Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review.

BACKGROUND: Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. METHOD: A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. RESULTS: In total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. DISCUSSION AND CONCLUSION: Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.

Maternal Prenatal Mental Health and Placental 11ß-HSD2 Gene Expression: Initial Findings from the Mercy Pregnancy and Emotional Wellbeing Study.

High intrauterine cortisol exposure can inhibit fetal growth and have programming effects for the child's subsequent stress reactivity. Placental 11beta-hydroxysteroid dehydrogenase (11ß-HSD2) limits the amount of maternal cortisol transferred to the fetus. However, the relationship between maternal psychopathology and 11ß-HSD2 remains poorly defined. This study examined the effect of maternal depressive disorder, antidepressant use and symptoms of depression and anxiety in pregnancy on placental 11ß-HSD2 gene (HSD11B2) expression. Drawing on data from the Mercy Pregnancy and Emotional Wellbeing Study, placental HSD11B2 expression was compared among 33 pregnant women, who were selected based on membership of three groups; depressed (untreated), taking antidepressants and controls. Furthermore, associations between placental HSD11B2 and scores on the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale (EPDS) during 12-18 and 28-34 weeks gestation were examined. Findings revealed negative correlations between HSD11B2 and both the EPDS and STAI (r = -0.11 to -0.28), with associations being particularly prominent during late gestation. Depressed and antidepressant exposed groups also displayed markedly lower placental HSD11B2 expression levels than controls. These findings suggest that maternal depression and anxiety may impact on fetal programming by down-regulating HSD11B2, and antidepressant treatment alone is unlikely to protect against this effect.

Multiple bout rTMS on spatial working memory: a comparison study of two cortical areas.

It has been established that acute (within-session) repetitive transcranial magnetic stimulation (rTMS) improves spatial working memory (SWM). However, questions remain regarding the safety and effectiveness of multiple bouts of rTMS and the optimal cortical area to stimulate. This preliminary study investigated, in healthy participants, multiple bouts of rTMS over the dorsolateral pre-frontal cortex (DLPFC), or posterior parietal cortex (PPC) on SWM. Twenty participants (10m, 10f), all naïve to rTMS, where randomized into a DLPFC or PPC group, receiving six sessions of rTMS (5Hz at 80% of motor threshold) every second day over two weeks. Prior to and post rTMS bouts, all participants completed testing for SWM measuring individuals' accuracy, strategy, and speed. Following repeated bouts of rTMS, significant improvements were observed with no contraindications in stimulating PPC but not DLPFC. This preliminary study has demonstrated that repeated rTMS bouts improve SWM safety providing potential for clinical application.