Cortisol reactivity and anxiety and depression in pregnant adolescents: a longitudinal perspective

The role of stress in perinatal depression and anxiety - A systematic review

Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.

Links between mental health problems and future thinking from the perspective of adolescents with experience of depression and anxiety: a qualitative study

BACKGROUND

Depression and anxiety are common during adolescence and could have detrimental impacts on young people's ability to make and implement plans for their future. However, to the best of our knowledge, no other study has adopted a qualitative approach in investigating these effects from the perspective of adolescents with lived experiences of depression and anxiety. We sought to understand how young people perceive and interpret the impact of mental health conditions on their thinking about the future.

METHODS

We conducted semi-structured interviews with 19 adolescents aged 16-19 years in the UK (median age = 19, IQR = 1.5), who had a history of protracted periods of clinical or subclinical depression and/or anxiety. They were asked to reflect on how their ability to think about the future and the content of the future-related thinking was impacted during periods of poor mental health, compared with periods of feeling well. Interviews were transcribed verbatim and subjected to thematic content analysis.

RESULTS

Five domains were identified. First, the impact of mood on future thinking capability focuses on reduced ability and motivation to engage in future thinking. Second, the impact of mood on images, thoughts, and feelings about the future includes the emotional valence of future-related thoughts, their vividness, structure, and the extent to which they intimated subjective feelings of control (i.e., agency). Third, social influences focuses on social factors that might ameliorate or exacerbate future thinking. Fourth, reflections on personal worries and expectations about the future captures personal interpretations of past worries and hopes and how future thinking affected mood. Finally, personal coping refers to how young people cope with the negative emotions that come with future thinking.

CONCLUSIONS

This study provided a nuanced and granular account of how depression and anxiety impacted young people's future thinking based on their lived experiences. By highlighting the different ways that variations in future thinking were experienced as a function of depression and anxiety, our analysis highlighted new factors that should be considered in studies of adolescent mental health risk, which could inform the development of new therapeutic approaches.

Evaluation of the psychological and biological changes of patients diagnosed with benign and malignant breast tumors

Purpose

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder developed by exposure to any incident or circumstance that results in psychological trauma. In this study we compared the psychological and physiological changes between patients with malignant and benign breast tumors.

Methods

We selected 150 Chinese women with a breast mass, aged 20 to 45 years, from the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital between 2009 and 2011 for this study; 30 healthy participants were enrolled into the control group. All subjects were examined and had their tumor mass aspirated for diagnosis. Equal numbers of patients with benign and malignant tumors were recruited. Patients with malignant tumors presented with low grade, minimal tumor invasion and non-involved lymph nodes. Questionnaires regarding anxiety, depression and PTSD were conducted 2 hours before getting the diagnostic result and 1 month after the diagnosis. Serum levels of IL-6, TNF-, cortisol and high-sensitivity C-reactive protein before and after diagnosis were investigated and compared. The number of occurrences of oral ulcerative mucositis was also recorded.

Results

All patients experienced a certain degree of anxiety and their biomarkers were elevated compared with the normal reference range before the pathological report was disclosed. However, 1 month after the operation, the benign tumor group showed significantly lower levels of biomarkers and anxiety scores than patients with a malignant breast tumor. The results were consistent throughout 12 months of study.

Conclusion

Study subjects with a benign tumor returned to their normal condition after being diagnosed, while patients with a malignant tumor suffered from a certain degree of PTSD or depression.

Cortisol Stress Response Variability in Early Adolescence: Attachment, Affect and Sex

Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic-pituitary-adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.

Diurnal cortisol patterns and psychiatric symptoms in pregnancy: short-term longitudinal study

Alteration in the HPA axis is a robust biomarker of anxiety and depression in adults, but questions remain about this association in pregnancy. We examined the longitudinal links between diurnal cortisol and mood symptoms from self-report questionnaire and diagnostic interview in an ethnically diverse, psychosocially at-risk sample of 101 women at mid-pregnancy and early third trimester. There were modest but significant associations between depression and elevated cortisol, indexed by a decreased morning level and diminished diurnal decline; the effects were strongest for diagnostic data from clinical interview. These effects were independent of socio-demographic factors and sleep disturbance. Associations with anxiety and trauma were generally non-significant. These findings extend prior work by showing that significant mood symptoms in pregnancy are associated with altered diurnal cortisol in pregnancy, which may have implications for maternal and child health.

