An exploratory study of perinatal hair cortisol concentrations in mother–infant dyads with severe psychiatric disorders versus healthy controls

Background Maternal psychopathology during pregnancy is associated with negative outcomes in offspring. Increased placental transfer of maternal cortisol may contribute to mediate this association. Hair cortisol concentrations (HCCs) appear to be a good biomarker of long-term prenatal stress exposure. Little is known about the associations between severe maternal psychopathology and perinatal infant HCCs. Aims We assessed HCCs in the perinatal period in mother–infant dyads with and without severe psychiatric disorders. Method We examined group differences in HCCs of mother–infant dyads (n = 18) subjected to severe maternal psychiatric disorders versus healthy control dyads (n = 27). We assessed the correlation of HCCs between mother and infant within both groups, and the association between current maternal symptoms and HCCs in patient dyads. Results Median (interquartile range) and distribution of HCC differed in patients compared with control mothers (U = 468.5, P = 0.03). HCCs in infants of patients did not differ from control infants (U = 250.0, P = 0.67). Subsequently, we found that HCCs within healthy control dyads were correlated (n = 27, r 0.55 (0.14), P = 0.003), but were not within patient dyads (n = 18, r 0.082 (0.13), P = 0.746). HCCs in infants of patients showed a positive correlation with maternal symptoms (n = 16, r = 0.63 (0.06), P = 0.008). Conclusions These preliminary findings suggest that infant HCC reflect perinatal stress exposure. In infants, these early differences could influence lifetime hypothalamic–pituitary–adrenal axis functioning, which might be associated with increased susceptibility to later disease.

Perinatal psychiatry

Perinatal psychiatric disorders are common, with around 10% of women experiencing depressive symptoms in pregnancy or in the months after delivery. They may also be severe, with post-partum psychosis representing some of the most severe episodes of illness seen in psychiatric practice. Perinatal mental illness is not only significant for the health of the mother, but also for the well-being of her child, and may have a considerable impact on her family and wider society. Despite their importance, maternal psychiatric disorders remain underdiagnosed and undertreated. This chapter will focus attention on episodes of severe mental illness occurring in the periantal period but will also consider other, more common mental disorders. The chapter will consider both episodes having their onset in the perinatal period and those that represent a continuation of pre-existing condition.

Psychiatric disorders in pregnancy and the postpartum

Obstetricians will frequently look after women with the new onset or recurrence of a psychiatric illness. Perinatal psychiatric disorders, in fact, are common, affecting over 15% of women in pregnancy or in the months after delivery, and have an impact not only on the health of the mother, but also on the well-being of their offspring. Untreated, severe postpartum disorders are associated with an increased risk of both suicide and, in rare but tragic cases, infanticide. Despite their importance, maternal psychiatric disorders are underdiagnosed and undertreated. This chapter provides a concise introduction to perinatal psychiatric disorders and emphasizes the role of prevention, early detection, and collaborative care.