Trinity Health Sciences Building, Tallaght Hospital (AMNCH), Dublin, Ireland.
J Neuroendocrinol. 2011 Nov;23(11):1149-55. doi: 10.1111/j.1365-2826.2011.02139.x.
Most women experience time-limited and specific mood changes in the days after birth known as the maternity blues (Blues). The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes gradual changes during pregnancy because of an increasing production of placental corticotrophin-releasing hormone (CRH). The abrupt withdrawal of placental CRH at birth results in a re-equilibration of the maternal HPA axis in the days post-delivery. These changes may be involved in the aetiology of the Blues given the central role of the HPA axis in the aetiology of mood disorders in general, and in perinatal depression in particular. We aimed to test the novel hypothesis that the experience of the Blues may be related to increased secretion of hypothalamic adrenocorticotrophic hormone (ACTH) secretagogue peptides, after the reduction in negative-feedback inhibition on the maternal hypothalamus caused by withdrawal of placental CRH. We therefore examined hormonal changes in the HPA axis in the days after delivery in relation to daily mood changes: our specific prediction was that mood changes would parallel ACTH levels, reflecting increased hypothalamic peptide secretion. Blood concentrations of CRH, ACTH, cortisol, progesterone and oestriol were measured in 70 healthy women during the third trimester of pregnancy, and on days 1-6 post-delivery. Blues scores were evaluated during the postpartum days. Oestriol, progesterone and CRH levels fell rapidly from pregnancy up to day 6, whereas cortisol levels fell modestly. ACTH concentrations declined from pregnancy to day 3 post-delivery and thereafter increased up to day 6. Blues scores increased, peaking on day 5, and were positively correlated with ACTH; and negatively correlated with oestriol levels during the postpartum days, and with the reduction in CRH concentrations from pregnancy. These findings give indirect support to the hypothesis that the 'reactivation' of hypothalamic ACTH secretagogue peptides may be involved in the aetiology of the Blues.
大多数女性在产后数天内会经历短暂的、特定的情绪变化，这种现象被称为产后忧郁（ Blues ）。在怀孕期间，由于胎盘促肾上腺皮质激素释放激素（CRH）的不断产生，母体下丘脑-垂体-肾上腺（HPA）轴逐渐发生变化。产后胎盘 CRH 的突然停止会导致产后数天内母体 HPA 轴的重新平衡。鉴于 HPA 轴在一般情绪障碍的发病机制中，特别是在围产期抑郁症中的核心作用，这些变化可能与 Blues 的发病机制有关。我们的目的是检验一个新的假说，即产后忧郁的发生可能与产后由于胎盘 CRH 的停止而导致的对下丘脑的负反馈抑制作用的减弱，导致下丘脑促肾上腺皮质激素释放激素（ACTH）分泌肽的分泌增加有关。因此，我们研究了产后 HPA 轴的激素变化与每日情绪变化的关系：我们的具体预测是，情绪变化将与 ACTH 水平平行，反映下丘脑肽分泌的增加。我们在 70 名健康女性怀孕期间的第 3 个三个月，以及产后第 1-6 天，测量了 HPA 轴的 CRH、ACTH、皮质醇、孕酮和雌三醇的血液浓度。在产后期间评估 Blues 评分。雌三醇、孕酮和 CRH 水平从怀孕迅速下降到第 6 天，而皮质醇水平略有下降。ACTH 浓度从怀孕下降到产后第 3 天，然后在第 6 天增加。 Blues 评分增加，在第 5 天达到峰值，与 ACTH 呈正相关；与产后雌三醇水平呈负相关，与怀孕时 CRH 浓度的下降呈负相关。这些发现间接支持了这样的假说，即下丘脑 ACTH 分泌肽的“再激活”可能与 Blues 的发病机制有关。
