Bibian van der Voorn

55 MATERNAL STRESS REFLECTED IN NEONATAL HAIR GC LEVELS METHODS STUDY DESIGN AND PARTICIPANTS The present study was part of a prospective cohort study that aimed to explore biomarkers (neonatal hair glucocorticoids [GCs] and urinary 5-hydroxyindoleacetid acid levels) of poor neonatal adaptation after exposure to selective antidepressants (SADs) or experienced maternal stress in utero 21,22 . Therefore, this cohort included an overrepresentation of mothers who experienced severe stress during their pregnancies. A total of 169 mother-infant pairs were recruited at the maternity department, as well as at the psychiatric-obstetric-pediatric (POP) clinic of the OLVG-west Hospital, Amsterdam, The Netherlands, which offers consultation to women with psychiatric disorders before, during and after pregnancy, on an outpatient basis. Approximately one third (n=66) of the total sample consisted of patients from the POP clinic. The other part of the sample (n=103) consisted of mothers admitted for other neonatal or maternal medical reasons. Mother-infant pairs with an expected hospital stay of ≥72h after delivery, and who were willing to donate hair and complete the Hospital Anxiety and Depression Scale (HADS) questionnaire were eligible for inclusion. Exclusion criteria were: use of psychotropic medication other than SADs, use of systemic corticosteroids, use of non-pharmacologic drugs, alcohol or nicotine smoking during the third trimester of pregnancy, insufficient knowledge of the Dutch or English language, mental impairment of one or both parents, and multiple pregnancies. Parents were informed and written informed consent was obtained within 24h after delivery. The study was approved by the Medical Ethics Committees of the OLVG-west Hospital and the VUMC. PRE- AND PERINATAL MATERNAL STRESS As part of standard care at the POP clinic, the HADS 23 was used as a screening instrument for clinically elevated stress levels experienced in the previous week, with a retest reliability that correlates good with the previous 6 weeks 24 . The HADS consists of 14 questions, seven for anxiety and seven for depression. Anxiety (HAS) and depression (HDS) subscores can be calculated and interpreted as independent, clinically relevant dimensions of the HADS. The HAS and HDS can be measured both as continuous and dichotomized variables, with ≥8 out of 21 points per subscale as cut-off for clinically elevated stress scores 23,24 . During the first or second trimester, and/or during the third trimester, the HADS was