Skip to main content

Advertisement

Log in

Altered stress patterns and increased risk for postpartum depression among low-income pregnant women

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adam E, Doane E, Zinbarg E, Mineka S, Craske M, Griffith J (2010) Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence. Psychoneuroendocrinology 35(6):921–931. doi:10.1016/j.psyneuen.2009.12.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Adam E, Kumari M (2009) Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology 34(10):1423–36

    Article  CAS  PubMed  Google Scholar 

  • Bloch M, Rubinow D, Schmidt P, Lotsikas A, Chrousos G, Cizza G (2005) Cortisol response to ovine corticotropin-releasing hormone in a model of pregnancy and parturition in euthymic women with and without a history of postpartum depression. J Clin Endocrinol Metabol 90(2):695–699. doi:10.1210/jc.2004-1388

    Article  CAS  Google Scholar 

  • Burke H, Fernald L, Gertler P, Adler N (2005) Depressive symptoms are associated with blunted cortisol stress responses in very low-income women. J Psychother Psychosom Med 67(2):211–216

    CAS  Google Scholar 

  • Centers for Disease Control and Prevention. (2010). Depression among women of productive age. Retrieved from http://www.cdc.gov/reproductivehealth/Depression/index.htm

  • Chandra P, Venkatasubramanian G, Thomas T (2002) Infanticidal ideas and infanticidal behavior in Indian woman with severe postpartum psychiatric disorders. J Educ Urban Soc 36(2):130–149

    Google Scholar 

  • Chapa J, De La Rosa D (2004) Latino population growth, socioeconomic and demographic characteristics and implications for educational attainment. J Biol Psychol 80:265–278

    Google Scholar 

  • Chida Y, Steptoe A (2009) Cortisol awakening response and psychosocial factors: a systematic review. J Nerv Ment Dis 190:457–461. doi:10.1016/j.biopsycho.2008.10.004

    Google Scholar 

  • Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  CAS  PubMed  Google Scholar 

  • Corwin E, Pajer K (2008) The psychoneuroimmunology of postpartum depression. J Womens Health 17(9):1529–1534. doi:10.1089/jwh.2007.0725

    Article  Google Scholar 

  • Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatr 150:782–786

    Article  CAS  Google Scholar 

  • Crowley P (2000) Prophylactic corticosteroids for preterm birth. The Cochrane Database of Systematic Reviews 1, CD000065. doi:10.1002/14651858

    Google Scholar 

  • Dayan J, Creveuil C, Marks M, Conroy S, Herlicoviez M, Dreyfus M, Tordjman S (2006) Prenatal depression, prenatal anxiety and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68:938–946. doi:10.1097/01.psy.0000244025. 20549.bd

    Article  PubMed  Google Scholar 

  • Dedovic K, Engert V, Duchesne A, Damika Lue S, Andrews J, Efanov S, Beaudry T, Pruessner J (2006) Prenatal depression, prenatal anxiety and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68:938–946. doi:10.1016/j.biopsych.2010.07.025

    Article  Google Scholar 

  • Dressendörfer R, Kirschbaum C, Rohde W, Strasburger C (1992) Synthesis of a cortisol-biotin conjugate and evaluation as a tracer in an immunoassay for salivary cortisol measurement. J Steroid Biochem Mol Biol 43(7):683–692

    Article  PubMed  Google Scholar 

  • Fiorentino L, Saxbe D, Alessia C, Woods D, Martin J (2012) Diurnal cortisol and functional outcomes in post-acute rehabilitation patients. J Gerontol Med Sci 67A(6):677–682. doi:10.1093/gerona/glr230

    Article  CAS  Google Scholar 

  • Gavin N, Gaynes B, Lohr K, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. J Obstet Gynaecol 106(5):1071–1083. doi:10.1097/01.AOG.0000183597.31630.db

    Article  Google Scholar 

  • Giesbrecht G, Campbell T, Letourneau N, Kooistra L, Kaplan B, APrON Study Team (2012) Psychological distress and salivary cortisol covary within persons during pregnancy. Psychoneuroendocrinology 37(2):270–279. doi:10.1016/j.psyneuen.2011.06.011

    Article  CAS  PubMed  Google Scholar 

  • Glynn L, Dunkel Schetter C, Hobel C, Sandman C (2001) Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychol 27(1):43–51. doi:10.1037/0278-6133.27.1.43

    Article  Google Scholar 

  • Glynn L, Davis E, Sandman C (2013) New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides 47:363–370. doi:10.1016/j.npep.2013.10.07

    Article  CAS  PubMed  Google Scholar 

  • Goodyear I, Croudace T, Dudbridge F, Ban M, Herbert J (2010) Polymorphisms in BDNF (Val66Met) and 5-HTTLPR, morning cortisol and subsequent depression in at-risk adolescents. Br J Psychiatr 197(5):365–371. doi:10.1192/bjp.bp.110.077750 DOI:10.1192%2Fbjp.bp.110.077750

  • Gröschl M, Wagner R, Rauh M, Dörr HG (2001) Stability of salivary steroids: the influences of storage, food, and dental care. Steroids 66:737–741

    Article  PubMed  Google Scholar 

  • Hahn-Holbrook J, Haselton M, Dunkel Schetter C, Glynn L (2013) Does breastfeeding offer protection against maternal depressive symptomology? Arch Womens Ment Health 16(5):411–422. doi:10.1007/s00737-013-0348-9

    Article  PubMed  Google Scholar 

  • Herbert J, Ban M, Brown G, Harris T, Ogilvie A, Uher R, Craig T (2012) Interaction between the BDNF gene Val/66/Met polymorphism and morning cortisol levels as a predictor of depression in adult women. Br J Psychiatry 201(4):313–319. doi:10.1192/bjp.bp.111.107037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hubner-Liebermann B, Hausner H, Wittmann M (2012) Recognizing and treating peripartum depression. Deutsches Ärzteblatt International Dtsch Arztebl International 109(24):419–424. doi:10.3238/arztebl.2012.0419

    Google Scholar 

  • Jarcho M, Slavich G, Tylova-Stein H, Wolkowitz O, Burke H (2013) Disregulated diurnal cortisol pattern is associated with glucocorticoid resistance in women with major depressive disorder. Biol Psychol 93:150–158. doi:10.1016/j.biopsycho.2013.01.018

    Article  PubMed  PubMed Central  Google Scholar 

  • Kammerer M, Taylor A, Glover V (2006) The HPA axis and perinatal depression: a hypothesis. Arch Womens Ment Health 9:187–196

    Article  CAS  PubMed  Google Scholar 

  • Kapoor A, Dunn E, Kostaki A, Andrews M, Matthews S (2006) Fetal programming of hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids. J Physiol 572:31–44. doi:10.1113/jphysiol.2006.105254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Karacam Z, Kitis Y (2008) The postpartum depression screening scale: its reliability and validity for the Turkish population. Turkish J Psychiatr 19(2):187–196

    Google Scholar 

  • Kivlighan K, DiPietro J, Costigan K, Laudenslager M (2008) Diurnal rhythm of cortisol during late pregnancy: associations with maternal psychological well-being and fetal growth. Psychoneuroendocrinology 33(9):1225–1235. doi:10.1016/j.psyneuen.2008.06.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Knight J, Avery E, Janssen I, Powell L (2010) Cortisol and depressive symptoms in a population-based cohort of midlife women. Psychosom Med 72(9):855–861. doi:10.1097/PSY.0b013e3181f4ab87

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lamers F, Vogelzangs N, Merikangas K, de Jonge P, Beekman A, Penninx B (2012) Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. J Mol Psychiatr 18:692–699

    Article  Google Scholar 

  • Mangold D, Marino E, Javors M (2011) The Cortisol awakening response predicts subclinical depressive symptomology in Mexican American adults. J Psychiatr Res 45(7):902–909. doi:10.1016/j.jpsychires.2011.01.001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Marucs S, Lopez J, McDonough S, MacKenzie M, Flynn H, Neal C, Gahagan S, Volling B, Kaciroti N, Vazquez D (2011) Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes. Infant Behav Dev 34(1):26–34. doi:10.1016/j.infbeh.2010.07.002

    Article  Google Scholar 

  • Meinlschmidt G, Martin C, Neumann I, Henrichs M (2010) Maternal cortisol in late pregnancy and hypothalamic-pituitary-adrenal reactivity to psychosocial stress postpartum in women. Informa Healthcare Stress Journal 13(2):163–171. doi:10.3109/10253890903128632

  • O’Connor T, Tang W, Gilchrist M, Moynihan J, Pressman E, Roberston Blackmore E (2014) Diurnal cortisol patterns and psychiatric symptoms in pregnancy: short-term longitudinal study. Biol Psychol 96:35–41. doi:10.1016/j.biopsycho.2013.11.002

    Article  PubMed  Google Scholar 

  • O’Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos A, Seneviratne G, Taylor A, Moore R (2011) Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to postpartum ‘blues’. J Neuroendocrinol 23(11):1149–1155. doi:10.1111/j.1365-2826.2011.02139.x

