Bruce Katharine E, Wouk Kathryn, Grewen Karen M, Pearson Brenda, Meltzer-Brody Samantha, Stuebe Alison M, Bauer Anna E
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, USA; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, USA.
Pacific Institute for Research and Evaluation, USA.
Psychoneuroendocrinology. 2025 Feb;172:107253. doi: 10.1016/j.psyneuen.2024.107253. Epub 2024 Nov 27.
Hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been implicated in the pathogenesis of perinatal mood disorders. Further, HPA axis response is known to be blunted during breastfeeding. We hypothesized that 1) postpartum depression/anxiety symptoms would be associated with HPA axis dysregulation, indexed by loss of expected adrenocorticotropic hormone (ACTH)-cortisol coupling, and 2) this association would vary by method of infant feeding.
Participants (N=222) intending to breastfeed were recruited in their 3rd trimester of pregnancy. During a lab visit at 2 months postpartum, depression and anxiety symptoms were assessed (Beck Depression Inventory score ≥14 and/or Speilberger State-Trait Anxiety Inventory score ≥40). Participants then breast or bottle-fed their infants as they would at home. After a 10-minute rest, participants completed the Trier Social Stress Test (TSST), a standardized stressor involving speech and math tasks. Blood ACTH and cortisol were measured 10 minutes after feeding, during each task, and at 10, 20, and 30 minutes of recovery. Multilevel models evaluated whether coupling of ACTH at time j with cortisol at time j+1 differed between those with and without depression/anxiety symptoms, and whether differences varied by feeding method.
Of 205 participants who completed the TSST, 44 had depression/anxiety symptoms at 2-months postpartum. Depression/anxiety symptoms were associated with reduced ACTH-cortisol coupling (adjusted beta: -0.03; p-value: 0.03). Among those who breastfed, those with depression/anxiety showed greater blunting of ACTH-cortisol coupling than those without (adjusted beta: -0.04; p-value: 0.02), while those who bottle-fed had similar coupling patterns regardless of depression/anxiety symptoms (adjusted beta: -0.01; p-value: 0.87).
HPA axis response was blunted in those with postpartum depression/anxiety symptoms, and blunting varied by method of infant feeding. Findings support HPA axis dysregulation in perinatal mood and anxiety disorders. Future research should explore how method of infant feeding influences the relationship between perinatal mood disorders and HPA axis dysregulation. Elucidating the mechanistic pathways underlying perinatal mood disorders can aid in the development of better diagnostic and treatment strategies.
下丘脑 - 垂体 - 肾上腺（HPA）轴功能失调与围产期情绪障碍的发病机制有关。此外，已知母乳喂养期间HPA轴反应会减弱。我们假设：1）产后抑郁/焦虑症状与HPA轴功能失调有关，以预期促肾上腺皮质激素（ACTH） - 皮质醇偶联丧失为指标；2）这种关联会因婴儿喂养方式而异。
招募了222名打算母乳喂养的孕妇，她们处于妊娠晚期。在产后2个月的实验室访视期间，评估抑郁和焦虑症状（贝克抑郁量表评分≥14分和/或斯皮尔伯格状态 - 特质焦虑量表评分≥40分）。然后，参与者按照在家中的方式用母乳喂养或奶瓶喂养婴儿。休息10分钟后，参与者完成了特里尔社会应激测试（TSST），这是一项涉及言语和数学任务的标准化应激源。在喂养后10分钟、每项任务期间以及恢复的10、20和30分钟测量血液中的ACTH和皮质醇。多水平模型评估了在有和没有抑郁/焦虑症状的人群中，j时刻的ACTH与j + 1时刻的皮质醇偶联是否存在差异，以及这种差异是否因喂养方式而异。
在完成TSST的205名参与者中，44人在产后2个月有抑郁/焦虑症状。抑郁/焦虑症状与ACTH - 皮质醇偶联减少有关（调整后的β值： - 0.03；p值：0.03）。在母乳喂养的人群中，有抑郁/焦虑症状的人比没有症状的人ACTH - 皮质醇偶联的减弱更明显（调整后的β值： - 0.04；p值：0.02），而用奶瓶喂养的人无论有无抑郁/焦虑症状，其偶联模式相似（调整后的β值： - 0.01；p值：0.87）。
产后抑郁/焦虑症状患者的HPA轴反应减弱，且减弱程度因婴儿喂养方式而异。研究结果支持围产期情绪和焦虑障碍中HPA轴功能失调的观点。未来的研究应探讨婴儿喂养方式如何影响围产期情绪障碍与HPA轴功能失调之间的关系。阐明围产期情绪障碍的机制途径有助于开发更好的诊断和治疗策略。
