women. We will focus on HPA axis function in depressive disorders at different reproductive stages including the menstrual cycle (e.g., premenstrual dysphoric disorder [PMDD]), perinatally (e.g., postpartum depression), and in perimenopausal depression. Each of these reproductive stages is characterized by vast physiological changes and presents major neuroendocrine reorganization. The HPA axis is one of the main targets of such functional alterations, and with its key role in stress response, it is an etiological factor in vulnerable windows for depression across the female lifespan. We begin with an overview of the HPA axis and a brief summary of techniques for measuring HPA axis parameters. We then describe the hormonal milieu of each of these key reproductive stages, and integrate information about HPA axis function in depression across these reproductive stages, describing similarities and differences. The role of a history of stress and trauma exposure as a contributor to female depression in the context of HPA axis involvement across the reproductive stages is also presented. This review advances the pursuit of understanding common biological mechanisms across depressive disorders among women. Our overarching goal is to identify unmet needs in characterizing stress-related markers of depression in women in the context of hormonal changes across the lifespan, and to support future research in women's mental health as it pertains to pathophysiology, early diagnosis, and treatment targets.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathleen M. Jagodnik
- Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - Andrew M. Novick
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ritika Baweja
- Department of Psychiatry and Behavioral Health, Penn State Health, Hershey, PA, United States
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, PA, United States
| | - Teresa Lanza di Scalea
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, United States
- Department of Women’s Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Erin C. McGlade
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake, UT, United States
- Department of Veterans Affairs, Mental Illness Research, Education, and Clinical Center (MIRECC), Salt Lake, UT, United States
| | - Diana I. Simeonova
- Department of Psychiatry and Behavioral Sciences, Brain Health Center, Emory University School of Medicine, Atlanta, GA, United States
- Goizueta Business School, Emory University, Atlanta, GA, United States
| | - Sharon Dekel
- Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - Sara L. Kornfield
- Center for Women’s Behavioral Wellness, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle Nazareth
- Department of Neuroscience, The Johns Hopkins University, Baltimore, MD, United States
| | - Sandra J. Weiss
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
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Howland MA. Recalibration of the stress response system over adult development: Is there a perinatal recalibration period? Dev Psychopathol 2023; 35:2315-2337. [PMID: 37641984 PMCID: PMC10901284 DOI: 10.1017/s0954579423000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.
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Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Mlili NE, Ahabrach H, Cauli O. Hair Cortisol Concentration as a Biomarker of Symptoms of Depression in the Perinatal Period. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:71-83. [PMID: 35297354 DOI: 10.2174/1871527321666220316122605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Abstract
Pregnancy is a sensitive period when women experience major hormonal and psychological changes. A high prevalence of the symptoms of depression and manifested major depression rates have been reported during this period, leading to negative outcomes both for mothers and the offspring. Despite its prevalence, the aetiology of depression is not yet fully understood. Nonetheless, alterations in cortisol levels have been proposed as a reliable biomarker to identify pregnant women at risk of perinatal depression. Hair cortisol has recently been extensively used in bio-psychological studies as a suitable non-invasive biomarker for several neuropsychiatric disorders. Various studies have published evidence regarding the relationship between cortisol fluctuations during the perinatal period, measured both in hair and in other substrates, and the onset of perinatal symptoms of depression. This current review provides an overview of cortisol level changes measured in women's hair during pregnancy or the postpartum period and its association with perinatal symptoms of depression. Further studies, including repetitive measurement of both hair cortisol and depression throughout the prenatal period, must be performed to clarify the relationship between cortisol levels and perinatal symptoms of depression.
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Affiliation(s)
- Nisrin El Mlili
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Hanan Ahabrach
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia 46010, Spain
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, Valencia 46010, Spain
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Oftedal A, Bekkhus M, Haugen G, Braithwaite E, Bollerslev J, Godang K, Thorsby PM, Kaasen A. Changes in maternal cortisol, cortisol binding globulin and cortisone levels following diagnosis of fetal anomaly. Psychoneuroendocrinology 2022; 135:105574. [PMID: 34741978 DOI: 10.1016/j.psyneuen.2021.105574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
The diagnosis of fetal anomaly can be a major stressor to the expectant mother. Current understanding of the relationship between psychological stress and cortisol in pregnancy is limited. This study examined: (1) differences in the ratio of serum cortisol to cortisol binding globulin (SC/CBG) and cortisone levels among women with and without a diagnosis of fetal anomaly, (2) the association between self-reported stress and cortisol from mid to late pregnancy, and (3) the agreement between two different techniques for analyzing cortisol: liquid chromatography-tandem mass spectrometry (LC-MS/MS) and radioimmunoassay (RIA). Thirty-six pregnant women with a diagnosis of fetal anomaly (study group) and 101 women with healthy pregnancies (comparison group) provided blood samples and completed self-report questionnaires at gestational weeks 18-24 (T1) and 30 (T2). In the comparison group, mean SC/CBG increased from 0.341 nmol/L at T1 to 0.415 at T2 (p < .001), whereas in the study group there was no change (0.342 nmol/L at T1, 0.343 at T2). There was no difference in cortisone levels between the groups at either timepoints. There was a negative association between both depression and traumatic stress at T1, and SC/CBG at T2 (p < .05). There was no association between general distress and SC/CBG. The two methods for analyzing cortisol gave similar results, but with LC-MS/MS showing a lower detection limit than RIA. Increased cortisol with advancing gestational age is expected, thus these findings indicate that under certain conditions of severe stress there may be a suppression of maternal cortisol increase from mid to late gestation. The discrepancy does not seem to be due to differences in the metabolization of cortisol, as indicated by the similar levels of cortisone. Further research is needed in order to understand the potential underlying mechanisms limiting the expression of cortisol in response to certain types of stress in pregnancy.
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Affiliation(s)
- Aurora Oftedal
- Oslo Metropolitan University, Faculty of Health Sciences, Norway.
| | - Mona Bekkhus
- Promenta Research Center, Department of Psychology, University of Oslo, Norway
| | - Guttorm Haugen
- Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; University of Oslo, Institute of Clinical Medicine, Norway
| | | | - Jens Bollerslev
- University of Oslo, Institute of Clinical Medicine, Norway; Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Per M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Biochemical Endocrinology And Metabolism Research Group, Oslo University Hospital, Aker, Oslo, Norway
| | - Anne Kaasen
- Oslo Metropolitan University, Faculty of Health Sciences, Norway
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Medina J, De Guzman RM, Workman JL. Lactation is not required for maintaining maternal care and active coping responses in chronically stressed postpartum rats: Interactions between nursing demand and chronic variable stress. Horm Behav 2021; 136:105035. [PMID: 34488064 DOI: 10.1016/j.yhbeh.2021.105035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/11/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
Women who do not breastfeed or discontinue breastfeeding early are more likely to develop postpartum depression (PPD) and stress is a significant risk factor for depression, including PPD. Using a rat model, we investigated whether the absence of nursing would increase the susceptibility to chronic stress-related behavioral and neural changes during the postpartum period. Adult female rats underwent thelectomy (thel; removal of teats), sham surgery, or no surgery (control) and were paired with males for breeding. All litters were rotated twice daily until postpartum day (PD) 26. Sham rats served as surrogates for thel litters, yielding a higher nursing demand for sham rats. Concurrently, rats received either no stress or chronic variable stress until PD 25. Rats were observed for maternal behaviors and tested in a series of tasks including open field, sucrose preference, and forced swim. We used immunohistochemistry (IHC) for doublecortin (DCX; to label immature neurons) or for mineralocorticoid receptor (MR). Contrary to our expectations, non-nursing thel rats were resistant to the effects of stress in all dependent measures. Our data indicate that even in chronic adverse conditions, nursing is not required for maintaining stable care to offspring or active coping responses in an acutely stressful task. We discuss the possible role of offspring contact and consider future directions for biomedical and clinical research. In rats with high nursing demand, however, chronic stress increased immobility, hippocampal neurogenesis, and MR expression (largely in opposition to the effects of stress in rats with typical nursing demand). We discuss these patterns in the context of energetics and allostatic load. This research highlights the complexity in relationships between stress, nursing, and neurobehavioral outcomes in the postpartum period and underscores the need for additional biomedical and clinical research geared toward optimizing treatments and interventions for women with PPD, regardless of breastfeeding status. SIGNIFICANCE STATEMENT: The goal of this research was to determine how the absence of nursing and higher nursing demand impact stress-coping behaviors and neural changes associated with chronic stress in order to disentangle the complex interplay of factors that contribute to psychological illness during the postpartum period.
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Affiliation(s)
- Joanna Medina
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America
| | - Rose M De Guzman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America
| | - Joanna L Workman
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America; Center for Neuroscience Research, University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, United States of America.
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10
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Figueiredo B, Pinto TM, Costa R. Exclusive Breastfeeding Moderates the Association Between Prenatal and Postpartum Depression. J Hum Lact 2021; 37:784-794. [PMID: 33571030 DOI: 10.1177/0890334421991051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exclusive breastfeeding has a wide range of benefits for maternal health. However, the benefit of exclusive breastfeeding for maternal mental health needs to be further explored. RESEARCH AIM To determine the moderating role of exclusive breastfeeding at 3 months on the association between prenatal and postpartum depression. METHODS This study had a prospective, longitudinal, and comparative design with two groups and three assessment waves. The sample comprised 334 participants (70 depressed and 264 non-depressed) recruited at public health services in northern Portugal. Participants completed a measure of depression symptoms between the second and the third trimester of pregnancy and between 3 and 6 months, and a measure of breastfeeding status at 3 months. RESULTS Exclusive breastfeeding at 3 months moderated the association between prenatal and postpartum depression. Participants with prenatal depression who were exclusively breastfeeding at 3 months showed fewer symptoms of depression and lower rates of depression between 3 and 6 months postpartum, compared to participants with prenatal depression who were not exclusively breastfeeding. Participants without prenatal depression who were exclusively breastfeeding at 3 months showed similar depression symptoms and similar rates of depression between 3 and 6 months postpartum, compared to participants without prenatal depression who were not exclusively breastfeeding. CONCLUSION Exclusive breastfeeding has a potential protective influence on postpartum depression among women with prenatal depression. Public health policies targeting women with prenatal depression should be implemented and include practices to promote and support exclusive breastfeeding in order to enhance women's exclusive breastfeeding and mental health.
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Affiliation(s)
- Bárbara Figueiredo
- 56059 School of Psychology, University of Minho, Campus of Gualtar, Braga, Portugal
| | - Tiago Miguel Pinto
- 56059 School of Psychology, University of Minho, Campus of Gualtar, Braga, Portugal
| | - Raquel Costa
- 26706 EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Universidade Europeia, Lisboa, Portugal
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Romijn M, van Tilburg LJL, Hollanders JJ, van der Voorn B, de Goede P, Dolman KM, Heijboer AC, Broekman BFP, Rotteveel J, Finken MJJ. The Association between Maternal Stress and Glucocorticoid Rhythmicity in Human Milk. Nutrients 2021; 13:nu13051608. [PMID: 34064929 PMCID: PMC8151700 DOI: 10.3390/nu13051608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic stress is often accompanied by alterations in the diurnal rhythm of hypothalamus–pituitary–adrenal activity. However, there are limited data on the diurnal rhythmicity of breast milk glucocorticoids (GCs) among women with psychological distress. We compared mothers who sought consultation at an expertise center for pregnant women with an increased risk of psychological distress with control mothers for GC diurnal rhythmicity in milk and saliva obtained at the same time. Methods: We included 19 mothers who sought consultation at the psychiatry–obstetric–pediatric (POP) outpatient clinic and 44 control mothers. One month postpartum, mothers collected on average eight paired milk and saliva samples during a 24 h period. GC levels were measured using liquid chromatography–tandem mass spectrometry. GC rhythmicity parameters were determined with specialized software. Results: For both milk and saliva, no group differences regarding GC rhythms were found. Milk cortisol area under the curve with respect to the ground was lower in the POP group than in the control group (p = 0.02). GC levels in human milk and saliva were highly correlated within each group (p < 0.001). Conclusion: Although there were no differences between groups in GC rhythmicity, the total amount of milk cortisol was lower in the POP group. Long-term follow-up is needed to address the impact of vertical transmission of breast milk GCs.
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Affiliation(s)
- Michelle Romijn
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)20-444-3137
| | - Luca J. L. van Tilburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Jonneke J. Hollanders
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Bibian van der Voorn
- Department of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands;
| | - Paul de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, 1105 AZ Amsterdam, The Netherlands;
| | - Koert M. Dolman
- Department of Pediatrics, Onze Lieve Vrouwe Gasthuis (OLVG), 1006 AE Amsterdam, The Netherlands;
| | - Annemieke C. Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Birit F. P. Broekman
- Department of Psychiatry, VU University Medical Centre, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
| | - Martijn J. J. Finken
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands; (L.J.L.v.T.); (J.J.H.); (J.R.); (M.J.J.F.)
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
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12
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Conde A, Costa R, Figueiredo B. Anxiety and depressive symptoms effects on cortisol trajectories from pregnancy to postpartum: Differences and similarities between women and men. Horm Behav 2021; 128:104917. [PMID: 33387466 DOI: 10.1016/j.yhbeh.2020.104917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023]
Abstract
Anxiety and depressive symptoms may influence cortisol trajectories in women and men during pregnancy and the postpartum period. Using a multilevel approach, anxiety and depressive symptoms effects on 24-hour urinary free cortisol trajectories from the 2nd trimester to 3-months postpartum were examined in a sample of 66 women and 65 men with no known psychosocial or medical risk (N = 131; 33 (50%) of them were couples that participated in the same assessment waves). Results showed that both anxiety and depressive symptoms influence women's and men's cortisol trajectories from mid-pregnancy to 3-months postpartum. Women with high depressive symptoms and men with high anxiety or high depressive symptoms exhibited less accentuated variations in the 24-hour urinary free cortisol trajectories compared with women with low depressive symptoms and men with low anxiety or depressive symptoms, respectively. These effects were significant for women's cortisol trajectories from the 2nd to the 3rd pregnancy trimester and for men's cortisol trajectories throughout the entire period. The effect of anxiety and depressive symptoms on HPA axis functioning and cortisol production during pregnancy and postpartum, seems to be sex-specific. Reproductive-related alterations (associated with gestation, parturition and lactation) in women's HPA axis functioning may explain these sex-specific effects.
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Affiliation(s)
- Ana Conde
- INPP - Portucalense Institute for Human Development, Portucalense University, Porto, Portugal; Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal.
| | - Raquel Costa
- Universidade Europeia, Lisboa, Portugal; EPIUnit, ISPUP - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Bárbara Figueiredo
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
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Qiu W, Hodges TE, Clark EL, Blankers SA, Galea LAM. Perinatal depression: Heterogeneity of disease and in animal models. Front Neuroendocrinol 2020; 59:100854. [PMID: 32750403 DOI: 10.1016/j.yfrne.2020.100854] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Perinatal depression (PND) can have either an antepartum or postpartum onset. Although the greatest risk factor for PND is previous depression history,de novoPND occurs with the majority of cases occurring in the postpartum. Timing of depression can impact etiology, prognosis, and response to treatment. Thus, it is crucial to study the impact of the heterogeneity of PND for better health outcomes. In this review, we outline the differences between antepartum and postpartum depression onset of PND. We discuss maternal physiological changes that differ between pregnancy and postpartum and how these may differentially impact depression susceptibility. We highlight changes in the maternal steroid and peptide hormone levels, immune signalling, serotonergic tone, metabolic factors, brain morphology, and the gut microbiome. Finally, we argue that studying the heterogeneity of PND in clinical and preclinical models can lead to improved knowledge of disease etiopathology and treatment outcomes.
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Affiliation(s)
- Wansu Qiu
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Travis E Hodges
- Department of Psychology, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Emily L Clark
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Samantha A Blankers
- Graduate Program in Neuroscience, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Liisa A M Galea
- Graduate Program in Neuroscience, University of British Columbia, Canada; Department of Psychology, University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada.
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Nazzari S, Fearon P, Rice F, Ciceri F, Molteni M, Frigerio A. The biological underpinnings of perinatal depressive symptoms: A multi-systems approach. J Affect Disord 2020; 274:1004-1012. [PMID: 32663926 DOI: 10.1016/j.jad.2020.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/29/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Well-established evidence exists of an association between depressive symptoms and alterations in the stress and inflammatory response systems; however, the picture is far less coherent during the perinatal period. This study combines the assessment of multiple stress and inflammatory biomarkers in late pregnancy and after delivery in order to investigate cross-sectional and prospective associations with perinatal depressive symptoms. METHODS One-hundred-ten healthy women were assessed in late pregnancy (mean gestational age=34.76; SD=1.12) and 89 were re-evaluated after delivery (mean hours after delivery=52.36; SD=19.70) for depressive and anxiety symptoms through the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. Serum Interleukin-6 (IL-6), C-Reactive Protein (CRP) and diurnal salivary cortisol levels were measured on both occasions, while diurnal salivary alpha amylase (sAA) levels were assessed in late pregnancy. RESULTS Using Hierarchical Linear Models, higher depressive symptoms were found to be associated with higher IL-6 levels, lower morning cortisol levels and a flatter cortisol diurnal slope during pregnancy, while adjusting for potential confounders. No significant associations were found after delivery or with change in biomarker levels from pre- to post-partum. Furthermore, preliminary evidence of a positive association between inflammation and stress markers in women with higher antenatal depressive symptoms was found. LIMITATIONS The sample was relatively small and highly selected, thus limiting generalizability of the findings. CONCLUSIONS Results emphasize the need for an integrated multi-systems approach to the understanding of the biological underpinnings of perinatal depression and suggest that the stress-immune interactions represent a promising avenue for future endeavor.
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Affiliation(s)
- S Nazzari
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - P Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - F Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, United Kingdom
| | - F Ciceri
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - M Molteni
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
| | - A Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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Aparicio M, Browne PD, Hechler C, Beijers R, Rodríguez JM, de Weerth C, Fernández L. Human milk cortisol and immune factors over the first three postnatal months: Relations to maternal psychosocial distress. PLoS One 2020; 15:e0233554. [PMID: 32437424 PMCID: PMC7241837 DOI: 10.1371/journal.pone.0233554] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Many biologically active factors are present in human milk including proteins, lipids, immune factors, and hormones. The milk composition varies over time and shows large inter-individual variability. This study examined variations of human milk immune factors and cortisol concentrations in the first three months post-partum, and their potential associations with maternal psychosocial distress. Methods Seventy-seven healthy mothers with full term pregnancies were enrolled, of which 51 mothers collected morning milk samples at 2, 6 and 12 weeks post-delivery. Maternal psychosocial distress was assessed at 6 weeks post-delivery using questionnaires for stress, anxiety, and depressive symptoms. Immune factors were determined using multiplex immunoassays and included innate immunity factors (IL1β, IL6, IL12, IFNγ, TNFα), acquired immunity factors (IL2, IL4, IL10, IL13, IL17), chemokines (IL8, Groα, MCP1, MIP1β), growth factors (IL5, IL7, GCSF, GMCSF, TGFβ2) and immunoglobulins (IgA, total IgG, IgM). Cortisol was quantified using liquid chromatography-tandem mass spectrometry. A linear mixed effects model was fit to test whether stress, anxiety, and depressive symptoms individually predicted human milk cortisol concentrations after accounting for covariates. Repeated measurement analyses were used to compare women with high (n = 13) versus low psychosocial distress (n = 13) for immune factors and cortisol concentrations. Results Virtually all immune factors and cortisol, with the exception of the granulocyte-macrophage colony-stimulating factor (GMCSF), were detected in the human milk samples. The concentrations of the immune factors decreased during the first 3 months, while cortisol concentrations increased over time. No correlation was observed between any of the immune factors and cortisol. No consistent relationship between postnatal psychosocial distress and concentrations of immune factors was found, whereas higher psychosocial distress was predictive of higher cortisol concentrations in human milk. Conclusion In the current study we found no evidence for an association between natural variations in maternal distress and immune factor concentrations in milk. It is uncertain if this lack of association would also be observed in studies with larger populations, with less uniform demographic characteristics, or with women with higher (clinical) levels of anxiety, stress and/or depressive symptoms. In contrast, maternal psychosocial distress was positively related to higher milk cortisol concentrations at week 2 post-delivery. Further investigation on maternal psychosocial distress in relation to human milk composition is warranted.
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Affiliation(s)
- Marina Aparicio
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Pamela D. Browne
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christine Hechler
- Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail: (CdW); (LF)
| | - Leonides Fernández
- Departmental Section of Galenic Pharmacy and Food Technology, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
- * E-mail: (CdW); (LF)
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16
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Werner A, Wu C, Zachariae R, Nohr EA, Uldbjerg N, Hansen ÅM. Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum-A randomized controlled trial. PLoS One 2020; 15:e0230704. [PMID: 32357152 PMCID: PMC7194394 DOI: 10.1371/journal.pone.0230704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. Methods In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. Findings During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). Conclusion Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.
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Affiliation(s)
- Anette Werner
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Chunsen Wu
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Robert Zachariae
- Department of Oncology, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Denmark
- Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Ellen A. Nohr
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Niels Uldbjerg
- Department of Gynecology and Obstetrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Ng TKS, Fam J, Feng L, Cheah IKM, Tan CTY, Nur F, Wee ST, Goh LG, Chow WL, Ho RCM, Kua EH, Larbi A, Mahendran R. Mindfulness improves inflammatory biomarker levels in older adults with mild cognitive impairment: a randomized controlled trial. Transl Psychiatry 2020; 10:21. [PMID: 32066726 PMCID: PMC7026149 DOI: 10.1038/s41398-020-0696-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 10/24/2019] [Accepted: 11/20/2019] [Indexed: 12/21/2022] Open
Abstract
Few randomized controlled trials investigated the effects of mindfulness intervention on older adults diagnosed with mild cognitive impairment (MCI). Furthermore, there have been hypotheses and theoretical mechanisms on the benefits of mindfulness intervention on biomarkers of stress, inflammation, and neuroplasticity implicated in MCI that warrant empirical evidence. We conducted a pilot randomized controlled trial to examine whether Mindful Awareness Practice (MAP) improved biomarker levels in older adults with MCI. Fifty-five community-dwelling older adults aged 60 and above were randomized into either the treatment arm, MAP, or the active control arm, the health education program (HEP). Researchers who were blinded to treatment allocation assessed the outcomes at baseline, 3-month, and 9-month follow-ups. Linear-mixed models were used to examine the effect of MAP on biomarker levels. MAP participants had significantly decreased high-sensitivity c-reactive protein (hs-CRP) levels at 9-month (β = -0.307, 95% CI = -0.559 to -0.054 P = 0.018). Exploratory sub-group analyses by sex showed significantly decreased hs-CRP in females only (β = -0.445, 95% CI = -0.700 to -0.189, P = 0.001), while stratification by MCI subtype showed hs-CRP decreased only in amnestic-MCI (aMCI) (β = -0.569, 95% CI = -1.000 to -0.133, P = 0.012). Although total sample analyses were not significant, males had significantly decreased interleukin (IL)-6 (β = -1.001, 95% CI = -1.761 to -0253, P = 0.011) and IL-1β (β = -0.607, 95% CI = -1.116 to -0.100, P = 0.021) levels at 3-month and non-significant improvements at 9-month time-point. MAP improved inflammatory biomarkers in sex- and MCI subtype-specific manners. These preliminary findings suggest the potential of mindfulness intervention as a self-directed and low-cost preventive intervention in improving pathophysiology implicated in MCI.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.
| | - Johnson Fam
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore ,grid.412106.00000 0004 0621 9599Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Lei Feng
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Irwin Kee-Mun Cheah
- grid.4280.e0000 0001 2180 6431Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Crystal Tze-Ying Tan
- grid.185448.40000 0004 0637 0221Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fadzillah Nur
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Sin Tho Wee
- grid.4280.e0000 0001 2180 6431Office of the President, National University of Singapore, Singapore, Singapore
| | - Lee Gan Goh
- grid.4280.e0000 0001 2180 6431Department of Family Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chow
- grid.4280.e0000 0001 2180 6431Development Office, National University of Singapore, Singapore, Singapore
| | - Roger Chun-Man Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore ,grid.412106.00000 0004 0621 9599Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Ee Heok Kua
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore ,grid.412106.00000 0004 0621 9599Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Anis Larbi
- grid.185448.40000 0004 0637 0221Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rathi Mahendran
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, National University of Singapore, Singapore, Singapore ,grid.412106.00000 0004 0621 9599Department of Psychological Medicine, National University Hospital, Singapore, Singapore
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Allopregnanolone-based treatments for postpartum depression: Why/how do they work? Neurobiol Stress 2019; 11:100198. [PMID: 31709278 PMCID: PMC6838978 DOI: 10.1016/j.ynstr.2019.100198] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 01/01/2023] Open
Abstract
Recent FDA approval of an allopregnanolone-based treatment specifically for postpartum depression, brexanolone, now commercially called Zulresso®, is an exciting development for patients and families impacted by postpartum depression and allows us to start asking questions about why and how this compound is so effective. Allopregnanolone is a neuroactive steroid, or neurosteroid, which can be synthesized from steroid hormone precursors, such as progesterone, or synthesized de novo from cholesterol. Neurosteroids are positive allosteric modulators at GABAA receptors (GABAARs), a property which is thought to mediate the therapeutic effects of these compounds. However, the durability of effect of brexanolone in clinical trials questions the mechanism of action mediating the remarkable antidepressant effects, leading us to ask why and how does this drug work. Asking why this drug is effective may provide insight into the underlying neurobiology of postpartum depression. Exploring how this drug works will potentially elucidate a novel antidepressant mechanism of action and may provide useful information for next generation drug development. In this review, we examine the clinical and preclinical evidence supporting a role for allopregnanolone in the underlying neurobiology of postpartum depression as well as foundational evidence supporting the therapeutic effects of allopregnanolone for treatment of postpartum depression.
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Browne PD, Aparicio M, Alba C, Hechler C, Beijers R, Rodríguez JM, Fernández L, de Weerth C. Human Milk Microbiome and Maternal Postnatal Psychosocial Distress. Front Microbiol 2019; 10:2333. [PMID: 31695687 PMCID: PMC6817470 DOI: 10.3389/fmicb.2019.02333] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022] Open
Abstract
Human milk contains many bioactive components, including bacteria, which are transferred to the developing infant through breastfeeding. Milk bacteria appear to, amongst others, originate from the maternal gut. A mother’s postnatal psychosocial distress may alter maternal gut microbiota, which in turn may affect the bacteria present in milk. The aim of this study was to explore whether maternal postnatal psychosocial distress was related to alterations in the relative abundances of specific bacteria and to milk microbial diversity. Healthy mothers (N = 77; N = 51 with complete data) collected breast milk samples at 2, 6, and 12 weeks postpartum and filled in mood questionnaires on experienced stress, anxiety, and depressive symptoms at 6 weeks postpartum. A metataxonomic approach (16S rRNA gene sequencing (region V3 and V4) using Illumina MiSeq technology) was used to assess bacterial abundances and diversity. For the group as a whole, an increase in diversity of the milk bacterial community was observed during the first 3 months of breastfeeding (Shannon index). This general increase in diversity appears to be explained by an increase of Lactobacillus and other minor genera, together with a decrease in Staphylococcus. With respect to psychological distress and milk microbial composition, no significant differences in the relative abundance of major bacterial genera were detected between women with high (N = 13) and low (N = 13) psychosocial distress. However, progressive and distinct changes in the content of Firmicutes, Proteobacteria, and Bacteroidetes at the phylum level and Acinetobacter, Flavobacterium, and Lactobacillus at the genera level were observed in milk samples of women with low psychosocial distress. With respect to milk microbial diversity, high maternal psychosocial distress, compared to low maternal psychosocial distress, was related to significantly lower bacterial diversity in milk at 3 months post-delivery. Anxiety, stress, and depressive symptoms separately were unrelated to specific bacterial profiles. The current study suggests a potential relation between maternal psychosocial distress and milk microbiota, providing first evidence of a possible mechanism through which post-partum psychological symptoms may affect infant development and health.
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Affiliation(s)
- Pamela D Browne
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marina Aparicio
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Claudio Alba
- Departmental Section of Galenic Pharmacy and Food Technology, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Christine Hechler
- Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Leonides Fernández
- Departmental Section of Galenic Pharmacy and Food Technology, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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20
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Nguyen AJ, Hoyer E, Rajhans P, Strathearn L, Kim S. A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression. J Neuroendocrinol 2019; 31:e12794. [PMID: 31520440 DOI: 10.1111/jne.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/19/2022]
Abstract
Postpartum depression (PPD) is a common but complex condition that is poorly understood and multifactorial in aetiology. It is a condition that can compromise the mother's care for her infant, which may pose challenges to the formation of the mother-infant bond and the infant's overall development. Past research has looked at abnormalities in the brain circuitry and hormonal profiles of mothers with PPD compared to non-depressed mothers. However, abnormalities in PPD that may specifically affect the mother's care of her infant have not been clearly assessed. Thus, the present review aims to synthesise studies of altered brain and hormonal responses in mothers with PPD in relation to their care of their infant. First, we review maternal brain responses and their relation to PPD symptomatology, focusing on the salience/fear network, reward/attachment network and default mode network. Next, we discuss oxytocin and hypothalamic-pituitary-adrenal axis hormones in the context of maternal behaviour and PPD. Finally, we synthesise these findings and propose how future studies may benefit from the combined study of both neural and hormonal activity to better understand the underlying neurobiology of maternal care in PPD.
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Affiliation(s)
- Amanda J Nguyen
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elisabeth Hoyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Purva Rajhans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Sohye Kim
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Center for Reproductive Psychiatry, Pavilion for Women, Texas Children's Hospital, Houston, TX, USA
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Kofman YB, Eng ZE, Busse D, Godkin S, Campos B, Sandman CA, Wing D, Yim IS. Cortisol reactivity and depressive symptoms in pregnancy: The moderating role of perceived social support and neuroticism. Biol Psychol 2019; 147:107656. [PMID: 30703466 DOI: 10.1016/j.biopsycho.2019.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 01/17/2023]
Abstract
Perinatal depression negatively impacts mother-infant health and well-being. Previous work has linked cortisol reactivity to perinatal depressive symptoms, but moderating effects including social support and neuroticism, have not been studied. Forty-nine pregnant women (9-30 weeks' gestational age; GA) provided saliva samples in response to the Trier Social Stress Test (TSST) and to awakening (cortisol awakening response, CAR), and completed questionnaires on perceived social support, personality, and depressive symptoms. Two hierarchical logistic regressions, one including the TSST response and one including the CAR as predictor variables, suggest that cortisol reactivity, social support from the baby's father, and neuroticism contribute to depressive symptoms, controlling for GA (both p < .01). Significant statistical interactions among predictors of pregnancy depressive symptoms were, however, only found in the model using the CAR. Findings highlight the importance of considering biopsychosocial interactions in studies predicting perinatal depressive symptoms.
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Affiliation(s)
- Yasmin B Kofman
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Zoe E Eng
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - David Busse
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Sophia Godkin
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Belinda Campos
- Department of Chicano and Latino Studies, University of California, Irvine, 3151 Social Science Plaza, Irvine, CA 92697-5100, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Early Human and Lifespan Development Program, 1 University Drive, Orange, CA 92866, USA
| | - Deborah Wing
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine, 333 City Blvd. West, Suite 1400, Orange CA 92868, USA
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA.
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22
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Ulmer-Yaniv A, Djalovski A, Priel A, Zagoory-Sharon O, Feldman R. Maternal depression alters stress and immune biomarkers in mother and child. Depress Anxiety 2018; 35:1145-1157. [PMID: 30133052 DOI: 10.1002/da.22818] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 06/08/2018] [Accepted: 07/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Exposure to maternal depression bears long-term negative consequences for children's well-being. Yet, no study has tested the joint contribution of maternal and child's hypothalamic pituitary axis and immune systems in mediating the effects of maternal depression on child psychopathology. METHODS We followed a birth cohort over-represented for maternal depression from birth to 10 years (N = 125). At 10 years, mother and child's cortisol (CT) and secretory immunoglobulin A (s-IgA), biomarkers of the stress and immune systems, were assayed, mother-child interaction observed, mothers and children underwent psychiatric diagnosis, and children's externalizing and internalizing symptoms reported. RESULTS Depressed mothers had higher CT and s-IgA levels and displayed more negative parenting, characterized by negative affect, intrusion, and criticism. Children of depressed mothers exhibited more Axis-I disorders, higher s-IgA levels, and greater social withdrawal. Structural equation modeling charted four paths by which maternal depression impacted child externalizing and internalizing symptoms: (a) increasing maternal CT, which linked with higher child CT and behavior problems; (b) augmenting maternal and child's immune response, which were associated with child symptoms; (c) enhancing negative parenting that predicted child social withdrawal and symptoms; and (d), via a combined endocrine-immune pathway suppressing symptom formation. CONCLUSIONS Our findings, the first to test stress and immune biomarkers in depressed mothers and their children in relation to social behavior, describe mechanisms of endocrine synchrony in shaping children's stress response and immunity, advocate the need to follow the long-term effects of maternal depression on children's health throughout life, and highlight maternal depression as an important public health concern.
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Affiliation(s)
- Adi Ulmer-Yaniv
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,The Gonda Multidisciplinary Center, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Djalovski
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,Department of Psychology, Bar-Ilan University, Israel
| | - Avital Priel
- Department of Psychology, Bar-Ilan University, Israel
| | - Orna Zagoory-Sharon
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzlia, Israel.,Yale Child Study Center, Yale University, New Haven, Connecticut
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Luecken LJ, Crnic KA, Gonzales NA, Winstone LK, Somers JA. Mother-infant dyadic dysregulation and postpartum depressive symptoms in low-income Mexican-origin women. Biol Psychol 2018; 147:107614. [PMID: 30391479 DOI: 10.1016/j.biopsycho.2018.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
The current study evaluated a mechanistic pathway by which prenatal stress increases the risk of postpartum depressive (PPD) symptoms via observed dyadic emotional, behavioral, and attentional dysregulation and associated cortisol responses during mother-infant interactions. METHODS Participants included 322 low-income Mexican American mother-infant dyads. Depressive symptoms, economic hardship, and negative life events were assessed at a prenatal visit. Dysregulation in dyadic (mother-infant) interactions and cortisol responses to mother-infant interaction were evaluated at 12 weeks after the birth. Twenty-four weeks after the birth, PPD symptoms were predicted from prenatal stress (negative life events and economic hardship) and prenatal depressive symptoms, mediated through dyadic dysregulation and maternal and infant cortisol responses. RESULTS More negative life events in the prenatal period predicted more dyadic dysregulation at 12 weeks postpartum. Dyadic dysregulation and economic hardship predicted elevated 12-week infant cortisol total response and reactivity, and higher total infant cortisol response predicted higher maternal PPD symptoms at 24 weeks. Maternal cortisol response was not associated with dyadic dysregulation, either form of prenatal stress, or PPD symptoms. CONCLUSION The results indicate the salience of early psychosocial processes and mother-infant relationship challenges for subsequent maternal affective well-being.
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Affiliation(s)
- Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, United States.
| | - Keith A Crnic
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, United States
| | - Nancy A Gonzales
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, United States
| | - Laura K Winstone
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, United States
| | - Jennifer A Somers
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, United States
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24
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Riazanova OV, Alexandrovich YS, Ioscovich AM. The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial. Rom J Anaesth Intensive Care 2018; 25:123-130. [PMID: 30393769 DOI: 10.21454/rjaic.7518.252.rzn] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Postpartum depression (PPD) is the main psychological status disorder and women suffering from postpartum depression often need long-term psychological and socio-economic rehabilitation. The study is dedicated to the evaluation of the role of labor pain management using epidural analgesia in natural delivery on stress level in labor and frequency of postnatal depression. Materials and methods 210 women were investigated and divided into two groups. In the first group for labor pain management in natural delivery, patient-controlled epidural analgesia was used (bolus - 10.0 - 0.08% ropivacaine hydrochloride, lockout - 30 min, limit - 120 ml/6 h) with a background of continuous-flow infusion of local anesthetic 0.08% ropivacaine hydrocluoride solution. Patients in the second group had no pain relief in delivery. The stress level was evaluated using blood plasma cortisol level in the early stages of labor, 6 hours and 3 days after delivery. The assessment of depression development was carried out step-by-step: Before the delivery, 6 hours after, 3 days and 6 weeks after the delivery. Results The baby blues frequency 6 hours after the delivery in the group where the pain relief was conducted was 29.91%, with cortisol level below and equal to 2310.91 nmol/l. In the group with no pain relief 6 hours after delivery, baby blues was found in 15.53% of puerperas (p < 0.05) and the cortisol level was 2673.82 nmol/l (p < 0.05). Six weeks after the birth, postpartum depression was diagnosed in 4.67% of women who received epidural analgesia during delivery, in comparison to 6.79% with no pain relief during delivery. However, the difference was not statistically significant (p < 0.05). Conclusions The use of epidural analgesia leads to a significant reduction of pain syndrome and stress response during natural delivery, increases the risk of baby blues in the early postnatal period, but slightly influences the frequency of postpartum depression.