Ambulatory assessments of psychological and peripheral stress-markers predict birth outcomes in teen pregnancy

OBJECTIVE

Pregnant adolescents have high rates of poor birth outcomes, but the causes are unclear. We present a prospective, longitudinal study of pregnant adolescents assessing associations between maternal psychobiological stress indices and offspring gestational age at birth and birthweight.

METHOD

Healthy nulliparous pregnant adolescents were recruited (n=205) and followed during pregnancy. Ambulatory assessments over 24h of perceived psychological stress (collected every 30 min) and salivary cortisol (6 samples) and a summary questionnaire, the Perceived Stress Scale, were collected at three time points (13-16, 24-27, and 34-37 gestational weeks). Corticotropin-releasing hormone, C-reactive protein, and interleukin 6 were assayed from blood taken at the latter 2 sessions. A final sample of 119 participants was selected for analyses.

RESULTS

The ambulatory assessment of perceived psychological stress was positively correlated with the Perceived Stress Scale (r=.20, p=.03) but neither was associated with any of the biological assays (all ps>.20). Based on backward selection regression models that included all stress variables and relevant covariates, the ambulatory assessments of perceived psychological stress and cortisol - though not the Perceived Stress Scale - were negatively associated with gestational age at birth (F(4, 107)=3.38, p=.01) while cortisol was negatively related to birthweight (F(5, 107)=14.83, p<.0001).

CONCLUSIONS

Targeted interventions to reduce psychological and biological indicators of heightened stress during pregnancy may have positive public health benefits for the offspring given the associations of shortened gestation and lower birthweight with risk for poor mental and physical health outcomes.

Optimism and other psychosocial influences on antenatal depression: a systematic review

Antenatal depression is a debilitating experience for many women with significant personal and familial sequelae. Low-income pregnant women living in rural settings are especially vulnerable because of isolation, decreased resources, and stressful living environments. This systematic review summarizes what is known about antenatal depression and synthesizes the evidence regarding the role psychosocial variables could play in the development of safe, effective, and culturally-acceptable non-pharmacological interventions. Searches of the CINAHL, MEDLINE, PSYCHINFO, and ERIC databases, as well as the Cochrane Library, were conducted in September 2010 to identify articles relevant to our topic of study. Psychosocial variables have a significant association with antenatal depression. Optimism has been shown to be inversely correlated with depression, and directly correlated with improved birth outcomes. Optimism is a potentially modifiable variable that could be used to design antenatal prevention and treatment programs. As depression continues to increase in prevalence, and treatment options for pregnant women remain limited, effective interventions must be developed that address the psychosocial variables examined in this review.

Regulation of anxiety during the postpartum period

Healthy mother-infant interactions are critical for the physical, cognitive, and psychological development of offspring. Such interactions rely on numerous factors, including a positive maternal emotional state. However, many postpartum women experience emotional dysregulation, often involving elevated anxiety. Neuroendocrine factors contributing to the onset of postpartum anxiety symptoms are mostly unknown, but irregularities in hypothalamic-pituitary-adrenal axis function, reduced prolactin and oxytocin signaling, or parturitional withdrawal of ovarian, placental and neural steroids could contribute to anxiety in susceptible women. Although the causes of initial onset are unclear, postpartum anxiety can be mitigated by recent contact with infants. Numerous neurochemical systems, including oxytocin, prolactin, GABA, and norepinephrine mediate this anxiolytic effect of infant contact. Insight into the etiology of postpartum anxiety disorders, and how contact with infants helps counter existing anxiety dysregulation, will surely facilitate the diagnosis and treatment of postpartum women at risk for, or experiencing, an anxiety disorder.

Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis

OBJECTIVE

The purpose of this study was to identify correlates of anxiety symptoms during pregnancy and determine the strength of the relationship between anxiety symptoms and adverse perinatal outcomes.

STUDY DESIGN

A meta-analytic review was conducted of studies that evaluated the relationship between self-reported anxiety symptoms during pregnancy and potential correlates or perinatal outcomes.

RESULTS

Fifty studies of 48 samples of women met inclusion criteria. Anxiety symptoms during pregnancy were associated with a number of psychosocial variables including depressive symptoms (r = 0.66), stress (r = 0.40), and self-esteem/self-worth (r = -0.47). There were no significant associations of anxiety symptoms with perinatal outcomes (all rs < 0.19).

CONCLUSION

Anxiety symptoms during pregnancy appear to be associated with similar psychosocial variables as anxiety at other times. There is no evidence of an association of anxiety symptoms with adverse perinatal outcomes among those studied thus far. However, significant gaps still exist in the literature in this area.

Maternal psychophysiological change during the second half of gestation

This study investigated the trajectory of physiological and psychological functioning during the second half of pregnancy and compared responsiveness to a laboratory stressor between pregnant and non-pregnant women. Monitoring of 137 pregnant women at 20, 24, 28, 32, 36, and 38 weeks of pregnancy included measures of heart period (HP), heart period variability (HPV), skin conductance (SCL), respiratory period (RP), respiratory sinus arrhythmia (RSA), and self-report of mood disturbance. HP and RSA declined during this period; SCL and mood disturbance increased. Parity was a significant moderator. HP and SCL responsiveness to the Stroop color-word task was assessed twice in pregnant participants and compared to a sample of 27 non-pregnant women. Physiologic responsiveness was reduced in pregnant women. Pregnant women perceived the Stroop to be more difficult, but performance was unaffected. Despite buffered responsivity to stressful stimuli during pregnancy, advancing gestation is associated with escalating sympathetic tone and declining parasympathetic tone.

Experiential and hormonal correlates of maternal behavior in teen and adult mothers

This study explores the role of cortisol and early life experiences in the regulation of maternal behavior and mood in teen and adult mothers. Primiparous mothers (n=119) (teen mothers < 19 years, n=42), young mothers (19-25 years, n= 4), and mature mothers, (>25 years, n=43) were assessed for their maternal behavior, mood, and hormonal profile at approximately 6 weeks postpartum. Outcome measures were analyzed as a function of age and early life experience. Results showed an interaction between age and type of maternal behavior, where teen mothers engaged in more instrumental (e.g. changing diapers, adjusting clothes) less affectionate (e.g., stroking, kissing, patting) behavior, and mature mothers engaged in more affectionate and less instrumental behavior. When groups were reassessed based on early life experience (consistency of care during the first 12 years of life: consistent care; having at least one consistent caregiver, inconsistent care; having multiple and changing caregivers), an interaction was also found between consistency of care and type of behavior shown, where mothers who received inconsistent care engaged in more instrumental and less affectionate behavior. Compared to mature mothers, teen mothers who were breast feeding also had higher salivary cortisol levels, and high cortisol in teen mothers related to decreased fatigue and increased energy. These results suggest that early life experiences are linked to mothering behavior and are consistent with the emerging human and animal literature on intergenerational effects of mothering style.

Perinatal risks of untreated depression during pregnancy

OBJECTIVE

To review the literature on the perinatal risks involved in untreated depression during pregnancy.

METHOD

We searched Medline and medical texts for all studies pertaining to this area up to the end of April 2003. Key phrases entered were depression and pregnancy, depression and pregnancy outcome, and depression and untreated pregnancy. We did not include bipolar depression.

RESULTS

While there is wide variability in reported effects, untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treatment with antidepressants in pregnancy, results in adverse perinatal outcome.

CONCLUSION

The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication. No in-depth discussion of the role of psychotherapy is available. Because they are not aware of the potentially catastrophic outcome of untreated maternal depression, this imbalance may lead women suffering from depression to fear teratogenic effects and refuse treatment.

