Prepartal Stress, Prepartal and Postpartal Hair Glucocorticoid Concentrations, and Symptoms of Postpartum Depression 3 Days and 12 Weeks After Delivery

Postpartum depression (PPD) is a serious mental health problem that affects about 17% of mothers. The aims of the current study were to observe the associations between prenatal stress, self- and expert-rated PPD, and prepartal and postpartal hair cortisol and cortisone concentrations as proxies for altered hypothalamic-pituitary-adrenal axis activity (HPA-AA). A total of 129 mothers (mean age 33.1 years) completed the Edinburgh Postnatal Depression Scale 3 days (baseline) and 12 weeks (study end) postpartum. At the end of the study, participants reported on prepartum stressful life events, experts rated participants’ symptoms of depression, and participants provided 6 cm of hair strands for analysis of hair glucosteroid levels 12 weeks before and 12 weeks after delivery. Prepartal stress was associated with higher scores for self- and expert-rated PPD and with lower hair cortisone concentrations as a proxy for less adaptive HPA-AA. Higher prepartal and postpartal hair cortisol/cortisone ratios (i.e., higher cortisol/lower cortisone concentrations) were associated with higher PPD symptom scores. Women with prepartal stress were at increased risk of experiencing PPD 12 weeks after delivery. Altered hair steroid levels (lower cortisone concentrations) as a proxy for altered HPA-AA further substantiated this association. Results suggest that 1) both prepartal stress and the suppression of HPA-AA appear to be involved in the development of PPD; 2) hair steroid analysis can be used to predict PPD; and 3) women with prepartal stressful life events may benefit from timely support and relief to decrease their risk of developing PPD. Postpartum depression is a severe psychiatric problem that affects about 17% of mothers. We showed among 129 mothers (mean age 33.1 years) that prenatal stress was associated with a higher risk of experiencing symptoms of self- and expert-rated postpartum depression 12 weeks after delivery. Lower hair cortisone concentrations and higher hair cortisol/hair cortisone ratios accompanied this association. Thus, psychological ratings and physiological processes were associated. Given that standardized programs to cope with (prenatal) stress are available, pregnant women with high stress may benefit from such interventions to decrease their risk of postpartum depression.