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Affiliation(s)
- Oksana V Riazanova
- Department of Anesthesiology and Intensive Care, Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Yurii S Alexandrovich
- Department of Anesthesiology and Intensive Care, Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Alexander M Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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de Rezende MG, Rosa CE, Garcia-Leal C, de Figueiredo FP, Cavalli RDC, Bettiol H, Salmon CEG, Barbieri MA, de Castro M, Carlos Dos Santos A, Del-Ben CM. Correlations between changes in the hypothalamic-pituitary-adrenal axis and neurochemistry of the anterior cingulate gyrus in postpartum depression. J Affect Disord 2018; 239:274-281. [PMID: 30029155 DOI: 10.1016/j.jad.2018.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/28/2018] [Accepted: 07/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to investigate associations between indicators of hypothalamic-pituitary-adrenal axis (HPA) functioning and metabolite levels in the anterior cingulate gyrus (ACG) of women with postpartum depression (PPD). METHODS The sample (mean age = 28.5 ± 4.6 years) consisted of 20 women with PPD and 19 postpartum euthymic (PPE) women. Brain metabolites were quantified by proton magnetic resonance spectroscopy (1H-MRS). Salivary cortisol samples were collected upon awakening and 30 min and 12 h later, at 20.6 ± 6.6 (PPD) and 23.0 ± 7.4 (PPE) weeks after childbirth. RESULTS There were no significant differences between groups in respect to metabolite levels in the ACG. Compared with PPE, PPD women had less diurnal variation (DVr%). In the PPD group, positive correlations were found between DVr% and myo-inositol (mI/Cr) levels, and between cortisol awakening response (CARi%) and glutamate + glutamine (Glx/Cr) levels. The correlation between CARi% and Glx/Cr remained significant even after controlling for the interval, in weeks, from birth and MR spectroscopy and to hormonal data collection, and the use of contraceptives. LIMITATIONS The limitations of the study include the small sample size and the use of oral contraceptives by around half of the sample. CONCLUSIONS In the remote postpartum period (mean 21.8 ± 6.9 weeks) and in the presence of depressive episodes, the decreased responsiveness of the HPA axis after awakening and a smaller decrease in cortisol levels over the day were associated with lower levels of metabolites in the ACG. These results may contribute to the development of biological models to explain the etiology of PPD.
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Affiliation(s)
- Marcos Gonçalves de Rezende
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil.
| | - Carlos Eduardo Rosa
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil; Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cybele Garcia-Leal
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Felipe Pinheiro de Figueiredo
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
| | | | - Heloisa Bettiol
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Carlos Ernesto Garrido Salmon
- Department of Physics, Faculty of Philosophy, Sciences and Literature of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Barbieri
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Margaret de Castro
- Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Cristina Marta Del-Ben
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Av. dos Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
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Szpunar MJ, Parry BL. A systematic review of cortisol, thyroid-stimulating hormone, and prolactin in peripartum women with major depression. Arch Womens Ment Health 2018; 21:149-161. [PMID: 29022126 PMCID: PMC5857206 DOI: 10.1007/s00737-017-0787-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/04/2017] [Indexed: 01/07/2023]
Abstract
Pregnancy and postpartum are periods of high susceptibility to major depression (MD) and other mood disorders. The peripartum period is also a time of considerable changes in the levels of hormones, including cortisol, thyroid-stimulating hormone (TSH), prolactin, gonadotropins, and gonadal steroids. To investigate the relationship between mood and hormonal changes during and after pregnancy, we reviewed published reports of hormonal measures during this time frame, searched via PubMed and Web of Science. Studies were included if women in the antepartum or postpartum periods were clinically diagnosed with MD, and if there were repeated measures of cortisol, TSH, or prolactin. For these three hormones, the numbers of human studies that met these criteria were 15, 7, and 3, respectively. Convergent findings suggest that morning cortisol is reduced in pregnant and postpartum women with MD. Evidence did not support changes in TSH as a marker of MD during the peripartum period, and evidence for changes in prolactin in peripartum MD was equivocal. Aside from reduced morning cortisol in peripartum women with MD, definitive evidence for an association between specific hormonal fluctuations and mood disorders in the peripartum period remains elusive.
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Affiliation(s)
- Mercedes J Szpunar
- UC San Diego Department of Psychiatry, La Jolla, CA, 92093, USA.
- Department of Psychiatry, UC San Diego School of Medicine, 9500 Gilman Dr., #9116A, La Jolla, CA, 92093, USA.
| | - Barbara L Parry
- UC San Diego Department of Psychiatry, La Jolla, CA, 92093, USA
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27
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Thayer ZM, Agustin Bechayda S, Kuzawa CW. Circadian cortisol dynamics across reproductive stages and in relation to breastfeeding in the Philippines. Am J Hum Biol 2018; 30:e23115. [DOI: 10.1002/ajhb.23115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/29/2018] [Accepted: 02/10/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Zaneta M. Thayer
- Department of Anthropology; Dartmouth College; Hanover New Hampshire
| | - Sonny Agustin Bechayda
- USC-Office of Population Studies; University of San Carlos; Cebu City Philippines
- Department of Anthropology, Sociology and History; University of San Carlos; Cebu City Philippines
| | - Christopher W. Kuzawa
- Department of Anthropology; Northwestern University; Evanston Illinois
- Institute for Policy Research; Northwestern University; Evanston Illinois
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28
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Garcia-Leal C, De Rezende MG, Corsi-Zuelli FMDG, De Castro M, Del-Ben CM. The functioning of the hypothalamic-pituitary-adrenal (HPA) axis in postpartum depressive states: a systematic review. Expert Rev Endocrinol Metab 2017; 12:341-353. [PMID: 30058891 DOI: 10.1080/17446651.2017.1347500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A large body of literature suggests the role of the hypothalamic-pituitary-adrenal (HPA) axis in postpartum depression (PPD). Nonetheless, these studies present discrepant methodology and results; thus, this hypothesis deserves further exploration. Areas covered: This review included studies investigating the HPA axis in PPD or postpartum blues published until November 2016. In total, 48 studies met the inclusion criteria. The HPA axis was mostly investigated in the immediate postpartum period (62.5%), and the majority of studies collected samples in the morning (43.8%), with one measure in a single day (43.8%), and blood was the fluid more often collected (58.4%). Seven out of 21 studies evaluating postpartum blues, and 15 out of 28 studies evaluating PPD detected abnormalities in the HPA axis functioning. Expert commentary: We found a significant heterogeneity in the methodology adopted by studies and consequently, in the results. Despite that, the majority of studies reported HPA changes in women with PPD during the remote period. Notably, reactivity tests pointed to attenuated HPA axis response. Ideally, future investigations should use validated reactivity tests, include larger sample sizes, consider many measures of cortisol throughout the day, and more than one day of collection. We also recommend that studies continue to use validated scales for mood assessment.
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Affiliation(s)
- Cybele Garcia-Leal
- a Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Marcos Gonçalves De Rezende
- a Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Fabiana Maria das Graças Corsi-Zuelli
- a Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Margaret De Castro
- b Division of Endocrinology, Department of Internal Medicine, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
| | - Cristina Marta Del-Ben
- a Division of Psychiatry, Department of Neuroscience and Behavior, Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto , Brazil
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29
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Howland LC, Jallo N, Connelly CD, Pickler RH. Feasibility of a Relaxation Guided Imagery Intervention to Reduce Maternal Stress in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46:532-543. [DOI: 10.1016/j.jogn.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 10/19/2022] Open
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30
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Ferguson EH, Di Florio A, Pearson B, Putnam KT, Girdler S, Rubinow DR, Meltzer-Brody S. HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression. Arch Womens Ment Health 2017; 20:411-420. [PMID: 28251369 PMCID: PMC5441453 DOI: 10.1007/s00737-017-0716-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/10/2017] [Indexed: 12/29/2022]
Abstract
It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12-24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F 8,125, p = 0.02, Greenhouse-Geisser corrected p = 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.
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Affiliation(s)
- Elizabeth H Ferguson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
| | - Arianna Di Florio
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Brenda Pearson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
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31
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van der Voorn B, de Waard M, van Goudoever JB, Rotteveel J, Heijboer AC, Finken MJ. Breast-Milk Cortisol and Cortisone Concentrations Follow the Diurnal Rhythm of Maternal Hypothalamus-Pituitary-Adrenal Axis Activity. J Nutr 2016; 146:2174-2179. [PMID: 27629575 DOI: 10.3945/jn.116.236349] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/11/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Very preterm infants often receive donor milk from mothers who deliver at term, but its composition differs from that of their own mother's milk. Because breast-milk glucocorticoids can support developing neonates, we explored concentration variability within and between mothers. OBJECTIVE We hypothesized that breast-milk glucocorticoid concentrations would be higher after very preterm delivery [gestational age (GA) <32 wk; study 1] and would follow the diurnal rhythm of maternal adrenocortical activity (study 2). METHODS Study 1 assessed differences in milk cortisol, cortisone, and the cortisone-to-(cortisol+cortisone) ratio of mothers who delivered at (median) GA: 28.6 wk or at term weekly during the first month postpartum. Study 2 assessed variations in milk cortisol, cortisone, and the cortisone-to-(cortisol+cortisone) ratio over 24 h, and tested Pearson correlations between milk and salivary concentrations in mothers who delivered at term (median GA: 38.9 wk) during week 4 postpartum. In these studies, foremilk glucocorticoids were measured by liquid chromatography-tandem mass spectrometry. Associations of milk cortisol, milk cortisone, and the milk cortisone-to-(cortisol+cortisone) ratio with prematurity (study 1) or collection time (study 2) were studied with longitudinal data analyses. RESULTS In study 1, giving birth to a very preterm infant was associated with reductions in milk cortisol and cortisone concentrations of 50% (β: 0.50; 95% CI: 0.26, 0.99; P = 0.05) and 53% (β: 0.53; 95% CI: 0.30, 0.93; P = 0.03), respectively, when adjusted for collection time. In study 2, concentrations of milk cortisol and cortisone were associated with collection time (both P < 0.01), peaking at ∼0700. Milk and salivary concentrations of cortisol (r = 0.92, P < 0.01) and cortisone (r = 0.93, P < 0.01) as well as the cortisone-to-(cortisol+cortisone) ratio (r = 0.64, P < 0.01) were correlated with one another. CONCLUSIONS Breast-milk glucocorticoid concentrations follow the diurnal rhythm of maternal hypothalamus-pituitary-adrenal axis activity and are lower in mothers who deliver very preterm.
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Deligiannidis KM, Kroll-Desrosiers AR, Svenson A, Jaitly N, Barton BA, Hall JE, Rothschild AJ. Cortisol response to the Trier Social Stress Test in pregnant women at risk for postpartum depression. Arch Womens Ment Health 2016; 19:789-97. [PMID: 26951216 PMCID: PMC5014732 DOI: 10.1007/s00737-016-0615-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/29/2016] [Indexed: 01/12/2023]
Abstract
Antepartum depression and anxiety are risk factors for postpartum depression (PPD). Postpartum abnormalities in hypothalamic-pituitary-adrenal (HPA) reactivity are associated with PPD. It is not known if antepartum HPA abnormalities exist in women at risk for PPD (AR-PPD). We measured salivary cortisol response to the Trier Social Stress Test (TSST) in 44 (24 AR-PPD, 20 healthy comparison) pregnant women. Depression and anxiety were measured using the Edinburgh Postnatal Depression Scale (EPDS) and Spielberger State-Trait Anxiety Inventory-State (STAI-S). We analyzed longitudinal changes in cortisol using generalized estimating equation methods to control for the correlation within subjects at the six TSST time points. Group differences in area under the curve (AUC) were examined. A majority (70.8 %) of the AR-PPD had prior depression. EPDS total score was higher in AR-PPD vs. comparison women (mean EPDS = 9.8 ± 4.9 vs. mean EPDS = 2.4 ± 2.0 respectively, p < 0.001). Mean STAI-S total score was higher in AR-PPD vs. comparison women at all TSST time points and over time (z = 2.71, df = 1, p = 0.007). There was no significant difference in cortisol concentration over time between groups. We observed no detectable difference in cortisol response to psychosocial stress induced by the TSST despite clinically significant between-group differences in current/past depression and current symptomatology.
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Affiliation(s)
- Kristina M Deligiannidis
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01605, USA.
- Women's Mental Health Program, Departments of Psychiatry and Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, 55 Lake Avenue, North, Worcester, MA, 01605, USA.
| | - Aimee R Kroll-Desrosiers
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Abby Svenson
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Nina Jaitly
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01605, USA
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709-2233, USA
| | - Bruce A Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Janet E Hall
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709-2233, USA
- Reproductive Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02114-2696, USA
| | - Anthony J Rothschild
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01605, USA
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Chinese Herbal Medicine for Postpartum Depression: A Systematic Review of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5284234. [PMID: 27774110 PMCID: PMC5059536 DOI: 10.1155/2016/5284234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 07/26/2016] [Accepted: 08/10/2016] [Indexed: 12/02/2022]
Abstract
Background. Postpartum depression (PPD) does great harm to women following childbirth. The aim of this study was to conduct a systematic review of the literature to assess the efficacy and safety of CHM for the treatment of PPD. Methods. Published or ongoing registered trials were searched for from the inception of the various databases to December 31, 2015. Data extraction and methodology assessment were conducted independently by two researchers. RevMan 5.3 software was used to analyze the data. Results. Forty-seven registered clinical trials (RCTs) were identified and reviewed. The results showed CHM alone or in combination with routine treatments could reduce HAMD score, EPDS score, incidence of adverse events, TESS, and SERS. CHM combined with routine treatment was more effective in increasing serum estradiol levels and reducing progesterone levels than routine treatment alone. Meanwhile, pooled data revealed that MRLQS combined with routine treatments or MRLQS plus MSHS combined with routine treatments were more effective than other therapeutic methods in TCM. MRLQS plus MSHS alone was found to be an effective alternative when compared to routine treatments. Conclusions. This review suggested that CHM was safe and effective in the treatment of PPD. However, this could not be proven conclusively. To ensure evidence-based clinical practice, more rigorously designed trials are warranted.
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Seth S, Lewis AJ, Galbally M. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth 2016; 16:124. [PMID: 27245670 PMCID: PMC4886446 DOI: 10.1186/s12884-016-0915-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 05/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. METHOD A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. RESULTS In total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. DISCUSSION AND CONCLUSION Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.
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Affiliation(s)
- Sunaina Seth
- School of Psychology, Deakin University, Melbourne, 3125, Australia
| | - Andrew J Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, 6150, Australia. .,Harry Perkins South Medical Research Institute, Perth, Western Australia, 6009, Australia.
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, 6150, Australia.,School of Medicine, University of Notre Dame, Perth, Western Australia, 6959, Australia.,Fiona Stanley Hospital, Perth, 6150, Australia.,Harry Perkins South Medical Research Institute, Perth, Western Australia, 6009, Australia
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Scheyer K, Urizar GG. Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Arch Womens Ment Health 2016; 19:317-28. [PMID: 26275372 PMCID: PMC4754170 DOI: 10.1007/s00737-015-0563-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/30/2015] [Indexed: 12/29/2022]
Abstract
Postpartum depression (PPD) has been associated with a number of negative maternal and infant health outcomes. Despite these adverse health effects, few studies have prospectively examined patterns of pre- and postnatal stress that may increase a woman's risk for PPD. The current study examined whether the timing of altered salivary cortisol patterns and perceived stress levels during pregnancy and at 3 months postpartum was associated with PPD symptoms among 100 low-income mothers. Higher levels of PPD were found among women with a lower cortisol awakening response (first and second trimester), lower average daily cortisol (second trimester), a flatter diurnal cortisol pattern (second and third trimester and at 3 months postpartum), and a less abrupt drop in both cortisol and perceived stress from the third trimester to 3 months postpartum. These results support the need for early screening and regulation of stress levels to promote depression prevention efforts in at-risk populations.
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Affiliation(s)
- Kathryn Scheyer
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA
| | - Guido G Urizar
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA.
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Eatough E, Shockley K, Yu P. A Review of Ambulatory Health Data Collection Methods for Employee Experience Sampling Research. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2016. [DOI: 10.1111/apps.12068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erin Eatough
- Baruch College & The Graduate Center, The City University of New York; USA
| | - Kristen Shockley
- Baruch College & The Graduate Center, The City University of New York; USA
| | - Peter Yu
- Baruch College & The Graduate Center, The City University of New York; USA
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de Rezende MG, Garcia-Leal C, de Figueiredo FP, Cavalli RDC, Spanghero MS, Barbieri MA, Bettiol H, de Castro M, Del-Ben CM. Altered functioning of the HPA axis in depressed postpartum women. J Affect Disord 2016; 193:249-56. [PMID: 26773916 DOI: 10.1016/j.jad.2015.12.065] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/18/2015] [Accepted: 12/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The present study aimed to evaluate the relationship between the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and major depressive episodes in the remote postpartum period. METHODS The sample (mean age, 28.0±5.3 years) consisted of 37 depressed postpartum women (DPP), 42 euthymic postpartum women (EPP) and 25 non-postpartum healthy women (HC). Salivary cortisol samples were collected immediately after awakening and 30min, 3 and 12h later, at approximately the sixth month postpartum (mean, 169.6±60.3 days). RESULTS Differences in cortisol levels were observed at awakening (DPP<EPP=HC), at 30min (DPP<EPP<HC), at 3h (DPP=EPP<HC) and at 12h (DPP>EPP=HC). The relative increment in the cortisol awakening response (CARi%) was significantly higher in HC (113.5±94.3) than in EPP (63.1±69.8) and DPP (32.2±49.6). The relative reduction in diurnal variation (DVr%) was lower in DPP (56.5±41.8) than in EPP (75.6±22.4) and HC (75.1±13.0). LIMITATIONS The main limitation was cortisol collection on a single day and without measurement at midnight. CONCLUSIONS Our findings suggest that the remote postpartum period involves attenuation of HPA axis reactivity; this dysregulation is more pronounced in the presence of DPP, which is associated with a reduction in cortisol diurnal variation. Abnormalities in the neuroendocrine system related to stress processing, present even several months after delivery, can represent vulnerability to mental disorders. Thus, improvements in the mental health care of postpartum women are needed.
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Affiliation(s)
- Marcos Gonçalves de Rezende
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Cybele Garcia-Leal
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Marco Antonio Barbieri
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Heloisa Bettiol
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Margaret de Castro
- Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Li J, Zhao R, Li X, Sun W, Qu M, Tang Q, Yang X, Zhang S. Shen-Qi-Jie-Yu-Fang exerts effects on a rat model of postpartum depression by regulating inflammatory cytokines and CD4(+)CD25(+) regulatory T cells. Neuropsychiatr Dis Treat 2016; 12:883-96. [PMID: 27143890 PMCID: PMC4841396 DOI: 10.2147/ndt.s98131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Shen-Qi-Jie-Yu-Fang (SJF) is composed of eight Chinese medicinal herbs. It is widely used in traditional Chinese medicine for treating postpartum depression (PPD). Previous studies have shown that SJF treats PPD through the neuroendocrine mechanism. AIM To further investigate the effect of SJF on the immune system, including the inflammatory response system and CD4(+)CD25(+) regulatory T (Treg) cells. MATERIALS AND METHODS Sprague Dawley rats were used to create an animal model of PPD by inducing hormone-simulated pregnancy followed by hormone withdrawal. After hormone withdrawal, the PPD rats were treated with SJF or fluoxetine for 1, 2, and 4 weeks. Levels of Treg cells in peripheral blood were measured by flow cytometry analysis. Serum interleukin (IL)-1β and IL-6 were evaluated by enzyme-linked immunosorbent assay, and gene and protein expressions of IL-1RI, IL-6Rα, and gp130 in the hippocampus were observed by reverse-transcription polymerase chain reaction and Western blot. RESULTS Serum IL-1β in PPD rats increased at 2 weeks and declined from then on, while serum IL-6 increased at 1, 2, and 4 weeks. Both IL-1β and IL-6 were downregulated by SJF and fluoxetine. Changes in gene and protein expressions of IL-1RI and gp130 in PPD rats were consistent with changes in serum IL-1β, and were able to be regulated by SJF and fluoxetine. The levels of Treg cells were negatively correlated with serum IL-1β and IL-6, and were decreased in PPD rats. The levels of Treg cells were increased by SJF and fluoxetine. CONCLUSION Dysfunction of proinflammatory cytokines and Tregs in different stages of PPD was attenuated by SJF and fluoxetine through the modulation of serum concentrations of IL-1β and IL-6, expressions of IL-1RI, and gp130 in the hippocampus, and CD4(+)CD25(+) Treg cells in peripheral blood.
