Bibian van der Voorn

52 CHAPTER 4 ABSTRACT BACKGROUND Maternal stress during pregnancy has been associated with unfavorable infant neurodevelopment, possibly through an increased placental transfer of maternal glucocorticoids (GCs). Hair GC levels offer a retrospective view on chronic GC exposure. Since neonatal hair GCs might reflect intra-uterine GC regulation, we assessed whether maternal stress experienced pre- and perinatally is associated with neonatal and maternal hair GCs postpartum (pp). METHODS A total of 169 mother-infant pairs donated hair on the first day pp. Of this group, 66 pairs had consulted a center of expertise for pregnancy and psychiatric disorders, where maternal stress was scored on the Hospital Anxiety and Depression Scale (HADS) during the first or second (n=45) and third trimester (n=57). In addition, all mothers filled in the HADS directly pp. Hair cortisol and cortisone levels were determined by LC-MS/MS. The influence of maternal pre- and postnatal HADS- scores, anxiety (HAS) and depression (HDS) subscores, as well as antidepressant use, on maternal and neonatal hair GC levels was analyzed with linear regression, and expressed as log 10 (β [95%CI]). RESULTS Neonatal hair glucocorticoids were negatively associated with elevated HAS-scores during the first or second trimester (cortisol -0.19 [-0.39 to 0.02], p=0.07 and cortisone -0.10 [-0.25 to 0.05], p=0.17), third trimester (cortisol -0.17 [-0.33 to 0.00] p=0.05 and cortisone -0.17 [-0.28 to -0.05] p=0.01), and pp (cortisol -0.14 [-0.25 to -0.02] p=0.02 and cortisone -0.07 [-0.16 to 0.02] p=0.10). A similar pattern was observed for elevated HDS-scores. Elevated HAS- and HDS-scores throughout the entire pregnancy showed the strongest negative associations. Maternal hair GCs were positively associated with elevated HAS-scores pp (cortisol 0.17 [0.01 to 0.32] p=0.04, cortisone 0.18 [0.06 to 0.31] p=0.01), but not with elevated HDS-scores pp or prenatally. Antidepressant use was associated with elevated maternal hair GCs (p≤0.05), but did not affect neonatal hair GCs.