Bibian van der Voorn

60 CHAPTER 4 TABLE 3. The course of HADS-scores over time frommothers who were seen at the POP clinic during pregnancy, in association with neonatal hair cortisol and cortisone levels Category Cortisol Cortisone n Beta (95%CI) Beta (95%CI) HAS Low pre- & low postnatally 36 ref ref High pre- & low postnatally 6 -0.03 (-0.29; 0.23) 0.01 (-0.18; 0.20) Low pre- & high postnatally 10 -0.09 (-0.30; 0.12) -0.14 (-0.29; 0.02) † High pre- & high postnatally 12 -0.19 (-0.39; 0.01) † -0.15 (-0.29;- 0.01) * HDS Low pre- & low postnatally 49 ref High pre- & low postnatally 2 -0.13 (-0.55 to 0.29) -0.14 (-0.45 to 0.17) Low pre- & high postnatally 5 -0.09 (-0.36 to 0.19) -0.18 (-0.38 to 0.03) † High pre- & high postnatally 8 -0.27 (-0.49 to- 0.05) * -0.17 (-0.33 to 0.00) * Data are presented as Log10 transformed β (95%CI). Cortisol and cortisone levels are reported in pg/mg hair. Prenatal stress is scored in either the first, second, or third trimester. * p<0.05 † p<0.10 Abbreviations: HAS = Hospital Anxiety Scale score ≥8; HDS= Hospital Depression Scale score ≥8 THE INFLUENCE OF MATERNAL STRESS ON MATERNAL HAIR GCS Maternal hair cortisol and cortisone levels were positively associated with maternal anxiety experienced directly pp, but not associated with HADS-scores measured prenatally ( Table 4 ). Correction for gender, birth weight percentiles or primiparity did not significantly change these associations. THE INFLUENCE OF SAD USE ON NEONATAL AND MATERNAL HAIR GLUCOCORTICOID LEVELS In total, 65 mothers (38%) reported using SADs: 44 SSRIs, 7 SNRIs, 9 NaSSAs and 5 a combination of SADs (4 SSRI with NaSSA, and 1 NaSSA with SNRI). When analyzed dichotomously, maternal SAD use was not associated with neonatal hair GC levels, and positively associated with maternal hair cortisol and cortisone levels (0.13 [0.00, 0.26] p=0.05 and 0.18 [0.09 to 0.28] p< 0.01, respectively). When analyzed categorically, neonatal hair cortisol and cortisone was not associated with SSRI, SNRI, or NaSSA use. However neonatal hair cortisol and cortisone was negatively associated with the use of a combination of SADs, as compared to neonates that were not exposed to SADs in utero (-0.32 [-0.57 to -0.06] p=0.02 and -0.22 [-0.42 to -0.02] p=0.04, respectively). Maternal hair cortisol and cortisone levels were positively associated with SSRI-use, as compared to no SAD use (0.16 [0.01 to 0.30] p=0.03 and 0.24 [0.14 to 0.35] p<0.01, respectively), but not with SNRI or NaSSa use. Maternal hair cortisol levels showed a trend towards a positive association with the use of a combination of SADs (0.33 [-0.04 to 0.70] p=0.08), as compared to no SAD use, maternal hair cortisone levels were not associated.