    Article  PubMed  Google Scholar 

  • Pedersen CA, Stern RA, Pate J, Senger MA, Bowes WA, Mason GA (1993) Thyroid and adrenal measures during late pregnancy and the puerperium in women who have major depression or who become dysphoric postpartum. J Affect Disord 29:201–211

    Article  CAS  PubMed  Google Scholar 

  • Rosmond R, Bjorntorp P (2000) The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 247:188–197. doi:10.1046/j.1365-2796.2000.00603.x

    Article  CAS  PubMed  Google Scholar 

  • Slattery D, Neumann I (2008) No stress please! Mechanisms of stress hyporesponsiveness of the maternal brain. J Physiol 582(2):377–385. doi:10.1113/jphysiol.2007.145896

    Article  Google Scholar 

  • Staufenbiel S, Penninx B, Spijker A, Elzinga B, van Rossum E (2013) Hair cortisol, stress exposure, and mental health in humans: a systematic review. Psychoneuroendocrinology 38:1220–1235. doi:10.1016/j.psyneuen.2012.11.015

    Article  CAS  PubMed  Google Scholar 

  • Stetler C, Dickerson S, Miller G (2004) Uncoupling of social zeitgebers and diurnal cortisol secretion in clinical depression. Psychoneuroendocrinology 29(10):1250–1259. doi:10.1016/j.psyneuen.2004.03.003

    Article  CAS  PubMed  Google Scholar 

  • Taylor A, Glover V, Marks M, Kammerer M (2009) Diurnal pattern of cortisol output in postnatal depression. Psychoneuroendocrinology 34:1184–1188. doi:10.1016/j.psyneuen.2009.03.004

    Article  CAS  PubMed  Google Scholar 

  • Urizar G, Muñoz R (2011) Impact of prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants. Psychoneuroendocrinology 36(10):1480–1494. doi:10.1016/j.psyneuen.2011.04.002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Urizar G, Perian T, Dunkel Schetter C, Yim I (2014) Impact of a prenatal cognitive behavioral stress management intervention on maternal stress and mood outcomes during pregnancy: the SMART Moms Project. Psychosom Med 76(3):A72

    Google Scholar 

  • Willner C, Morris P, Charles McCoy D, Adam E (2014) Diurnal cortisol rhythms in youth from risky families: effects of cumulative risk exposure and variation in the serotonin transporter linked polymorphic region gene. Dev Psychol J 26:999–1019. doi:10.1017/S0954579414058

  • Wilhelm I, Born J, Kudielka B, Scholtz W, Wust S (2007) Is the cortisol awakening rise a response to awakening? Psychoneuroendocrinology 32(4):358–366. doi:10.1016/j.psyneuen.2007.01.008

    Article  CAS  PubMed  Google Scholar 

  • Yim I, Glynn L, Dunkel Schetter C, Hobel C, Chicz-DeMet A, Sandman C (2009) Elevated corticotrophin-releasing hormone in human pregnancy increases the risk of postpartum depressive symptoms. Arch Gen Psychiatry 66(2):162–169. doi:10.1001/archgenpsychiatry.2008.533

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Kathryn Scheyer and Guido G. Urizar Jr. are in the Department of Psychology, California State University, Long Beach. This study was conducted as part of a collaboration between the Partners in Research and Outreach for Health (PRO-Health) Research Lab (Guido G. Urizar Jr., Director), St. Mary Medical Center (Miguel Gutierrez, Director), and the African American Infant Health Program at the Long Beach Department of Health and Human Services (Pamela Shaw, Director). Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number SC2HD068878 (Guido G. Urizar Jr., PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors gratefully acknowledge the contributions of Yasmin Kofman, Janessa Cuomo, Crystal Tandler, and the other members of the PRO-Health Research Lab for their instrumental support in data collection. The authors would also like to thank Chi-Ah Chun, Ph.D. and Ilona Yim, Ph.D. for reviewing a previous version of this manuscript, as well as Nicolas Rohleder, Ph.D. for conducting the cortisol assays. This publication is based on the first author’s undergraduate honors thesis at California State University, Long Beach.

Correspondence concerning this article should be addressed to Guido G. Urizar Jr., Ph.D., Psychology Department, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA 90840-0901 (email: guido.urizar@csulb.edu).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guido G. Urizar Jr.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scheyer, K., Urizar, G.G. Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Arch Womens Ment Health 19, 317–328 (2016). https://doi.org/10.1007/s00737-015-0563-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-015-0563-7

Keywords

Navigation