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Affiliation(s)
- Jingya Li
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Ruizhen Zhao
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xiaoli Li
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Wenjun Sun
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Miao Qu
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Qisheng Tang
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xinke Yang
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Shujing Zhang
- School of Basic Medical Sciences, Beijing University of Chinese Medicine, Beijing, People's Republic of China
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Guintivano J, Kaminsky ZA. Role of epigenetic factors in the development of mental illness throughout life. Neurosci Res 2016; 102:56-66. [DOI: 10.1016/j.neures.2014.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 12/15/2022]
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Ahn S, Corwin EJ. The association between breastfeeding, the stress response, inflammation, and postpartum depression during the postpartum period: Prospective cohort study. Int J Nurs Stud 2015; 52:1582-90. [PMID: 26143358 PMCID: PMC4540671 DOI: 10.1016/j.ijnurstu.2015.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/16/2015] [Accepted: 05/19/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Research suggests that exclusive breastfeeding may have a stress-protective role in postpartum depression; however, less is known about the underlying mechanisms by which this protection may occur or whether the protective relationship holds for women who mix breast and bottle feeding. OBJECTIVES To examine patterns of the stress response, inflammation, and depressive symptoms among women predominantly breastfeeding or bottle feeding their infants at 6 months postpartum. DESIGN A part of a larger longitudinal study across 6 months postpartum investigating the psychoneuroimmunology (PNI) of postpartum depression. SETTING Prenatal clinics and community. PARTICIPANTS One hundred nineteen postpartum women who met inclusion/exclusion criteria and followed up from the prenatal period to postpartum 6 months. METHODS Data were collected during seven home visits occurring during the 3rd trimester (weeks 32-36) and on postpartum days 7 and 14, months 1, 2, 3, and 6. Women completed stress and depression surveys and provided blood for pro- (IL-1β, IL-6, IL-8, TNF-a, IFN-γ) and anti-inflammatory (IL-10) cytokines, and collected saliva for diurnal cortisol. RESULTS Self-report of predominant breastfeeding during 6 months postpartum ranged from 91.9% at day 7 to 70.6% at month 6 postpartum. There were no associations between the pattern of feeding and depressive symptoms. Biological differences, however, existed between the groups, with levels of salivary cortisol at 8 AM and 8:30 AM at month 6 higher and levels of IL-6 at month 6 lower in women who primarily breastfed compared to those who primarily bottle fed their infants after controlling for confounding variables. CONCLUSIONS Breastfeeding was not related to postpartum depression however differences in stress and inflammatory markers are apparent at month 6 postpartum.
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Affiliation(s)
- Sukhee Ahn
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
| | - Elizabeth J Corwin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 244, Atlanta, GA 30322, United States.
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Iliadis SI, Comasco E, Sylvén S, Hellgren C, Sundström Poromaa I, Skalkidou A. Prenatal and Postpartum Evening Salivary Cortisol Levels in Association with Peripartum Depressive Symptoms. PLoS One 2015; 10:e0135471. [PMID: 26322643 PMCID: PMC4556108 DOI: 10.1371/journal.pone.0135471] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/22/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The biology of peripartum depression remains unclear, with altered stress and the Hypothalamus-Pituitary-Adrenal axis response having been implicated in its pathophysiology. METHODS The current study was undertaken as a part of the BASIC project (Biology, Affect, Stress, Imaging, Cognition), a population-based longitudinal study of psychological wellbeing during pregnancy and the postpartum period in Uppsala County, Sweden, in order to assess the association between evening salivary cortisol levels and depressive symptoms in the peripartum period. Three hundred and sixty-five pregnant women from the BASIC cohort were recruited at pregnancy week 18 and instructed to complete a Swedish validated version of the Edinburgh Postnatal Depression Scale at the 36th week of pregnancy as well as the sixth week after delivery. At both times, they were also asked to provide evening salivary samples for cortisol analysis. A comprehensive review of the relevant literature is also provided. RESULTS Women with postpartum EPDS score ≥ 10 had higher salivary evening cortisol at six weeks postpartum compared to healthy controls (median cortisol 1.19 vs 0.89 nmol/L). A logistic regression model showed a positive association between cortisol levels and depressive symptoms postpartum (OR = 4.1; 95% CI 1.7-9.7). This association remained significant even after controlling for history of depression, use of tobacco, partner support, breastfeeding, stressful life events, and sleep problems, as possible confounders (aOR = 4.5; 95% CI 1.5-14.1). Additionally, women with postpartum depressive symptoms had higher postpartum cortisol levels compared to both women with depressive symptoms antenatally and controls (p = 0.019 and p = 0.004, respectively). CONCLUSIONS Women with depressive symptoms postpartum had higher postpartum cortisol levels, indicating an altered response of the HPA-axis in postpartum depression.
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Affiliation(s)
- Stavros I. Iliadis
- Dept. of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
- * E-mail:
| | - Erika Comasco
- Dept. of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
- Dept. of Neuroscience, Uppsala University, 751 24, Uppsala, Sweden
| | - Sara Sylvén
- Dept. of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Charlotte Hellgren
- Dept. of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | | | - Alkistis Skalkidou
- Dept. of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
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Castro-Diehl C, Diez Roux AV, Redline S, Seeman T, Shrager SE, Shea S. Association of Sleep Duration and Quality With Alterations in the Hypothalamic-Pituitary Adrenocortical Axis: The Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Endocrinol Metab 2015; 100:3149-58. [PMID: 26046965 PMCID: PMC4524997 DOI: 10.1210/jc.2015-1198] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Short sleep duration and poor sleep quality are associated with cardiovascular outcomes. One mechanism proposed to explain this association is altered diurnal cortisol secretion. OBJECTIVE The objective of the study was to examine the associations of sleep duration and sleep quality with diurnal salivary cortisol levels. DESIGN This was a cross-sectional analysis using data from examination 5 (2010-2012) of the Multi-Ethnic Study of Atherosclerosis. Actigraphy-based measures of sleep duration and efficiency were collected over 7 days, and salivary cortisol samples were collected over 2 days from participants aged 54-93 years (n = 600 with analyzable data). RESULTS Shorter average sleep duration (<6 h/night) was associated with less pronounced late decline in cortisol [2.2% difference in slope; 95% confidence interval (CI) 0.8-3.7; P ≤ .01] and less pronounced wake-to-bed slope (2.2% difference; 95% CI 1.0-3.4; P ≤ .001) compared with longer sleep duration (≥6 h/night). Lower sleep efficiency (<85%) was associated with less pronounced early decline in cortisol (29.0% difference in slope; 95% CI 4.1-59.7; P < .05) compared with higher sleep efficiency (≥85%). Subjects reporting insomnia had a flatter cortisol awakening response (-16.1% difference in slope; 95% CI -34.6 to -0.1; P < .05) compared with those not reporting insomnia. CONCLUSIONS Shorter sleep duration, lower sleep efficiency, and insomnia are associated with alterations in diurnal cortisol levels consistent with changes in hypothalamic-pituitary-adrenal regulation.
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Affiliation(s)
- Cecilia Castro-Diehl
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
| | - Ana V Diez Roux
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
| | - Susan Redline
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
| | - Teresa Seeman
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
| | - Sandi E Shrager
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
| | - Steven Shea
- Department of Medicine (C.C.-D., S. S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Epidemiology (C.C.-D., S. S.), Mailman School of Public Health, Columbia University, New York, New York 10032; Department of Epidemiology and Biostatistics (A.V.D.R.), Drexel University School of Public Health, Philadelphia, Pennsylvania 19104; Departments of Medicine (S.R.), Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115; Department of Medicine/Geriatrics (T.S.), University of California, Los Angeles, Los Angeles, California 90095; and Department of Biostatistics (S. E. S.), University of Washington, Seattle, Washington 98115
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Kim Y, Ahn S. A Review of Postpartum Depression: Focused on Psychoneuroimmunological Interaction. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2015; 21:106-114. [PMID: 37684816 DOI: 10.4069/kjwhn.2015.21.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/07/2015] [Accepted: 05/24/2015] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this review was to describe a psychoneuroimmunology (PNI) framework for postpartum depression (PPD) and discuss its implications for nursing research and practice for postpartum women. METHODS This study explored the role of hypothalamic-pituitary-adrenal (HPA) axis and inflammation as possible mediators of risk factors for PPD through literature review. RESULTS From this PNI view, human bodies are designed to respond with the reciprocal interactions among the neuro-endocrine and immune system when they are faced with physical or psychological stressors. Chronic stress induces alterations in the function of HPA axis, and a chronic low-grade inflammatory response is associated with depression. The dysfunctions of cytokines and HPA axis have been observed during the postpartum period. Stress promotes glucocorticoid receptor resistance, which can promote inflammatory responses. This, in turn, can contribute to the pathophysiology of depression. This can especially affect populations at vulnerable time-points, such as women in the postpartum. CONCLUSION From a PNI perspective, well-designed prospective research evaluating the role of stress and inflammation as an etiology of PPD and the effect of stress reduction is warranted to prevent PPD.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Gachon University, Incheon, Korea
| | - Sukhee Ahn
- College of Nursing, Gachon University, Incheon, Korea
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Castral T, Warnock F, dos Santos C, Daré M, Moreira A, Antonini S, Scochi C. Maternal mood and concordant maternal and infant salivary cortisol during heel lance while in kangaroo care. Eur J Pain 2015; 19:429-38. [DOI: 10.1002/ejp.566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/06/2022]
Affiliation(s)
- T.C. Castral
- Faculty of Nursing Federal University of Goiás Goiânia Brazil
| | - F. Warnock
- School of Nursing University of British Columbia Vancouver Canada
| | - C.B. dos Santos
- Department of Maternal‐Child and Public Health Nursing College of Nursing University of São Paulo at Ribeirão Preto Brazil
| | - M.F. Daré
- College of Nursing University of São Paulo at Ribeirão Preto Brazil
| | - A.C. Moreira
- Department of Internal Medicine Faculty of Medicine University of São Paulo Ribeirão Preto Brazil
| | - S.R.R. Antonini
- Department of Pediatrics Faculty of Medicine University of São Paulo Ribeirão Preto Brazil
| | - C.G.S. Scochi
- Department of Maternal‐Child and Public Health Nursing College of Nursing University of São Paulo at Ribeirão Preto Brazil
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Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annu Rev Clin Psychol 2015; 11:99-137. [PMID: 25822344 PMCID: PMC5659274 DOI: 10.1146/annurev-clinpsy-101414-020426] [Citation(s) in RCA: 369] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.
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Affiliation(s)
- Ilona S Yim
- Department of Psychology and Social Behavior, University of California, Irvine, California 92697;
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Perani CV, Slattery DA. Using animal models to study post-partum psychiatric disorders. Br J Pharmacol 2014; 171:4539-55. [PMID: 24527704 DOI: 10.1111/bph.12640] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/09/2014] [Accepted: 01/31/2014] [Indexed: 12/24/2022] Open
Abstract
The post-partum period represents a time during which all maternal organisms undergo substantial plasticity in a wide variety of systems in order to ensure the well-being of the offspring. Although this time is generally associated with increased calmness and decreased stress responses, for a substantial subset of mothers, this period represents a time of particular risk for the onset of psychiatric disorders. Thus, post-partum anxiety, depression and, to a lesser extent, psychosis may develop, and not only affect the well-being of the mother but also place at risk the long-term health of the infant. Although the risk factors for these disorders, as well as normal peripartum-associated adaptations, are well known, the underlying aetiology of post-partum psychiatric disorders remains poorly understood. However, there have been a number of attempts to model these disorders in basic research, which aim to reveal their underlying mechanisms. In the following review, we first discuss known peripartum adaptations and then describe post-partum mood and anxiety disorders, including their risk factors, prevalence and symptoms. Thereafter, we discuss the animal models that have been designed in order to study them and what they have revealed about their aetiology to date. Overall, these studies show that it is feasible to study such complex disorders in animal models, but that more needs to be done in order to increase our knowledge of these severe and debilitating mood and anxiety disorders.
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Affiliation(s)
- C V Perani
- Department of Behavioural and Molecular Neurobiology, University of Regensburg, Regensburg, Germany
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Evaluation of the association between placental corticotrophin-releasing hormone and postpartum depressive symptoms. Psychosom Med 2014; 76:355-62. [PMID: 24915294 DOI: 10.1097/psy.0000000000000066] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Postpartum depression (PPD) represents a significant threat to maternal-child health. Although PPD is common, with an estimated prevalence of 10% to 15%, critical questions concerning its etiology remain unanswered. Existing studies seem to provide conflicting evidence regarding the relation between placental corticotrophin-releasing hormone (pCRH) and the development of PPD. The purpose of the present investigation was to determine whether maternal prepartum hypothalamic-pituitary-adrenal and placental dysregulation, in particular elevated midgestational pCRH, represent markers of risk for the development of PPD symptoms. METHODS One hundred seventy adult women with singleton, term pregnancies were recruited during the first trimester and participated in study visits at 15, 19, 25, 31, and 36+ weeks' gestation and at 3 and 6 months postpartum. At each prenatal visit, blood samples were obtained and assayed to determine maternal cortisol, adrenocorticotropic hormone, and pCRH concentrations. Depressive symptoms were assessed at all visits. RESULTS Depressive symptoms at 3 months postpartum were associated with elevated midgestational pCRH (partial r = 0.26; p < .01) and also accelerated trajectories of pCRH (B values ranged from 6.9 to 8.3, p < .05). Placental CRH was not predictive of PPD symptoms at 6 months postpartum. Furthermore, prepartum cortisol and corticotrophin profiles were not associated with PPD symptoms. CONCLUSIONS The current prospective study provides results that reconcile both the positive and negative findings in the existing literature and identifies elevated pCRH as a marker of risk for the development of PPD symptoms.
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Figueiredo B, Canário C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med 2014; 44:927-936. [PMID: 23822932 DOI: 10.1017/s0033291713001530] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This prospective cohort study explored the effects of prenatal and postpartum depression on breastfeeding and the effect of breastfeeding on postpartum depression. METHOD The Edinburgh Postpartum Depression Scale (EPDS) was administered to 145 women at the first, second and third trimester, and at the neonatal period and 3 months postpartum. Self-report exclusive breastfeeding since birth was collected at birth and at 3, 6 and 12 months postpartum. Data analyses were performed using repeated-measures ANOVAs and logistic and multiple linear regressions. RESULTS Depression scores at the third trimester, but not at 3 months postpartum, were the best predictors of exclusive breastfeeding duration (β = -0.30, t = -2.08, p < 0.05). A significant decrease in depression scores was seen from childbirth to 3 months postpartum in women who maintained exclusive breastfeeding for ⩾3 months (F 1,65 = 3.73, p < 0.10, η p 2 = 0.05). CONCLUSIONS These findings suggest that screening for depression symptoms during pregnancy can help to identify women at risk for early cessation of exclusive breastfeeding, and that exclusive breastfeeding may help to reduce symptoms of depression from childbirth to 3 months postpartum.
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Affiliation(s)
- B Figueiredo
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - C Canário
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - T Field
- University of Miami Medical School, Miami, FL, USA
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Glynn LM, Davis EP, Sandman CA. New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides 2013; 47:363-70. [PMID: 24210135 DOI: 10.1016/j.npep.2013.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
Abstract
Postpartum depression affects 10-20% of women following birth and exerts persisting adverse consequences on both mother and child. An incomplete understanding of its etiology constitutes a barrier to early identification and treatment. It is likely that prenatal hormone trajectories represent both markers of risk and also causal factors in the development of postpartum depression. During pregnancy the maternal hypothalamic-pituitary-adrenal axis undergoes dramatic alterations, due in large part, to the introduction of the placenta, a transient endocrine organ of fetal origin. We suggest that prenatal placental and hypothalamic-pituitary-adrenal axis dysregulation is predictive of risk for postpartum depression. In this model the positive feedback loop involving the systems regulating the products of the HPA axis results in higher prenatal levels of cortisol and placental corticotropin-releasing hormone. Greater elevations in placental corticotropin-releasing hormone are related to a disturbance in the sensitivity of the anterior pituitary to cortisol and also perhaps to decreased central corticotropin-releasing hormone secretion. Secondary or tertiary adrenal insufficiencies of a more extreme nature, which emerge during the prenatal period, may be predictive of an extended or more pronounced postpartum hypothalamic-pituitary-adrenal refractory period, which in turn represents a risk factor for development of postpartum depression. In addition to reviewing the relevant existing literature, new data are presented in support of this model which link elevated placental corticotropin-releasing hormone with low levels of ACTH at 3-months postpartum. Future research will further elucidate the role of hypothalamic-pituitary-adrenal axis dysregulation in postpartum depression and also whether prenatal placental and hypothalamic-pituitary-adrenal profiles might prove useful in the early identification of mothers at risk for postpartum mood dysregulation.
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Affiliation(s)
- Laura M Glynn
- Crean School of Health and Life Sciences, Chapman University, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, United States.
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Kim S, Soeken TA, Cromer SJ, Martinez SR, Hardy LR, Strathearn L. Oxytocin and postpartum depression: delivering on what's known and what's not. Brain Res 2013; 1580:219-32. [PMID: 24239932 DOI: 10.1016/j.brainres.2013.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 12/20/2022]
Abstract
The role of oxytocin in the treatment of postpartum depression has been a topic of growing interest. This subject carries important implications, given that postpartum depression can have detrimental effects on both the mother and her infant, with lifelong consequences for infant socioemotional and cognitive development. In recent years, oxytocin has received attention for its potential role in many neuropsychiatric conditions beyond its well-described functions in childbirth and lactation. In the present review, we present available data on the clinical characteristics and neuroendocrine foundations of postpartum depression. We outline current treatment modalities and their limitations, and proceed to evaluate the potential role of oxytocin in the treatment of postpartum depression. The aim of the present review is twofold: (a) to bring together evidence from animal and human research concerning the role of oxytocin in postpartum depression, and (b) to highlight areas that deserve further research in order to bring a fuller understanding of oxytocin's therapeutic potential. This article is part of a Special Issue entitled Oxytocin and Social Behav.
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Affiliation(s)
- Sohye Kim
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Timothy A Soeken
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Sara J Cromer
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Sheila R Martinez
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA
| | - Leah R Hardy
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA
| | - Lane Strathearn
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Attachment and Neurodevelopment Laboratory, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Suite 4004, Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; The Meyer Center for Developmental Pediatrics, Texas Children's Hospital, 8080 N. Stadium Drive, Houston, TX 77054, USA.
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