Is pregnancy anxiety a distinctive syndrome?

OBJECTIVE

Assessment of general anxiety during pregnancy may underestimate anxiety specifically related to pregnancy. Pregnancy anxiety rather than general anxiety has been shown to predict birth outcome and neuroendocrine changes during pregnancy. Therefore, a questionnaire on pregnancy anxieties was used to test their structure, and to examine their associations with general anxiety and depression.

METHOD

Nulliparous pregnant women with a normal risk status (N=230) filled in a 34-item questionnaire on pregnancy-related anxiety and other questionnaires covering general anxiety and depression. These questionnaires were filled in at 15-17, 27-28, and 37-38 weeks of gestation.

RESULTS

A three-factor model of pregnancy anxiety was found by means of confirmatory factor analysis, reflecting 'fear of giving birth', 'fear of bearing a handicapped child' and 'concern about one's appearance'. General anxiety and depression measures explain only a small part of the variance of these fears.

CONCLUSION

Pregnancy anxiety should be regarded as a relatively distinctive syndrome. Its measurement enables researchers and clinicians to address issues of prediction, identification and risk reduction more precisely and perhaps more effectively in the future.

Plasma cortisol is associated with handedness in infant rhesus monkeys

In this research we examined the relationship between plasma cortisol and handedness in infant rhesus macaques (Macaca mulatta). Specifically, we tested the hypothesis that stress functioning is related to hemispheric specialization and manifested in a positive correlation between cortisol levels and the frequency of right- versus left- hand use. We found a significant positive relationship between cortisol levels sampled at ages 1 and 3 months and lateral bias toward greater use of the right hand versus left hand sampled between ages 4 and 11 months. Further, we found a significant negative relationship between cortisol sampled at age 5 months and strength of lateral bias (independent of direction). These data suggest an early developmental influence of stress functioning on hemispheric specialization for manual control in infant monkeys.

Handedness and cortisol in tufted capuchin monkey infants

In this research, we examined the relationship between handedness and levels of plasma cortisol in infant monkeys (Cebus apella). Specifically, we sought to test the hypothesis that stress functioning is related to hemispheric specialization and is manifested in a positive correlation between cortisol levels and the frequency of right- versus left-hand use. We found a significant relationship between stress cortisol at age 6 months and lateral bias towards greater use of the right versus left hand at ages 6 and 12 months. These data suggest an early developmental influence of stress reactivity on the emergence of hemispheric specialization for manual control in infant monkeys through the 1st year of postnatal life.

Maternal depression and risk for postpartum complications: role of prenatal corticotropin-releasing hormone and interleukin-1 receptor antagonist

The pregnancies of 58 healthy adolescents (ages 13 to 19 years) were followed to examine links between symptoms of depression, corticotropin-releasing hormone (CRH), interleukin-1 beta, (IL-1 beta), and IL-1 receptor antagonist (IL-1ra) as possible predictors of maternal and infant outcomes. Maternal psychological adjustment and medical complications during gestation, labor, delivery, and the postpartum period were monitored. Plasma samples collected during gestation were assayed for CRH, IL-1 beta, and IL-1ra. During gestation, symptoms of maternal depression were found to be associated with lower levels of CRH; lower levels of CRH were associated with lower levels of IL-1ra. In addition, lower levels of IL-1ra predicted higher rates of maternal complications after childbirth. IL-1 beta, detected in only 4 mothers, was not associated with any predictor or outcome measures. During gestation, CRH may induce circulating cytokine inhibitors without significantly affecting cytokine production or synthesis. Maternal symptoms of depression during gestation may attenuate the association between CRH and IL-1ra.

Can Excess Glucocorticoid, Predispose to Cardiovascular and Metabolic Disease in Middle Age?

