Maternal parity and perinatal cortisol adaptation: The role of pregnancy-specific distress and implications for postpartum mood

被引:42
作者
Gillespie, Shannon L. [1 ]
Mitchell, Amanda M. [2 ]
Kowalsky, Jennifer M. [3 ]
Christian, Lisa M. [4 ,5 ]
机构
[1] Ohio State Univ, Coll Nursing, 1585 Neil Ave, Columbus, OH 43210 USA
[2] Univ Louisville, Dept Counseling & Human Dev, Louisville, KY 40292 USA
[3] Ohio Univ, Dept Psychol, Athens, OH 45701 USA
[4] Ohio State Univ, Wexner Med Ctr, Dept Psychiat & Behav Hlth, Columbus, OH 43210 USA
[5] Ohio State Univ, Wexner Med Ctr, Inst Behav Med Res, 460 Med Ctr Dr,Room 112, Columbus, OH 43210 USA
关键词
Cortisol; Parity; Postpartum; Pregnancy; Stress; Psychological; Depressive symptoms; CORTICOTROPIN-RELEASING HORMONE; DEPRESSIVE SYMPTOMS; SALIVARY CORTISOL; STRESS; ASSOCIATION; RISK; ANXIETY; BIRTH; PREVALENCE; MOTHERS;
D O I
10.1016/j.psyneuen.2018.07.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Compared to women who have given birth before (i.e., multiparas), those giving birth for the first time (i.e., primiparas) show higher cortisol levels. Psychological factors may play a role; hypothalamic-pituitary-adrenal activation is a well-described stress response. Primiparity also predicts greater risk for postpartum depression, which may be related to greater correspondence between cortisol and mood following prenatal cortisol elevations. The current study examined associations among parity, perinatal cortisol adaptation, pregnancy-specific distress, and postpartum mood. Methods: This longitudinal study assayed serum cortisol levels among 137 women at early, mid-, and late pregnancy and postpartum. Pregnancy-specific distress and depressive symptoms were assessed. Maternal age, race, body mass index, sleep quality, depressive symptoms, and sampling time of day were statistically controlled. Results: Primiparous women showed higher cortisol levels than multiparous women during mid- (chi(2) = 11.8, p < 0.01) and late pregnancy (chi(2) = 18.9, p < 0.01) and higher distress across pregnancy (F-1,F-126 = 22.1, p < 0.01). Mediation analyses demonstrated that the association between parity and prenatal cortisol (per area under the curve; AUC) was partially accounted for by distress (ab = 1.0, 95%CI [0.05, 2.9]). Prenatal cortisol (per AUC) did not predict postpartum depressive symptoms (b* = 0.03, p = 0.81), with no difference by parity (b* = 0.03, p = 0.91). At postpartum, a significant interaction between parity and cortisol (b* = 0.40, p = 0.03) revealed no significant association between cortisol and mood among multiparas (b* = -0.11, p = 0.28) but a trend toward a positive association among primiparas (b* = 0.24, p = 0.06). Discussion: Cortisol levels and pregnancy-specific distress are higher in primiparas versus multiparas, with pregnancy-specific distress partially mediating the association between parity and cortisol levels. Cortisol levels and mood display correspondence at postpartum in primiparous but not multiparous women. While observational studies must be interpreted with caution due to potential unmeasured confounders, these findings suggest that future studies examining mechanisms underlying perinatal and postpartum hypothalamic-pituitary-adrenal perturbations and designing interventions aimed at preventing related complications should carefully consider potential differences by parity.
引用
收藏
页码:86 / 93
页数:8
相关论文
共 59 条
  • [1] The association between breastfeeding, the stress response, inflammation, and postpartum depression during the postpartum period: Prospective cohort study
    Ahn, Sukhee
    Corwin, Elizabeth J.
    [J]. INTERNATIONAL JOURNAL OF NURSING STUDIES, 2015, 52 (10) : 1582 - 1590
  • [2] A review and psychometric evaluation of pregnancy-specific stress measures
    Alderdice, Fiona
    Lynn, Fiona
    Lobel, Marci
    [J]. JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY, 2012, 33 (02) : 62 - 77
  • [3] Belmaker RH, 2008, NEW ENGL J MED, V358, P55, DOI [10.1056/NEJMra073096, 10.1038/nrdp.2016.65]
  • [4] Depressed natural killer cell cytotoxicity against Plasmodium falciparum-infected erythrocytes during first pregnancies
    Bouyou-Akotet, MK
    Issifou, S
    Meye, JF
    Kombila, M
    Ngou-Milama, E
    Luty, AJF
    Kremsner, PG
    Mavoungou, E
    [J]. CLINICAL INFECTIOUS DISEASES, 2004, 38 (03) : 342 - 347
  • [5] Buysse D J, 1989, Psychiatry Res, V28, P193
  • [6] Serum brain-derived neurotrophic factor (BDNF) across pregnancy and postpartum: Associations with race, depressive symptoms, and low birth weight
    Christian, Lisa M.
    Mitchell, Amanda M.
    Gillespie, Shannon L.
    Palettas, Marilly
    [J]. PSYCHONEUROENDOCRINOLOGY, 2016, 74 : 69 - 76
  • [7] Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety and depression in new mothers
    Clout, Danielle
    Brown, Rhonda
    [J]. JOURNAL OF AFFECTIVE DISORDERS, 2015, 188 : 60 - 67
  • [8] Cohen S., 1995, Measuring Stress: A Guide for Health and Social Scientists, DOI DOI 10.1093/OSO/9780195086416.003.0001
  • [9] 24-h urinary free cortisol from mid-pregnancy to 3-months postpartum: Gender and parity differences and effects
    Conde, Ana
    Figueiredo, Barbara
    [J]. PSYCHONEUROENDOCRINOLOGY, 2014, 50 : 264 - 273
  • [10] Cook R., 1982, Residuals and Influence in Regression