Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II

Harris B; Lovett L; Newcombe RG; Read GF; Walker R; Riad-Fahmy D

doi:10.1136/bmj.308.6934.949

Postpartum Mental Health

Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II

Harris B, Lovett L, Newcombe RG, Read GF, Walker R, Riad-Fahmy D

Published April 9, 1994 BMJ (Clinical Research Ed.), 308(6934), 949-953

DOI 10.1136/bmj.308.6934.949 PMID 8173402 PMC PMC2539811

RRM Academy Synopsis

Blues after a first birth are linked to a fall in progesterone

A Cardiff cohort study of 120 first-time mothers found maternity blues were linked to a steeper fall in progesterone after delivery. Researchers tested saliva from two weeks before delivery to 35 days after. Cortisol showed no significant link with mood.

Key Findings

Maternity blues scores peaked on day five after delivery, with a mean of 5.3 on the Stein scale (P < 0.02 against other postpartum days).
Women with blues (a peak Stein score of 8 or more) had higher progesterone the day before delivery (P = 0.03). They had lower progesterone ten days postpartum (P = 0.048).
On the day of peak blues score, progesterone had fallen further from its prenatal level in women with blues than in women without (P = 0.006).
Cortisol was not significantly associated with mood, and plasma hormone measures showed no association with blues.

Interpretation

The study followed first-time mothers at one Cardiff hospital. Women with major marital, financial or medical problems or cesarean deliveries were excluded, leaving 120 vaginal deliveries. The study reports associations between hormone levels and mood scores, which the authors call weak but significant. Saliva measures the free, active part of progesterone, and the association appeared there. Total progesterone in blood showed none, possibly because only a small part of it is active, the authors say. The authors suggest that breakdown products of progesterone may relate to blues more closely than progesterone itself.

RRM Context

Restorative reproductive medicine treats the body's own progesterone as a signal worth reading. Progesterone rises through pregnancy and drops sharply after the placenta is delivered. The authors link that drop to mood in the first days after birth. They call for research on progesterone breakdown products and on progesterone treatment of blues.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objectives

To define relation between mood and concentrations of progesterone and cortisol during perinatal period to test hypothesis that rapid physiological withdrawal of steroid hormones after delivery is associated with depression.

Design

Prospective study of primiparous women from two weeks before expected date of delivery to 35 days postpartum.

Setting

Antenatal clinic in university hospital, obstetric inpatient unit, patients' homes.

Subjects

120 of 156 primiparous women interviewed. Remainder excluded because of major marital, socioeconomic, or medical problems or because caesarean section required.

Main Outcome Measures

Concentrations of progesterone and cortisol in saliva samples; women's moods assessed by various scores for depression.

Results

Changes in salivary progesterone and cortisol concentrations were similar to those already characterised for plasma. Peak mean score for maternity blues (5.3 on Stein scale) was on day five postpartum (P < 0.02 compared with mean scores on other postpartum days). High postpartum scores for maternity blues were associated with high antenatal progesterone concentrations on day before delivery (P < 0.05), with high rate of rise of antenatal progesterone concentrations (P < 0.05), with decreasing progesterone concentrations from day of delivery to day of peak blues score (P > or = 0.01), and with low progesterone concentrations on day of peak blues score (P < 0.01). Seventy eight women were designated as having maternity blues (peak score > or = 8 on Stein scale) while 39 had no blues. Women with blues had significantly higher antenatal progesterone concentrations and lower postnatal concentrations than women without blues (geometric mean progesterone concentrations: one day before delivery 3860 pmol/l v 3210 pmol/l respectively, P = 0.03; ten days postpartum 88 pmol/l v 114 pmol/l, P = 0.048). Cortisol concentrations were not significantly associated with mood.

Conclusion

Maternal mood in the days immediately after delivery is related to withdrawal of naturally occurring progesterone.

Topics

Postpartum › Mental Health › Postpartum Depression · Reproductive Endocrinology › Neuroendocrinology › Hypothalamic Pituitary Axis

Brian Harris

B Harris

PMID 8173402 8173402 DOI 10.1136/bmj.308.6934.949 10.1136/bmj.308.6934.949 Harris et al. 1994, Harris 1994

Keywords

Adult, Affect, Depression/etiology/psychology, Female, Humans, Hydrocortisone/analysis/blood, Pregnancy, Progesterone/analysis/blood, Prospective Studies, Psychometrics, Puerperal Disorders/etiology/psychology, Saliva/chemistry, Progesterone, Hydrocortisone

Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II

Blues after a first birth are linked to a fall in progesterone

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords