title: Increased morning adrenocorticotrophin hormone (ACTH) levels in women with postpartum thoughts of harming the infant.
abstract: BACKGROUND
  Some postpartum women experience intrusive thoughts of harming the infant. The hypothalamic-pituitary-adrenal (HPA) axis, which has been linked to postpartum depression, may play a role in the aetiology of postpartum thoughts of harming the infant. We aimed to study whether HPA axis hormones measured early postpartum are related to postpartum intrusive thoughts.
  
  
  METHODS
  132 women who delivered a child at a university hospital participated in a follow-up study with visits at 2-3 days postpartum and 8th week postpartum. Participants were assessed for trait anxiety, social support, peripartum or postpartum anxiety or depression, stressful life events and obstetric variables including perinatal complications and lactation. Postpartum thoughts of harming the infant were assessed with a semi-structured interview. Serum cortisol, and plasma CRH and ACTH levels were measured within 48 h postpartum at 8-9 AM. A logistic regression was performed to explore the relationship between clinical variables, hormonal measures and postpartum intrusive thoughts.
  
  
  RESULTS
  Patients with postpartum thoughts of harming the infant had, when compared to those women without intrusive thoughts, higher ACTH levels (7.59 pmol/L vs 5.09 pmol/L, p<0.05) without significant differences in CRH or cortisol levels. In the logistic regression analysis, adjusted for breast-feeding and psychopathological status, only ln ACTH was associated with the presence of postpartum thoughts of harming the infant (OR=5.2, CI 95% 1.2-22.6, p=0.029). No other clinical variables were associated with postpartum intrusive thoughts.
  
  
  CONCLUSIONS
  Our study suggests that a dysregulation of the hypothalamic-pituitary-adrenal axis may play a role in the aetiology of postpartum thoughts of harming the infant.
authors.affiliation: Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain. labadj@peremata.com
authors.forename: Javier
authors.initials: J
authors.lastname: Labad
authors.forename: Elisabet
authors.initials: E
authors.lastname: Vilella
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
authors.forename: Teresa
authors.initials: T
authors.lastname: Sans
authors.forename: Pere
authors.initials: P
authors.lastname: Cavallé
authors.forename: Joaquín
authors.initials: J
authors.lastname: Valero
authors.forename: Pino
authors.initials: P
authors.lastname: Alonso
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Menchón
authors.forename: Antonio
authors.initials: A
authors.lastname: Labad
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gutiérrez-Zotes
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism; D000328:Adult; D001942:Breast Feeding; D002649:Child Abuse / Q000523:psychology*; D002940:Circadian Rhythm / Q000502:physiology; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003863:Depression / Q000097:blood / Q000503:physiopathology / Q000523:psychology; D019052:Depression, Postpartum / Q000097:blood / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007231:Infant, Newborn; D007406:Interview, Psychological; D008016:Life Change Events; D009035:Mothers / Q000523:psychology*; D009770:Obsessive Behavior / Q000097:blood / Q000503:physiopathology* / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D049590:Postpartum Period / Q000097:blood / Q000502:physiology / Q000523:psychology*; D011581:Psychological Tests; D011644:Puerperal Disorders / Q000097:blood / Q000503:physiopathology* / Q000523:psychology; D013850:Thinking
chemical_list: D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone