Abstract：
BACKGROUND: Cortisol is a biological marker of stress, and its levels reflect the hypothalamic-pituitary-adrenal (HPA) axis response to stress over time. Saliva, blood, and urine cortisol reflect acute stress, whereas assessment of hair cortisol is a better reflection of chronic stress. There is limited information on hair cortisol concentration (HCC) in the perinatal period, particularly, in the preconception and postpartum periods. In addition to being a biomarker for stress, high levels of cortisol are typically associated with poor psychosocial outcomes, and adverse pregnancy outcomes. The objectives of this study were: (1) to measure HCC from six months preconception to six months postpartum; (2) to examine the relationship between HCC and demographic characteristics, depressive symptoms, and perceived stress in the first six months postpartum period; (3) and to assess the associations between HCC and systemic inflammatory markers in the first six months postpartum.
METHODS: The analysis included 96 women from a longitudinal study with up to 3 study visits in the first six months postpartum. Blood and hair samples were collected at 1-2 months (PP1), 3-4 months (PP2), and 5-6 months (PP3) postpartum. We obtained sociodemographic information, depressive symptoms, and perceived stress scores at PP1-PP3. To quantify cortisol levels over time, 8 segments were derived corresponding to 6 (PC1) and 3 (PC2) months preconception as well as for each trimester (T1-T3) and postpartum (PP1-PP3). Eight cytokines (Granulocyte-macrophage colony-stimulating factor (GM-CSF), Interferon- gamma [IFN- γ], Interleukin [IL]-10, IL-2, IL-4, IL-6, IL-8, and Tumor necrosis factor-alpha (TNF- α) were measured in plasma in the postpartum samples. Univariate, bivariate, correlations, and linear mixed modelling were performed using SAS 9.4. Multiple testing correction was conducted for correlations using false discovery rate and a Q value of <0.05 was deemed significant.
RESULTS: Median HCC varied over time peaking in the third trimester and declining in the postpartum. Significant differences were noted in median cortisol levels by race with Black/African American postpartum women experiencing higher levels at all timepoints. Significantly, higher median cortisol levels were also observed at PP1 and PP2 for mothers who reported their relationship status as single. Ethnicity, education, median age, depressive symptoms, and perceived stress were not associated with median cortisol levels. Pro-inflammatory cytokines IFN- γ (q= 0.01; r=-0.50) and IL-8 (q= 0.00; r=-0.55) showed correlations with HCC at PP1.
CONCLUSIONS: HCC increased during pregnancy, peaking at T3 and declining PP consistent with previous work. Black/African American women and single women have significantly higher median cortisol levels in the postpartum period. The marked increase of HCC in Black women may be an important factor in understanding maternal health racial inequities. Future studies should investigate how the relationships between HCC, sociodemographics, and systemic cytokines impact perinatal outcomes.
METHODS: The analysis included 96 women from a longitudinal study with up to 3 study visits in the first six months postpartum. Blood and hair samples were collected at 1-2 months (PP1), 3-4 months (PP2), and 5-6 months (PP3) postpartum. We obtained sociodemographic information, depressive symptoms, and perceived stress scores at PP1-PP3. To quantify cortisol levels over time, 8 segments were derived corresponding to 6 (PC1) and 3 (PC2) months preconception as well as for each trimester (T1-T3) and postpartum (PP1-PP3). Eight cytokines (Granulocyte-macrophage colony-stimulating factor (GM-CSF), Interferon- gamma [IFN- γ], Interleukin [IL]-10, IL-2, IL-4, IL-6, IL-8, and Tumor necrosis factor-alpha (TNF- α) were measured in plasma in the postpartum samples. Univariate, bivariate, correlations, and linear mixed modelling were performed using SAS 9.4. Multiple testing correction was conducted for correlations using false discovery rate and a Q value of <0.05 was deemed significant.
RESULTS: Median HCC varied over time peaking in the third trimester and declining in the postpartum. Significant differences were noted in median cortisol levels by race with Black/African American postpartum women experiencing higher levels at all timepoints. Significantly, higher median cortisol levels were also observed at PP1 and PP2 for mothers who reported their relationship status as single. Ethnicity, education, median age, depressive symptoms, and perceived stress were not associated with median cortisol levels. Pro-inflammatory cytokines IFN- γ (q= 0.01; r=-0.50) and IL-8 (q= 0.00; r=-0.55) showed correlations with HCC at PP1.
CONCLUSIONS: HCC increased during pregnancy, peaking at T3 and declining PP consistent with previous work. Black/African American women and single women have significantly higher median cortisol levels in the postpartum period. The marked increase of HCC in Black women may be an important factor in understanding maternal health racial inequities. Future studies should investigate how the relationships between HCC, sociodemographics, and systemic cytokines impact perinatal outcomes.