For many years, both human and animal studies correlated changes in behaviour of the young offspring with the degree of maternal stress or glucocorticoid exposure of the foetus/neonate. In the past ten years there has been overwhelming epidemiological evidence to suggest that growth retardation in utero is a very important risk factor for the development of cardiovascular and metabolic disease in adult life. More recently, it has been shown that one important, even key, determinant is the exposure of the foetus to excess glucocorticoid. Even a brief period (48 h) of dexamethasone exposure very early in pregnancy was able to programme permanently hypertensive adult sheep. Understanding how such programming works, and the underlying physiological changes that occur, provides one of the most exciting challenges in contemporary endocrinology and developmental biology.

Corticotropin-releasing hormone and cortisol: longitudinal associations with depression and antisocial behavior in pregnant adolescents

OBJECTIVE

To examine the concurrent and longitudinal associations between corticotropin-releasing hormone (CRH) and cortisol concentrations and depression and antisocial behavior (conduct disorder symptoms) in pregnant adolescents.

METHOD

Fifty-nine adolescents were evaluated in early pregnancy (9-21 weeks' gestation), late pregnancy (32-34 weeks' gestation), and the postpartum period (4-5 weeks postpartum). Symptoms of depression and conduct disorder were obtained from the Diagnostic Interview Schedule for Children.

RESULTS

Lower concentrations of CRH were related to a greater number of depression symptoms in early pregnancy (p < .05) and in late pregnancy (p < .05). Lower concentrations of CRH also were related to a greater number of conduct disorder symptoms in early pregnancy (p < .06) and in the postpartum period (p < .05).

CONCLUSION

The findings support the long-standing hypothesis that stress-related products of the hypothalamic-pituitary-adrenal axis are associated with emotions and behavior during pregnancy.

Social stress of variable intensity: physiological and behavioral consequences

Stress effects in humans depend on stress type, intensity, and duration. Animal models of social stress serve as good ways to mimic stress experienced in humans. However, the available stress paradigms pay little attention to the relationship between the intensity and the type of social stressors. The aim of the present work is to study behavioral and endocrinological consequences of social stress by varying the intensity and type of agonistic social contacts. Subjects were exposed to the attacks of an experienced fighter resident rat once a day for 4 consecutive days. Mild versus strong effects were studied by varying the length of daily confrontations (30 min vs. 4 h). The type of social confrontations was varied by ceasing or maintaining sensory contacts among contestants between encounters. Endocrinological variables were measured on the 5th day. Anxiety was assessed by means of the elevated plus-maze. The stress state depended on the length of daily encounters: 30-min encounters did not, whereas 4-h encounters did result in weight loss and chronic elevation of plasma corticosterone. The type of contacts between subjects and dominants also affected the resulting stress state: adrenal hypertrophy was obtained only when contacts between contestants were maintained between encounters. Although the mildest stress procedure (30-min encounters on 4 consecutive days) did not affect endocrinological variables, it resulted in subtle behavioral modifications that changed the anxiety-related effects of additional acute stressors. Thus, anxiety-related behavioral changes resulting from repeated mild stressors may be hidden factors that can have long-term consequences on the development of anxiety-like behavioral deficits. Results outline the necessity of studying the effects of social stressors of different intensities and different types.

Salivary cortisol testing in children

Biological markers can identify links between human biology and human behavior. Cortisol, a marker of hypothalamic-pituitary-adrenocortical axis function, is a useful measure in research. Newer technology involving the measurement of cortisol in saliva is being utilized in research studies. Salivary cortisol measurement is inexpensive and noninvasive and offers many advantages over serum testing. Although there are various methods of saliva collection, it is relatively easy to perform in both infants and children. Salivary cortisol testing may offer a significant measure for pediatric stress, coping, and health research.

Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy

OBJECTIVE

Physiological processes including neuroendocrine function have been proposed as mediators of the relationship between prenatal psychological state and pregnancy outcome; however, there are virtually no human studies that have systematically assessed such mechanisms. Neuroendocrine processes are significantly altered during pregnancy, and are characterized by the evolution of a transient neuroendocrine system, the placenta, and modifications in endocrine control mechanisms. Because these alterations have implications for neuroendocrine responsivity to exogenous conditions, the aim of the present study was to examine the cross-sectional association between prenatal psychosocial factors and stress-related neuroendocrine parameters during human pregnancy.

