Abstract
The hypothalamic-pituitary-adrenal axis, with cortisol as its final metabolite, has been proposed as a potential underlying biological mechanism for associations between depression and stress symptoms during pregnancy and adverse perinatal outcomes. In this study, we explored associations between salivary cortisol as a potential biomarker for stress and depressive symptoms and several self-completed psychological measurement scales among pregnant women. In total, 652 pregnant women participating in the PRegnancy and Infant DEvelopment (PRIDE) Study completed the Edinburgh Depression Scale (EDS), Patient Health Questionnaire-2 (PHQ-2), Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R), and Tilburg Pregnancy Distress Scale (TPDS) and collected a single awakening salivary cortisol sample around gestational week 17. Odds ratios, Spearman's correlation coefficients (ρs) and Cohen's Kappa coefficients (κ) were calculated to examine the associations between the EDS, PHQ-2, PRAQ-R, TPDS, and maternal cortisol levels. The overall correlation coefficient between the score on the EDS and the salivary cortisol level was 0.01 (p = 0.89) with κ = -0.01 (95% confidence interval [CI] -0.08-0.06). We did not observe agreement between the PHQ-2 and cortisol levels either (κ = 0.06 (95% CI -0.02-0.14)). The results for the PRAQ-R and TPDS were similar with overall correlations with maternal cortisol levels of ρs = 0.01 (p = 0.81) and ρs = 0.06 (p = 0.35) and agreements of κ = 0.02 (95% CI -0.06-0.09) and κ = -0.02 (95% CI -0.11-0.07), respectively. Maternal awakening salivary cortisol levels and measures of maternal psychological distress, anxiety, depressive symptoms, and pregnancy-related anxiety, assessed by self-completed questionnaires, did not seem to be related in mid-pregnancy.
Highlights
Depression and stress disorders during pregnancy have been associated with adverse effects on the health of the mother and the unborn child [1,2,3,4]
The study population included 91 women who scored positive on the Edinburgh Depression Scale (EDS), 78 who scored positive on the Pregnancy-Related Anxiety QuestionnaireRevised (PRAQ-R), 162 who scored positive on the Patient Health Questionnaire-2 (PHQ-2), and 27 who scored positive on the Tilburg Pregnancy Distress Scale (TPDS)
All women in the subgroup recorded that they completed the TPDS questionnaire and collected the saliva sample at the same day
Summary
We aimed to explore the associations between cortisol level as a potential biomarker and several different self-completed psychosocial measurement scales among pregnant women
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