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Plasma marker ACTH, cortisol, and beta-endorphins profile on pregnant women as targeted marker of approach for antenatal depression

  • I Putu Satrya Wijaya ,
  • Titin Andri Wihastuti ,
  • I Wayan Arsana Wiyasa ,
  • Muhammad Chair Effendi ,


Abstract

Background: Antenatal depression is a frequent mental disorder with much less attention, and most women remain undiagnosed. Altered hypothalamic-pituitary-adrenal (HPA)-axis function mediates maternal depressive symptoms and has been widely reported. The present research aimed to determine the plasma marker HPA-axis including Adrenocorticotropic hormone (ACTH), cortisol, and beta-endorphin, as a suitable representation of mental health in pregnancy by evaluating the psychometric properties.

Methods: Therefore, we examined a case-control study of 216 Bontang pregnant women. Psychological measures were conducted during the 27th week of pregnancy, including the Patient Health Questionnaire-9 (PHQ-9) assessment and Depression Anxiety Stress Scale (DASS). Blood samples were collected for plasma ACTH, Cortisol, and beta-endorphins assay as a marker of the HPA axis profile. Data were analyzed Stata for Mac version 14 (StataCorp, USA).

Results: our finding showed that DASS scores correlated with PHQ-9 (r=0.79), ACTH (r=0.22), and beta-endorphin (r=54). PHQ-9 score significantly related to ACTH (r=0.27), cortisol (r=0.36) and beta-endorphin (r=0.71). Women with the highest DASS score and PHQ-9 depression scores at 27 weeks of pregnancy had significantly lower baby birth weight (P=0.000) than those women whose stress improved to or normal state. Plasma ACTH, cortisol, and beta-endorphin concentrations were significantly higher in pregnant women with antenatal depression compared to normal pregnancy (p<0.01). All effects remain without controlling unwanted pregnancy.

Conclusion: Our study demonstrates a role for circulating ACTH in regulating maternal cortisol secretion and a significant correlation between the HPA-axis profile and antenatal depression at 27 weeks of pregnancy.

Keywords: ACTH antenatal depression beta-endorphins Cortisol HPA-axis Maternal Stress Index

