ABSTRACT
INTRODUCTION: Some postpartum women experience intrusive thoughts of harming the infant. The hypothalamic-pituitary-adrenal (HPA) axis, which has been linked to postpartum depression, may play a role in the aetiology of postpartum thoughts of harming the infant. We aimed to study whether HPA axis hormones measured early postpartum are related to postpartum intrusive thoughts. METHOD: 132 women who delivered a child at a university hospital participated in a follow-up study with visits at 2-3 days postpartum and 8th week postpartum. Participants were assessed for trait anxiety, social support, peripartum or postpartum anxiety or depression, stressful life events and obstetric variables including perinatal complications and lactation. Postpartum thoughts of harming the infant were assessed with a semi-structured interview. Serum cortisol, and plasma CRH and ACTH levels were measured within 48 h postpartum at 8-9 AM. A logistic regression was performed to explore the relationship between clinical variables, hormonal measures and postpartum intrusive thoughts. RESULTS: Patients with postpartum thoughts of harming the infant had, when compared to those women without intrusive thoughts, higher ACTH levels (7.59 pmol/L vs 5.09 pmol/L, p<0.05) without significant differences in CRH or cortisol levels. In the logistic regression analysis, adjusted for breast-feeding and psychopathological status, only ln ACTH was associated with the presence of postpartum thoughts of harming the infant (OR=5.2, CI 95% 1.2-22.6, p=0.029). No other clinical variables were associated with postpartum intrusive thoughts. CONCLUSIONS: Our study suggests that a dysregulation of the hypothalamic-pituitary-adrenal axis may play a role in the aetiology of postpartum thoughts of harming the infant.
Subject(s)
Adrenocorticotropic Hormone/blood , Child Abuse/psychology , Mothers/psychology , Obsessive Behavior/physiopathology , Postpartum Period/psychology , Puerperal Disorders/physiopathology , Adrenocorticotropic Hormone/metabolism , Adult , Breast Feeding , Circadian Rhythm/physiology , Corticotropin-Releasing Hormone/blood , Depression/blood , Depression/physiopathology , Depression/psychology , Depression, Postpartum/blood , Depression, Postpartum/physiopathology , Depression, Postpartum/psychology , Female , Humans , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/physiopathology , Infant, Newborn , Interview, Psychological , Life Change Events , Obsessive Behavior/blood , Obsessive Behavior/psychology , Pituitary-Adrenal System/physiopathology , Postpartum Period/blood , Postpartum Period/physiology , Psychological Tests , Puerperal Disorders/blood , Puerperal Disorders/psychology , ThinkingABSTRACT
CONTEXT: Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear. OBJECTIVE: To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD. DESIGN: This was a prospective cohort study of depression-free women studied in the postpartum period. SETTING: Women who give birth at obstetric units in several general hospitals in Spain. PARTICIPANTS: A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism. MAIN OUTCOME MEASURES: We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP. RESULTS: Overall, the women in the study had low iron concentrations (8.8 ± 6.9 µmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 µg/L vs. 21.6 ± 13.5 µg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84-7.56; P = 0.0001 for ferritin cutoff value of 7.26 µg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD. CONCLUSIONS: These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.
Subject(s)
Depression, Postpartum/blood , Ferritins/blood , Postpartum Period/blood , Adult , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/psychology , Chi-Square Distribution , Depression, Postpartum/etiology , Female , Ferritins/physiology , Humans , Logistic Models , Postpartum Period/psychology , Prospective Studies , Psychiatric Status Rating Scales , Spain , Statistics, Nonparametric , Time FactorsABSTRACT
The emotional states of pregnant women affect the course of their pregnancies, their deliveries and the behaviour and development of their infants. The aim of this study is to analyse the influence of positive and negative maternal emotional states on neonatal behaviour at 2-3 days after birth. A sample of 163 healthy full-term newborns was evaluated using the Neonatal Behavioral Assessment Scale. Maternal anxiety, perceived stress, and emotional stability during pregnancy were evaluated in the immediate postpartum period with the State Trait Anxiety Inventory and the Perceived Stress Scale. Moderate levels of anxiety during pregnancy alter infant orientation and self-regulation. These aspects of infant behaviour could lead to later attachment, behavioural and developmental problems. Maternal emotional stability during pregnancy improves infant self-regulation and several aspects of infant behaviour that may predispose them to better interactions with their parents.
