MATERNITY BLUES AND MAJOR ENDOCRINE CHANGES - CARDIFF PUERPERAL MOOD AND HORMONE STUDY .2.

Objectives-To define relation between mood and concentrations of proge sterone and cortisol during perinatal period to test hypothesis that r apid physiological withdrawal of steroid hormones after delivery is as sociated with depression. Design-Prospective study of Primiparous wome n from two weeks before expected date of delivery to 35 days postpartu m. Setting-Antenatal clinic in university hospital, obstetric inpatien t unit, patients' homes. Subjects-120 of 156 primiparous women intervi ewed. Remainder excluded because of major marital, socioeconomic, or m edical problems or because caesarean section required. Main outcome me asures-Concentrations of progesterone and cortisol in saliva samples; women's moods assessed by various scores for depression. Results-Chang es in salivary progesterone and cortisol concentrations were similar t o those already characterised for plasma. Peak mean score for maternit y blues (5.3 on Stein scale) was on day five postpartum (P < 0.02 comp ared with mean scores on other postpartum days). High postpartum score s for maternity blues were associated with high antenatal progesterone concentrations on day before delivery (P < 0.05), with high rate of r ise of antenatal progesterone concentrations (P<0.05), with decreasing progesterone concentrations from day of delivery to day of peak blues score (P greater-than-or-equal-to 0.01), and with low progesterone co ncentrations on day of peak blues score (P<0.01). Seventy eight women were designated as having maternity blues (peak score greater-than-or- equal-to 8 on Stein scale) while 39 had no blues. Women with blues had significantly higher antenatal progesterone concentrations and lower postnatal concentrations than women without blues (geometric mean prog esterone concentrations: one day before delivery 3860 pmol/l v 3210 pm ol/l respectively, P=0.03; ten days postpartum 88 pmol/l v 114 pmol/l, P=0.048). Cortisol concentrations were not significantly associated w ith mood. Conclusion-Maternal mood in the days immediately after deliv ery is related to withdrawal of naturally occurring progesterone.