References

  1. Weinstock M. The potential influence of maternal stress hormones on development and mental health of the offspring. Brain Behav Immun. 2005;19(4):296-308.
  2. Míguez MC, Vázquez MB. Risk factors for antenatal depression: A review. World J Psychiatry. 2021;11(7):325-336.
  3. Tsakiridis I, Dagklis T, Mamopoulos A, Athanasiadis A, Pearson R, Papazisis G. Antenatal depression and anxiety during the COVID-19 pandemic: a cross-sectional study in pregnant women from routine health care contact in Greece. J Perinat Med. 2021;49(6):656-663.
  4. Dadi AF, Miller ER, Woodman R, Bisetegn TA, Mwanri L. Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model. BMC Pregnancy Childbirth. 2020;20(1):168.
  5. Nazzari S, Fearon P, Rice F, Dottori N, Ciceri F, Molteni M, et al. Beyond the HPA-axis: Exploring maternal prenatal influences on birth outcomes and stress reactivity. Psychoneuroendocrinology. 2019;101:253-262.
  6. Jahnke JR, Terán E, Murgueitio F, Cabrera H, Thompson AL. Maternal stress, placental 11β-hydroxysteroid dehydrogenase type 2, and infant HPA axis development in humans: Psychosocial and physiological pathways. Placenta. 2021;104:179-187.
  7. Van den Bergh BR, Van Calster B, Smits T, Van Huffel S, Lagae L. Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood. Neuropsychopharmacology. 2008;33(3):2301.
  8. Molenaar NM, Tiemeier H, van Rossum EFC, Hillegers M, Bockting CLH, Hoogendijk WJG, et al. Prenatal maternal psychopathology and stress and offspring HPA axis function at 6 years. Psychoneuroendocrinology. 2019;99:120-127.
  9. Dickens MJ, Pawluski JL. The HPA Axis During the Perinatal Period: Implications for Perinatal Depression. Endocrinology. 2018;159(11):3737-3746.
  10. McKenna BG, Hammen C, Brennan PA. HPA-axis multilocus genetic profile score moderates the association between maternal prenatal perceived stress and offspring depression in early adulthood. Dev Psychopathol. 2021;33(1):122-134.
  11. Laurent H. Early calibration of the HPA axis by maternal psychopathology. Psychoneuroendocrinology. 2017;78:177-184.
  12. Pezirkianidis C, Karakasidou E, Lakioti A, Stalikas A, Galanakis M. Psychometric Properties of the Depression, Anxiety, Stress Scales-21 (DASS-21) in a Greek Sample. Psychology. 2018;9(15):2933-2950.
  13. Jiang L, Yan Y, Jin ZS, Hu ML, Wang L, Song Y, et al. The Depression Anxiety Stress Scale-21 in Chinese Hospital Workers: Reliability, Latent Structure, and Measurement Invariance Across Genders. Front Psychol. 2020;11(1):741.
  14. Seth S, Lewis AJ, Galbally M. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth. 2016;16(1):124.
  15. Luiza JW, Gallaher MJ, Powers RW. Urinary cortisol and depression in early pregnancy: role of adiposity and race. BMC Pregnancy Childbirth. 2015;15(1):30.
  16. Nandam LS, Brazel M, Zhou M and Jhaveri DJ. Cortisol and Major Depressive Disorder-Translating Findings From Humans to Animal Models and Back. Front Psychiatry. 2020;10:974.
  17. Feurer C, McGeary JE, Knopik VS, Brick LA, Palmer RH, Gibb BE. HPA axis multilocus genetic profile score moderates the impact of interpersonal stress on prospective increases in depressive symptoms for offspring of depressed mothers. J Abnorm Psychol. 2017;126(8):1017-1028.
  18. Van den Bergh BRH, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev. 2020;117:26-64.
  19. Hamada H, Matthews SG. Prenatal programming of stress responsiveness and behaviours: Progress and perspectives. J Neuroendocrinol. 2019;31(3):e12674.
  20. Bleker LS, van Dammen L, Leeflang MMG, Limpens J, Roseboom TJ, de Rooij SR. Hypothalamic-pituitary-adrenal axis and autonomic nervous system reactivity in children prenatally exposed to maternal depression: A systematic review of prospective studies. Neurosci Biobehav Rev. 2020;117:243-252.
  21. Smith R, Cubis J, Brinsmead M, Lewin T, Singh B, Owens P, et al. Mood changes, obstetric experience and alterations in plasma cortisol, beta-endorphin and corticotrophin releasing hormone during pregnancy and the puerperium. J Psychosom Res. 1990;34(1):53-69.
  22. Pilozzi A, Carro C, Huang X. Roles of β-Endorphin in Stress, Behavior, Neuroinflammation, and Brain Energy Metabolism. Int J Mol Sci. 2020;22:338.
  23. Yim IS, Glynn LM, Schetter CD, Hobel CD, Chicz-DeMet A, Sandman CA. Prenatal beta-endorphin as an early predictor of postpartum depressive symptoms in euthymic women. J Affect Disord. 2010;125(1):128-133.
  24. Woldetensay YK, Belachew T, Tesfaye M, Spielman K, Biesalski HK, Kantelhardt EJ, Scherbaum V. Validation of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version. PLoS One. 2018;13(2):e0191782.
  25. Levis B, Benedetti A, Thombs BD. DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365(I1476):l1781.
  26. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
  27. Zhao Y, Chan W, Lo BC. Comparing five depression measures in depressed Chinese patients using item response theory: an examination of item properties, measurement precision and score comparability. Health Qual Life Outcomes. 2017;15(1):60.
  28. Patrick S, Connick P. Psychometric properties of the PHQ-9 depression scale in people with multiple sclerosis: A systematic review. PLoS One. 2019;14(2):e0197943.
  29. Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67-75.
  30. Vaughan RS, Edwards EJ, MacIntyre TE. Mental Health Measurement in a Post Covid-19 World: Psychometric Properties and Invariance of the DASS-21 in Athletes and Non-athletes. Front Psychol. 2020;11:590559.
  31. Brunton PJ. Programming the brain and behaviour by early-life stress: a focus on neuroactive steroids. J Neuroendocrinol. 2015;27(6):468-480.
  32. Glover V, O'Connor TG, O'Donnell K. Prenatal stress and the programming of the HPA axis. Neurosci Biobehav Rev. 2010;35(1):17-22.
  33. Helfrich-Förster C. Interactions between psychosocial stress and the circadian endogenous clock. Psych J. 2017;6(4):277-289.
  34. Juruena MF, Eror F, Cleare AJ, Young AH. The Role of Early Life Stress in HPA Axis and Anxiety. Adv Exp Med Biol. 2020;1191:141-153.
  35. Faravelli C, Lo Sauro C, Lelli L, Pietrini F, Lazzeretti L, Godini L, et al. The role of life events and HPA axis in anxiety disorders: a review. Curr Pharm Des. 2012;18(35):5663-5674.
  36. Arborelius L, Owens MJ, Plotsky PM, Nemeroff CB. The role of corticotropin-releasing factor in depression and anxiety disorders. J Endocrinol. 1999;160(1):1-12.
  37. Zhang W, Li Q, Deyssenroth M, Lambertini L, Finik J, Ham J, et al. Timing of prenatal exposure to trauma and altered placental expressions of hypothalamic-pituitary-adrenal axis genes and genes driving neurodevelopment. J Neuroendocrinol. 2018;30(4):e12581.
  38. Russell AL, Tasker JG, Lucion AB, Fiedler J, Munhoz CD, Wu TYJ, et al. Factors promoting vulnerability to dysregulated stress reactivity and stress-related disease. J Neuroendocrinol. 2018;30(10):e12641.
  39. Froehlich JC. Opioid peptides. Alcohol Health Res World. 1997;21(2):132-136.
  40. Laurent H, Goodman SH, Stowe ZN, Halperin M, Khan F, Wright D, et al. Course of ante- and postnatal depressive symptoms related to mothers' HPA axis regulation. J Abnorm Psychol. 2018;127(4):404-416.
  41. O'Donnell K, O'Connor TG, Glover V. Prenatal stress and neurodevelopment of the child: focus on the HPA axis and role of the placenta. Dev Neurosci. 2009;31(4):285-292.
  42. Cowen PJ. Not fade away: the HPA axis and depression. Psychol Med. 2010;40(1):1-4.
  43. Pagehgiri HD, Puruhito I, Aditiawarman, Lestari P, Sembiring YE, Jiwangga D, et al. The role of transdermal carbon dioxide on changes in malondialdehyde levels as a marker of ischemia-reperfusion injury in patients with placenta accreta spectrum underwent temporary abdominal aortic cross-clamping as an adjunct procedure during cesarean hysterectomy. Bali Medical Journal. 2022;11(2):1023–1029.
  44. Meador-Woodruff JH, Greden JF, Grunhaus L, Haskett RF. Severity of depression and hypothalamic-pituitary-adrenal axis dysregulation: identification of contributing factors. Acta Psychiatr Scand. 1990;81(4):364-371.
  45. Hagaman AK, Baranov V, Chung E, LeMasters K, Andrabi N, Bates LM, et al. Association of maternal depression and home adversities with infant hypothalamic-pituitary-adrenal (HPA) axis biomarkers in rural Pakistan. J Affect Disord. 2020;276:592-599.
  46. Ulmer-Yaniv A, Djalovski A, Priel A, Zagoory-Sharon O, Feldman R. Maternal depression alters stress and immune biomarkers in mother and child. Depress Anxiety. 2018;35(12):1145-1157.
  47. Kinsella MT, Monk C. Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol. 2009;52(3):425-440.
  48. Adnyana IBP, Liwang F, Negara KS, Manuaba IBP, Bhargah A, Prabawa IPY. Clinical risk factor of preeclampsia: a five-year retrospective study in Bali Royal Hospital, Bali-Indonesia. Gineco. Eu. 2018;14(3):89-93.
  49. Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S. The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Front Psychiatry. 2021;12:721361.

How to Cite

Satrya Wijaya, I. P., Wihastuti, T. A., Wiyasa, I. W. A. ., & Muhammad Chair Effendi. (2023). Plasma marker ACTH, cortisol, and beta-endorphins profile on pregnant women as targeted marker of approach for antenatal depression. Bali Medical Journal, 12(1), 600–605. https://doi.org/10.15562/bmj.v12i1.3694
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I Putu Satrya Wijaya
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Titin Andri Wihastuti
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I Wayan Arsana Wiyasa
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Muhammad Chair Effendi
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