Cortisol response to the Trier Social Stress Test in pregnant women at risk for postpartum depression

Abstract

Purpose 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). Methods 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 was 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. Results A majority (70.8%) of the AR-PPD had prior depression. EPDS total score was higher in ARPPD 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. Conclusion 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.

The association between maternal cortisol and depression during pregnancy, a systematic review

“…The majority of the screened studies failed to meet inclusion because investigators reported on the association between maternal cortisol and infant outcomes (or between maternal depression with infant outcomes), rather than on the association between maternal cortisol and antepartum depression (N=774 out of 826, 93.7%). Table 1 provides a description of each of the 29 studies, 12 reported a statically significant association between maternal cortisol and antepartum depression (Bjelanovic et al, 2015, Diego et al, 2009, Evans et al, 2008, Field et al, 2009, Hoffman et al, 2016, Lommatzsch et al, 2006, Meliska et al, 2013, Monk et al, 2011, O’Connor et al, 2014, O’Keane et al, 2011, Peer et al, 2013, Voegtline et al, 2013) and 17 studies did not (Braithwaite et al, 2016, Davis et al, 2007, Deligiannidis et al, 2016, Glynn and Sandman, 2014, Goedhart et al, 2010, Hellgren et al, 2013, Iliadis et al, 2015, Kaasen et al, 2012, Katz et al, 2012, Luiza et al, 2015, Pedersen et al, 1993, Pluess et al, 2010, Rouse and Goodman, 2014, Salacz et al, 2012, Shea et al, 2007, Susman et al, 1999, Wikenius et al, 2016).…”

“…Some studies reported multiple collections of maternal cortisol throughout the pregnancy period (N=18 studies). However, such studies were predominately restricted to the second and third trimesters, and two studies reported no evidence of group by time interactions (Deligiannidis et al, 2016, Hellgren et al, 2013). No clear differences in association were observed across choice of laboratory assay or depression screener.…”

“…Lastly, Hoffman et al observed an association between second trimester hair cortisol concentrations and antepartum depression symptom scores at 16 weeks (r = 0.32, p=0.002) (Hoffman et al, 2016). Sixteen studies assessed cortisol at or after 28 weeks gestational age (approximately third trimester) (Bjelanovic et al, 2015, Braithwaite et al, 2016, Davis et al, 2007, Deligiannidis et al, 2016, Evans et al, 2008, Field et al, 2009, Glynn and Sandman, 2014, Hellgren et al, 2013, Hoffman et al, 2016, Iliadis et al, 2015, Lommatzsch et al, 2006, Monk et al, 2011, O’Connor et al, 2014, Pedersen et al, 1993, Pluess et al, 2010, Salacz et al, 2012). Among these studies, seven reported a statistically significant association, two of which also reported associations in previous trimesters (O’Connor et al, 2014, Hoffman et al, 2016).…”

“…When evaluating maternal cortisol concentrations (basal or in response to awakening or stressful stimuli) some investigators report statistically significant differences comparing pregnant women with and without depression (Bjelanovic et al, 2015, Diego et al, 2009, Field et al, 2009, Hoffman et al, 2016, Lommatzsch et al, 2006, Murphy et al, 2015, O’Connor et al, 2014, O’Keane et al, 2011, Parcells, 2010, Peer et al, 2013, Voegtline et al, 2013). However, a number of investigators have reported no such differences (Braithwaite et al, 2016, Davis et al, 2007, Deligiannidis et al, 2013, Evans et al, 2008, Glynn and Sandman, 2014, Goedhart et al, 2010, Hellgren et al, 2013, Iliadis et al, 2015, Kaasen et al, 2012, Katz et al, 2012, Luiza et al, 2015, Monk et al, 2011, Pluess et al, 2010, Rouse and Goodman, 2014, Salacz et al, 2012, Shaikh et al, 2011, Wikenius et al, 2016, Deligiannidis et al, 2016). Reasons for such inconsistencies may be due to differences in methodologies across studies, such as differences in the timing and method of maternal cortisol assessment.…”

Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development

“…The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides and neuroactive steroids (NAS) [123][124][125][126][127][128]. Several lines of research are actively examining the potential roles of cortisol [112,113,[129][130][131][132], corticotropin-releasing hormone (CRH) [106,[133][134][135][136], adrenocorticotropic hormone (ACTH) [137,138] oxytocin [139][140][141], prolactin [142,143], testosterone [144][145][146], NAS [121,147], and thyroid function [148][149][150][151] in PPD.…”