METHOD

Fifty-four adult women with a singleton, intrauterine pregnancy were recruited before 28 weeks of gestation. Maternal antecubital venous blood samples were withdrawn at 28 weeks of gestation for bioassays of adrenocorticotropin hormone (ACTH), beta-endorphin (beta E), and cortisol. Measures of prenatal stress, social support, and personality were collected using a two-part, self-report questionnaire administered at 28 and 30 weeks of gestation. Biomedical data were obtained from the medical record. Factors known to influence neuropeptide and hormone levels during pregnancy were controlled, including gestational age, circadian variation, and obstetric risk.

RESULTS

In the present sample, prenatal psychosocial stress, social support, and personality variables were associated with neuroendocrine parameters in two primary ways. First, certain psychosocial factors were significantly associated with plasma levels of ACTH, beta E, and cortisol, and second, psychosocial factors were associated with a measure of disregulation of the normal relationship between two pro-opiomelanocortin (POMC) derivatives, ACTH and beta E. Furthermore, a combination of the maternal psychosocial and sociodemographic factors during pregnancy accounted for 36% of the variance in ACTH, 22% of the variance in the ACTH-beta E disregulation index, 13% of the variance in cortisol, and 3% of the variance in beta E.

CONCLUSIONS

The present findings are consistent with the premise that maternal-placental-fetal neuroendocrine parameters are significantly associated, both in magnitude and specificity, with features of maternal psychosocial functioning in pregnancy despite the systemic alterations associated with the endocrinology of pregnancy. These findings provide a basis for further investigations of the role of the neuroendocrine system as a putative mediating pathway between prenatal psychosocial factors and birth outcome, and possibly also as a mechanism linking features of the maternal psychosocial environment to fetal/infant brain development.

Subjective anxiety measurements and cortisol responses in adults who stutter

Anxiety, as measured by self-report inventories and salivary cortisol levels, was examined in 11 males who stutter and 11 males who do not stutter during baseline, low stress, and high stress sessions. During the high stress session salivary cortisol was significantly greater in persons who stutter than in persons who do not stutter. No significant differences were found between the two groups on the State-Anxiety Inventory, Trait-Anxiety Inventory, or the Personal Report of Communication Apprehension. Significant differences in anxiety levels among the baseline, low stress, and high stress sessions for both groups of subjects were found for the State-Anxiety Inventory. No other significant differences or relationships were found between the two groups.

Serum and saliva cortisol relations in adolescents during pregnancy and the early postpartum period

The purpose of this investigation was to examine: (1) relations between serum and saliva cortisol in adolescents in pregnancy and early postpartum and (2) short-term consistency of serum and saliva cortisol across three samples, 20 minutes apart, as well as the long-term consistency from pregnancy to early postpartum. Pregnant adolescents (n = 40), ages 14 to 19 years, were enrolled in this study. Subjects were seen at 20 weeks gestation or earlier (T1), 34-36 weeks gestation (T2), and 2-3 weeks postpartum (T3). Blood samples were drawn at T1 and T3, at 0, 20, and 40 minutes. Saliva samples were collected across the same 40-minute period at T1, T2, and T3. Spearman rho (rs) correlation coefficients between serum and saliva ranged from 0.72 to 0.77 (T1), and 0.42 to 0.60 (T3) (p < or = 0.05). Short-term consistency between serum cortisol samples was 0.86-0.97 at T1 and 0.60-0.82 at T3. Short-term consistency for saliva cortisol samples was 0.70-0.96 at T1, 0.91-0.95 at T2, and 0.64-0.89 at T3. Long-term consistency (T1 to T3) for serum and saliva cortisol was low. Individual differences as well as dramatic changes in the endocrine environment in pregnancy and the early postpartum period may explain the more moderate serum-saliva correlations in the postpartum period.