Presented at the Society for Maternal Fetal Medicine, Las Vegas, NV, February 2019.

Alison M. Stuebe, Samantha Meltzer-Brody, Roger Mills-Koonce, Brenda Pearson, Julia Whitley, Karen Grewen

Objective: Oxytocin has been shown to blunt the HPA axis response to stressors. We conducted a longitudinal prospective cohort study to test the hypothesis that perinatal mood disorders are associated with dysregulation of the effects of breastfeeding, a physiologic stimulus for oxytocin, on maternal HPA axis activity.

Study Design: Women intending to breastfeed were recruited in the 3rd trimester of pregnancy. Psychiatric history was assessed at enrollment via Structured Clinical Interview, with oversampling of women with past or current anxiety or depression. Women with an active psychiatric diagnosis at enrollment comprised the prenatal depression/anxiety (PNDA) group. At 2 months postpartum, dyads attended a lab visit. Following peripheral IV placement, women chose to breast or bottle-feed their infants, as they would at home. After a 10-minute post-feed rest, women participated in the Trier Social Stress Test (TSST), a standardized social stressor that includes a speech task and a math task. Blood samples for Cortisol (CRT) were collected 10 minutes after feeding, during the speech and math tasks, and at 10, 20 and 30 minutes of recovery. Repeated measures analysis was used to test the extent to which infant feeding (breast vs. bottle) and PNDA or current depression symptoms, indexed by Beck Depression Inventory >11, were associated with CRT levels during the TSST. P values <0.05 were considered statistically significant.

Results: A total of 222 women were enrolled; 208 completed the 2-month visit, of whom 175 breastfed before the TSST (84.1%). PNDA modified the association between feeding type and CRT levels (group p=0.02, group x time p =0.07) , adjusting for current antidepressant use (figure). We similarly found that current depression symptoms modified the association between feeding type and CRT levels (group p=0.05, group x time p =0.02), adjusting for current antidepressant use. Women with perinatal mood symptoms who were bottle-feeding had the highest CRT levels during the TSST, whereas women with PNDA who were breastfeeding had the lowest CRT levels.

Conclusion: Among women with PNDA, we found larger infant-feeding associated differences in HPA axis response than among women without PNDA. Dysregulation of oxytocin’s effect on HPA axis reactivity may play a role in the pathophysiology of perinatal mood disorders.

Presented at the Society for Maternal Fetal Medicine, Las Vegas, NV, February 2019

Alison M. Stuebe, Samantha Meltzer-Brody, Roger Mills-Koonce, Brenda Pearson, Julia Whitley, Karen Grewen

Objective: We conducted a longitudinal prospective cohort study to test the hypothesis that perinatal depression is associated with reduced oxytocin during mother-infant interaction.

Study Design: Women intending to breastfeed were recruited in the 3rd trimester of pregnancy. Psychiatric history was assessed at enrollment via Structured Clinical Interview, with oversampling of women with a history or current diagnosis of major depressive disorder or anxiety disorders. Women with an active psychiatric diagnosis at enrollment comprised the prenatal depression/anxiety (PNDA) group. Dyads attended lab visits for a feeding session at 2 and 6 months postpartum; mothers fed their infants as they would at home. Venous maternal blood samples were collected via antecubital IV at baseline, at minutes 1, 4, 7, and 10 of feeding, and 10 minutes after feeding. OT levels were determined by enzyme immunoassay with extraction. Mood symptoms were quantified using the Beck Depression Inventory-II (BDI-II), the Spielberg State-Trait Anxiety Inventory (STAI), and the Edinburgh Postnatal Depression Scale (EPDS). Repeated measures analyses were used to compare OT levels by feeding type and PNDA, adjusting for current symptom score and antidepressant use. P values <.05 were considered statistically significant.

Results: A total of 222 women were enrolled, of whom 208 completed the 2-month visit and 204 completed the 6-month visit. During the 2 month visit, 84.1% breastfed (N=175), and at 6 months, 70.6% breastfed (N=144). Women without PNDA were more likely to breastfeed at the 6 month visit (74.5 vs. 61.0%, p=0.06). At 2 months postpartum, OT levels were highest among breastfeeding women with PNDA and lowest among bottle-feeding women with PNDA, adjusting for current mood symptoms and antidepressant use (group p=0.07, group x time p =0.001, figure). We similarly found that PNDA modified the association between feeding and OT levels at 6 months, adjusting for current mood symptoms and antidepressant use (group p=0.002, group x time p=0.0002, figure).

Conclusion: At 2 months, breastfeeding women with PNDA had the highest OT levels, whereas bottle-feeding women with PNDA had the lowest OT levels. We speculate that this differential OT response to infant feeding may mediate associations between depression and early weaning.

Presented at the Society for Maternal Fetal Medicine, Las Vegas, NV, February 2019.

Alison Goulding, Karen Grewen, Samantha Meltzer-Brody, Brenda Pearson, Alison Stuebe

Objective: We sought to examine the association between traumatic birth and measures of mood and parenting stress through 12 months postpartum.

Study Design: We conducted a secondary analysis of participants in the Mood, Mother and Infant (MMI) Study. Women intending to breastfeed were recruited in the 3rdtrimester for a longitudinal cohort study, oversampling for women with current/past depression or anxiety.  A structured clinical interview was performed at baseline to assess for history or current diagnosis of major depressive or anxiety disorders. Baseline anxiety and depression symptoms were measured using the Beck Depression Inventory (BDI) and the Spielberger State-Trait Anxiety Inventory (STAI). Mood was measured at baseline and monthly with the Edinburgh Postnatal Depression Scale (EPDS), and at 2, 6, and 12 months postpartum with the BDI, STAI, and Parenting Stress Index (PSI). Maternal post-traumatic stress disorder (PTSD) symptoms were assessed at 2 months postpartum using the modified Perinatal PTSD Questionnaire (PPQ); birth PTSD was defined using the established threshold of PPQ score ≥ 19. We used repeated measures analysis to quantify the association between birth PTSD and postpartum mood and parenting stress through 12 months postpartum, adjusting for prenatal PPD risk and mood symptoms.

Results: Data were available from 209 women, of whom 15 (7.2%) had birth PTSD. Compared to women without birth PTSD, these women had higher prenatal STAI-Trait (mean 45.1 vs. 33.6, p=0.01) and BDI (mean 18.4 vs. 8.6, p<0.01) scores. In repeated measures analysis adjusting for prenatal STAI-Trait score, BDI score and PPD risk status, we found that birth PTSD was independently associated with higher postpartum EPDS (group p=0.03, group x time p=0.01), BDI (group p<0.0001), state anxiety (group p=0.002, group x time p=0.01) and PSI (group p=0.002) scores through 12 months postpartum.

Conclusions: In our sample, 7% of women had birth PTSD. A traumatic birth experience was associated with postpartum anxiety and depression symptoms and parenting stress, independent of prenatal risk. These findings support efforts to minimize traumatic experiences during childbirth, and to provide additional support to women who endorse PTSD symptoms following birth.