Questionnaires and Salivary Cortisol to Measure Stress and Depression in Mid-pregnancy
Overview
Affiliations
The hypothalamic-pituitary-adrenal axis, with cortisol as its final metabolite, has been proposed as a potential underlying biological mechanism for associations between depression and stress symptoms during pregnancy and adverse perinatal outcomes. In this study, we explored associations between salivary cortisol as a potential biomarker for stress and depressive symptoms and several self-completed psychological measurement scales among pregnant women. In total, 652 pregnant women participating in the PRegnancy and Infant DEvelopment (PRIDE) Study completed the Edinburgh Depression Scale (EDS), Patient Health Questionnaire-2 (PHQ-2), Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R), and Tilburg Pregnancy Distress Scale (TPDS) and collected a single awakening salivary cortisol sample around gestational week 17. Odds ratios, Spearman's correlation coefficients (ρs) and Cohen's Kappa coefficients (κ) were calculated to examine the associations between the EDS, PHQ-2, PRAQ-R, TPDS, and maternal cortisol levels. The overall correlation coefficient between the score on the EDS and the salivary cortisol level was 0.01 (p = 0.89) with κ = -0.01 (95% confidence interval [CI] -0.08-0.06). We did not observe agreement between the PHQ-2 and cortisol levels either (κ = 0.06 (95% CI -0.02-0.14)). The results for the PRAQ-R and TPDS were similar with overall correlations with maternal cortisol levels of ρs = 0.01 (p = 0.81) and ρs = 0.06 (p = 0.35) and agreements of κ = 0.02 (95% CI -0.06-0.09) and κ = -0.02 (95% CI -0.11-0.07), respectively. Maternal awakening salivary cortisol levels and measures of maternal psychological distress, anxiety, depressive symptoms, and pregnancy-related anxiety, assessed by self-completed questionnaires, did not seem to be related in mid-pregnancy.
Hingorjo M, Owais M, Siddiqui S, Nazar S, Ali Y BMC Oral Health. 2025; 25(1):276.
PMID: 39984905 PMC: 11846471. DOI: 10.1186/s12903-024-05017-8.
Sic A, Cvetkovic K, Manchanda E, Knezevic N Diseases. 2024; 12(9).
PMID: 39329889 PMC: 11431196. DOI: 10.3390/diseases12090220.
Turan A, Kaya C Rev Assoc Med Bras (1992). 2023; 69(5):e20221610.
PMID: 37222328 PMC: 10204844. DOI: 10.1590/1806-9282.20221610.
Vlenterie R, Prins J, Roeleveld N, van Gelder M Arch Gynecol Obstet. 2022; 306(6):1989-1999.
PMID: 35320387 PMC: 9633479. DOI: 10.1007/s00404-022-06513-4.