Broeks Carlinde W, Bais Babette, Van Rien, Bijma Hilmar H, van Rossum Elisabeth F C, Hoogendijk Witte J G, Lambregtse-Van den Berg Mijke P, Kamperman Astrid M
Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Arkin Institute for Mental Health, Amsterdam, the Netherlands.
Compr Psychoneuroendocrinol. 2025 Apr 28;23:100297. doi: 10.1016/j.cpnec.2025.100297. eCollection 2025 Aug.
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been linked to peripartum depression, potentially contributing to symptom persistence. This study examines the relationship between the cortisol awakening response (CAR) during pregnancy and depressive symptom reduction postpartum.
Pregnant women with a current depressive episode were included in this study, part of a larger RCT on bright light therapy. At baseline (12-32 weeks of pregnancy), participants provided saliva samples at awakening, +30, and +60 min post-awakening. The CAR was assessed using three measures: area under the curve relative to ground (AUCg), area under the curve relative to increase (AUCi), and peak reactivity (difference between awakening and +30 min cortisol levels). Depressive symptoms were measured using the Hamilton Depression Rating Scale (HAM-D) at baseline and two months postpartum. Linear regression models assessed associations between CAR measures and depressive symptom change, adjusting for relevant covariates.
The study included 55 pregnant women (mean age: 32.3 years, SD 4.8; mean gestational age: 19.7 weeks). Mean HAM-D scores decreased from 16.7 (SD 5.3) at baseline to 5.7 (SD 5.6) postpartum. Higher AUCi during pregnancy was associated with less symptom reduction postpartum (unadjusted β = 0.36, p = .02; adjusted β = 0.36, p = .02), as was peak cortisol reactivity (unadjusted β = 0.33, p = .03; adjusted β = 0.32, p = .03), while AUCg showed no significant association with symptom change (unadjusted p = .19; adjusted p = .28).
Higher AUCi and peak cortisol reactivity of the cortisol awakening response during pregnancy were linked to persistence of depressive symptoms postpartum, suggesting that heightened cortisol reactivity to awakening may indicate persistent stress vulnerability in peripartum depression. Total cortisol output (AUCg) was not predictive of recovery. These findings underscore the potential relevance of stress reactivity over basal cortisol levels in peripartum depression and highlight the need for further research in larger samples to elucidate the usefulness in clinical practice.
下丘脑 - 垂体 - 肾上腺（HPA）轴功能失调与围产期抑郁症有关，可能导致症状持续存在。本研究探讨孕期皮质醇觉醒反应（CAR）与产后抑郁症状减轻之间的关系。
本研究纳入了当前有抑郁发作的孕妇，这是一项关于强光疗法的大型随机对照试验的一部分。在基线期（妊娠12 - 32周），参与者在醒来时、醒来后30分钟和60分钟提供唾液样本。使用三种指标评估CAR：相对于基线的曲线下面积（AUCg）、相对于增加值的曲线下面积（AUCi）和峰值反应性（醒来时与醒来后30分钟皮质醇水平之差）。在基线期和产后两个月使用汉密尔顿抑郁量表（HAM-D）测量抑郁症状。线性回归模型评估CAR指标与抑郁症状变化之间的关联，并对相关协变量进行调整。
该研究纳入了55名孕妇（平均年龄：32.3岁，标准差4.8；平均孕周：19.7周）。HAM-D平均得分从基线时的16.7（标准差5.3）降至产后的5.7（标准差5.6）。孕期较高的AUCi与产后症状减轻较少有关（未调整β = 0.36，p = 0.02；调整后β = 0.36，p = 0.02），皮质醇峰值反应性也是如此（未调整β = 0.33，p = 0.03；调整后β = 0.32，p = 0.03），而AUCg与症状变化无显著关联（未调整p = 0.19；调整后p = 0.28）。
孕期皮质醇觉醒反应中较高的AUCi和皮质醇峰值反应性与产后抑郁症状的持续存在有关，这表明对觉醒的皮质醇反应性增强可能表明围产期抑郁症中存在持续的应激易感性。皮质醇总输出量（AUCg）不能预测恢复情况。这些发现强调了应激反应性相对于基础皮质醇水平在围产期抑郁症中的潜在相关性，并突出了在更大样本中进行进一步研究以阐明其在临床实践中的有用性的必要性。
