Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark.
Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Psychoneuroendocrinology. 2024 Jul;165:107048. doi: 10.1016/j.psyneuen.2024.107048. Epub 2024 Apr 13.
The dynamic capacity of the hypothalamic-pituitary-adrenal (HPA) axis supports healthy adaptions to stress and play a key role in maintaining mental health. Perinatal adaptations in the HPA-axis dynamics in terms of the Cortisol Awakening Response (CAR), may be involved in dysregulation of perinatal mental health. We aimed to determine if CAR and absolute evening cortisol early postpartum differed from non-perinatal women and evaluate the association between the CAR and maternal mental well-being.
The CAR was computed as the area under the curve with respect to increase from baseline from serial home-sampling of saliva across 0-60 minutes from awakening. We evaluated differences in CAR and absolute evening cortisol between postpartum women (N=50, mean postpartum days: 38, SD: ±11) and non-perinatal women (N=91) in a multiple linear regression model. We also evaluated the association between CAR and maternal mental well-being in a multiple linear regression model.
We found that healthy postpartum women had a blunted CAR (p<0.001) corresponding to 84% reduction and 80% lower absolute evening cortisol (p<0.001) relative to non-perinatal healthy women. In the postpartum group, there was a trend-level association between lower CAR and higher scores on the WHO Well-Being Index (WHO-5) (p=0.048) and lower Edinburgh Postnatal Depression Scale (EPDS) scores (p=0.04).
Our data emphasize the unique hormonal landscape during the postpartum period in terms of blunted CAR and lower absolute evening cortisol in healthy women early postpartum compared to non-perinatal. Our findings show a potential association between a reduced CAR and improved mental well-being during early motherhood, which suggests that reduced CAR might reflect healthy adjustment to early motherhood.
下丘脑-垂体-肾上腺（HPA）轴的动态能力支持健康适应压力，并在维持心理健康方面发挥关键作用。HPA 轴动力学中皮质醇觉醒反应（CAR）的围产期适应性可能与围产期心理健康失调有关。我们旨在确定产后妇女的 CAR 和绝对傍晚皮质醇是否与非围产期妇女不同，并评估 CAR 与产妇心理健康之间的关联。
通过从觉醒后 0-60 分钟内连续在家中采集唾液，计算 CAR 作为基线增加的曲线下面积。我们在多元线性回归模型中评估了产后妇女（N=50，产后天数平均值：38，SD：±11）和非围产期妇女（N=91）之间 CAR 和绝对傍晚皮质醇的差异。我们还在多元线性回归模型中评估了 CAR 与产妇心理健康之间的关联。
我们发现，健康的产后妇女的 CAR 减弱（p<0.001），对应于与非围产期健康妇女相比，CAR 降低了 84%，绝对傍晚皮质醇降低了 80%。在产后组中，CAR 较低与 WHO 幸福指数（WHO-5）评分较高（p=0.048）和爱丁堡产后抑郁量表（EPDS）评分较低（p=0.04）之间存在趋势关联。
我们的数据强调了产后期间独特的荷尔蒙景观，与非围产期相比，产后早期健康妇女的 CAR 减弱和绝对傍晚皮质醇降低。我们的发现表明，CAR 减少与早期母亲身份期间的心理健康改善之间存在潜在关联，这表明 CAR 减少可能反映了对早期母亲身份的健康适应。
