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Are Stress-Induced Cortisol Changes During Pregnancy Associated With Postpartum Depressive Symptoms?

From the Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland (A.N., A.B., U.E.); and the Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland (R.Z.).

Address correspondence and reprint requests to Ulrike Ehlert, PhD, Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurichbergstrasse 43, CH-8044 Zurich, Switzerland. E-mail: u.ehlert{at}psychologie.unizh.ch

Objective: The purpose of this study was to examine the association between psychobiological stress reactivity during healthy pregnancy and depressive symptoms in the early puerperium.

Methods: A sample of healthy nulliparous pregnant women (N = 57) between the ages of 21 and 35 years underwent a standardized psychosocial stress test during pregnancy. Within an average of 13 days after delivery, postpartum depressive symptoms were assessed using the German version of the Edinburgh postnatal depression scale (EPDS). The sample was divided into a group with probable cases (EPDS score >9, N = 16) and a group with probable noncases (EPDS score 9, N = 41).

Results: The probable case group showed significantly higher cortisol responses to the stress test compared with the probable noncase group, whereas baseline levels did not differ. Additionally, women in the probable case group showed significantly higher state anxiety and lower mood state throughout the experiment. Furthermore, the probable case group showed higher stress susceptibility, higher trait anxiety, and higher levels in the Symptom Checklist. No differences were found for prior episodes of psychiatric disorders, obstetrical complications, birth weight, or mode of delivery.

Conclusions: Our data provide evidence that healthy pregnant women developing postpartum depressive symptoms might already be identified during pregnancy by means of their higher cortisol reactivity and their higher psychological reactivity in response to psychosocial stress. Further investigations are required to explore whether higher psychobiological stress responses not only precede depressive symptoms within 2 weeks after birth, but might also predict postpartum major depression.

Key Words: cortisol • psychosocial stress • pregnancy • postpartum depressive symptoms

Abbreviations: ANOVA = analysis of variance; ANCOVA = analysis of covariance; AUC = area under the curve; HPA = hypothalamic–pituitary–adrenal; EPDS = Edinburgh Postnatal Depression Scale; MDBF = Multidimensional Mood Questionnaire; MESA = Stress Susceptibility Scale; SEM = standard error of means; SD = standard deviation; SCL90-R = Symptom-Checklist-90-Revised; STAI = State-Trait Anxiety Inventory; TSST = Trier Social Stress Test; VAS=Visual Analog Scale.

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