Purpose Perinatal psychiatric disturbances are significant medical conditions that can have tragic sequelae, yet their genesis remains undetermined. While a causative role for estradiol and progesterone has been hypothesized, empirical support is inconclusive. This study was designed to measure adrenal hormone concentrations during and after pregnancy and to determine which, if any, were associated with development of significant perinatal mental illness.
Methods Twenty-eight healthy primigravid women aged 21-40 years consented to participate in this study. Salivary samples for progesterone (P), estrone (E1), estradiol (E2), estriol (E3), testosterone (T), and dehydroxyepiandrosterone sulfate (DHEAS) were collected at 37 weeks of pregnancy and within the first 10 days postpartum and quantified by enzyme-linked immunosorbent assay. Concurrently, nine psychiatric domains were assessed using the Symptom Checklist 90R.
Results No negative mood symptoms were associated with P, E1, or E3 either pre- or postpartum. Negative mood symptoms were associated with T and DHEAS in the full perinatal period but with E2 postdelivery only. Decreased predelivery T was associated with both pre- and postdelivery psychiatric symptoms, including predelivery increases in phobia (r = -.397, p < .05), psychoticism (r = -.424, p < .05), and global severity index (r = -.387, p < .05) and postdelivery elevations in anxiety (r = -.469, p < .05), hostility (r = -.609, p < .001), psychoticism (r = .411, p < .05), obsessive-compulsive behavior (r = -.589, p < .01), depression (r = -.471, p < .05) and with the overall severity of postpartum symptoms (r = -.628, p < .001). Postdelivery, increased DHEAS was significantly correlated with increased anxiety (r = .461, p < .05), phobia (r = .472, p < .05), paranoia (r = .441, p < .05), psychoticism (r = .541, p < .01), depression (r = .387, p < .05), and global severity index (r = .387, p < .05). Increased postpartum E2 was associated with increased paranoia (r = .482, p < .01).
Conclusion These findings suggest that adrenal androgen synthesis marked by diminished late pregnancy T and elevated puerperal DHEAS may underlie perinatal mental illness. While further investigation is merited, measurement of T and DHEAS in late-stage pregnancy may prove useful as predictors of postpartum psychiatric complications.