摘要：
背景：皮质醇是应激的生物学标记，其水平反映了下丘脑-垂体-肾上腺（HPA）轴对压力的响应。唾液,血,尿液皮质醇反映了急性压力，而头发皮质醇的评估是慢性压力的更好反映。关于围产期毛发皮质醇浓度（HCC）的信息有限，特别是,在孕前和产后。除了是压力的生物标志物，高水平的皮质醇通常与不良的社会心理结果有关，和不良妊娠结局。本研究的目的是：（1）测量从怀孕前六个月到产后六个月的HCC；（2）检查HCC与人口统计学特征之间的关系，抑郁症状,和感知压力在产后前6个月期间;（3）并评估HCC和全身炎症标志物在产后前6个月之间的关联。
方法：该分析包括来自纵向研究的96名妇女，在产后前六个月进行多达3次研究。在1-2个月（PP1）收集血液和头发样本，3-4个月（PP2），产后5-6个月（PP3）。我们获得了社会人口统计信息，抑郁症状,和感知压力评分在PP1-PP3。为了量化一段时间内的皮质醇水平，得出8个部分，分别对应于孕前6个月（PC1）和3个月（PC2）以及每个三个月（T1-T3）和产后（PP1-PP3）。八种细胞因子（粒细胞-巨噬细胞集落刺激因子（GM-CSF），干扰素-γ[IFN-γ]，在产后样品中测量血浆中的白细胞介素[IL]-10，IL-2，IL-4，IL-6，IL-8和肿瘤坏死因子-α（TNF-α）。单变量,双变量，相关性，使用SAS9.4进行线性混合建模。使用错误发现率对相关性进行多次测试校正,并且认为<0.05的Q值是显著的。
结果：中位HCC随时间变化，在妊娠晚期达到峰值，在产后下降。在所有时间点，黑人/非裔美国人产后妇女的种族皮质醇中位数水平均存在显着差异。重要的是,对于报告亲属关系状态为单身的母亲,PP1和PP2组的皮质醇中位数水平也较高.种族,教育,中位年龄,抑郁症状,感知压力与皮质醇中位数水平无关。促炎细胞因子IFN-γ（q=0.01;r=-0.50）和IL-8（q=0.00;r=-0.55）在PP1时与HCC相关。
结论：肝癌在怀孕期间增加，在T3达到峰值，PP下降，与以前的工作一致。黑人/非裔美国妇女和单身妇女在产后期间的皮质醇水平中位数明显较高。黑人妇女HCC的显着增加可能是理解孕产妇健康种族不平等的重要因素。未来的研究应该调查肝癌之间的关系，社会人口统计学，和全身细胞因子影响围产期结局。
方法：该分析包括来自纵向研究的96名妇女，在产后前六个月进行多达3次研究。在1-2个月（PP1）收集血液和头发样本，3-4个月（PP2），产后5-6个月（PP3）。我们获得了社会人口统计信息，抑郁症状,和感知压力评分在PP1-PP3。为了量化一段时间内的皮质醇水平，得出8个部分，分别对应于孕前6个月（PC1）和3个月（PC2）以及每个三个月（T1-T3）和产后（PP1-PP3）。八种细胞因子（粒细胞-巨噬细胞集落刺激因子（GM-CSF），干扰素-γ[IFN-γ]，在产后样品中测量血浆中的白细胞介素[IL]-10，IL-2，IL-4，IL-6，IL-8和肿瘤坏死因子-α（TNF-α）。单变量,双变量，相关性，使用SAS9.4进行线性混合建模。使用错误发现率对相关性进行多次测试校正,并且认为<0.05的Q值是显著的。
结果：中位HCC随时间变化，在妊娠晚期达到峰值，在产后下降。在所有时间点，黑人/非裔美国人产后妇女的种族皮质醇中位数水平均存在显着差异。重要的是,对于报告亲属关系状态为单身的母亲,PP1和PP2组的皮质醇中位数水平也较高.种族,教育,中位年龄,抑郁症状,感知压力与皮质醇中位数水平无关。促炎细胞因子IFN-γ（q=0.01;r=-0.50）和IL-8（q=0.00;r=-0.55）在PP1时与HCC相关。
结论：肝癌在怀孕期间增加，在T3达到峰值，PP下降，与以前的工作一致。黑人/非裔美国妇女和单身妇女在产后期间的皮质醇水平中位数明显较高。黑人妇女HCC的显着增加可能是理解孕产妇健康种族不平等的重要因素。未来的研究应该调查肝癌之间的关系，社会人口统计学，和全身细胞因子影响围产期结局。
