Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids

Research output: Contribution to journalResearch articleContributedpeer-review



BACKGROUND: Having a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms.

METHODS: Measures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAM HAIR.

RESULTS: A negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events.

LIMITATIONS: Analyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution.

CONCLUSIONS: Our results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.


Original languageEnglish
Pages (from-to)974-983
Number of pages10
JournalJournal of Affective Disorders
Early online date15 Jul 2023
Publication statusPublished - 15 Oct 2023

External IDs

Scopus 85166564915
Mendeley 48d2d74f-d363-342e-8c3a-55b171e9bcd4
ORCID /0000-0001-6790-8679/work/142232332
ORCID /0000-0002-1938-3414/work/142247687
ORCID /0000-0002-1171-7133/work/142255060
ORCID /0000-0002-7472-674X/work/142257814


Sustainable Development Goals


  • Birth experience, DREAM study, Glucocorticoids, Hair cortisol, Hair cortisone, Postpartum depression

Library keywords