Neuropsychopharmacology (2011) 36, 1886–1893

& 2011 American College of Neuropsychopharmacology. All rights reserved 0893-133X/11

www.neuropsychopharmacology.org

Plasma Oxytocin Concentration during Pregnancy is

associated with Development of Postpartum Depression


 Marta Skrundz1, Margarete Bolten1,2, Irina Nast1, Dirk H Hellhammer3 and Gunther Meinlschmidt*,1,4


 1
SesamFSwiss Etiological Study of Adjustment and Mental HealthFNational Centre of Competence in Research, Faculty of Psychology,

 University of Basel, Basel, Switzerland; 2Child and Adolescents Psychiatric Clinic, Department of Developmental Psychopathology, University

 of Basel, Basel, Switzerland; 3Division of Theoretical and Clinical Psychobiology, University of Trier, Trier, Germany; 4Department of Clinical

 Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland





 Postpartum depression (PPD) affects up to 19% of all women after parturition. The non-apeptide oxytocin (OXT) is involved in

 adjustment to pregnancy, maternal behavior, and bonding. Our aim was to examine the possible association between plasma OXT

 during pregnancy and the development of PPD symptoms. A total of 74 healthy, pregnant women were included in this prospective

 study. During the third trimester of pregnancy and within 2 weeks after parturition, PPD symptoms were assessed using the Edinburgh

 Postnatal Depression Scale (EPDS). Blood samples for plasma OXT assessment were collected in the third trimester. Following the

 literature, participants with postpartum EPDS scores of 10 or more were regarded as being at risk for PPD development (rPPD group).

 In a logistic regression analysis, plasma OXT was included as a potential predictor for being at risk for PPD. Results were controlled for

 prepartal EPDS score, sociodemographic and birth-outcome variables. Plasma OXT concentration in mid-pregnancy significantly

 predicted PPD symptoms at 2 weeks postpartum. Compared with the no-risk-for-PPD group, the rPPD group was characterized by

 lower plasma OXT concentrations. To our knowledge, this is the first study to show an association between prepartal plasma OXT

 concentration and postpartal symptoms of PPD in humans. Assuming a causal relationship, enhancing OXT release during pregnancy

 could serve as a potential target in prepartum PPD prevention, and help to minimize adverse effects of PPD on the mother–child

 relationship.

 Neuropsychopharmacology (2011) 36, 1886–1893; doi:10.1038/npp.2011.74; published online 11 May 2011

 Keywords: postpartum depression; oxytocin; pregnancy; EPDS; adaptation to motherhood




INTRODUCTION seen as a time of increased emotional vulnerability, partly

caused by dysregulations of the endocrinological homeo-
Postpartum depression (PPD) affects up to 19% of all
stasis (Wisner and Stowe, 1997). Because of the challenging
mothers and adversely influences maternal adaptation to
reorganization of physiological processes that comes along
motherhood (Gavin et al, 2005) with negative effects on
with pregnancy and parturition, research started to address
child development, as children of depressive mothers are endocrine factors as potential determinants in the etiology
more vulnerable to develop mental disorders in later life
of PPD. From animal models of PPD, we know that
(Grace et al, 2003).
withdrawal from high doses of estradiol and progesterone,
The etiology of PPD is closely related to psychological
comparable to the respective amounts available during
determinants and experiences during pregnancy (O’Hara
pregnancy, is followed by depression-like symptoms (Green
and Swain, 1996). Identification of psychological risk factors
et al, 2009). Addtionally, the regulation of the hypothalamic–
for PPD has been an important issue in the recent years.
pituitary–adrenal (HPA) axis seems to be disturbed in
Major identified risk factors are a history of previous PPD
women with PPD (Brummelte and Galea, 2010) or short
or affective disorders in general, stressful life events, lack of
periods of Postpartum Blues (Ehlert et al, 1990). However,
social support, and low self-esteem (Beck, 2006; Robertson
existing findings are not consistent (Bloch et al, 2003). One
et al, 2004). Additionally, the early postpartum period is biological parameter that has not yet been considered in
PPD etiology, is the non-apeptide oxytocin (OXT). OXT is
*Correspondence: Dr G Meinlschmidt, SesamFSwiss Etiological Study
synthesized in the paraventricular nucleus (PVN) and the
of Adjustment and Mental Health, Institute of Psychology, University of
Basel, Missionsstrasse 60–62, Basel CH-4055, Switzerland, supraoptic nucleus (SON) of the hypothalamus and released
Tel: + 41 61 267 0275, Fax: + 41 61 267 0659, peripherally into the blood and centrally into different brain
E-mail: gunther.meinlschmidt@unibas.ch regions (Gimpl and Fahrenholz, 2001). In context of
Received 5 December 2010; revised 24 February 2011; accepted 21 pregnancy, OXT is known for its involvement in the
March 2011 process of delivery (Russell et al, 2003) and its physiological
 Oxytocin and postpartum depression
M Skrundz et al
1887
role in the onset and maintenance of lactation (Sala and
Althabe, 1968).
Beyond its physiological functions in the periphery,
animal studies provide evidence for a major role of OXT
in behavioral adaptation to pregnancy and motherhood.
Characteristic maternal behaviors (pup-grooming, hover
over offspring and respond latency) are impaired, if OXT
availability is diminished (Higuchi and Kaba, 1997; Olazabal
and Young, 2005; Pedersen et al, 2006). Furthermore,
maternal OXT functioning influences reciprocal affective
behaviors between mother and offspring in mammalian
species (Nelson and Panksepp, 1998). Recently, this asso-
ciation was also shown in humans. Parents showing more
affectionate and stimulatory behaviors in interactions with
their children were characterized by higher plasma OXT
concentrations (Gordon et al, 2010). Further, Feldman et al.
(2007) reported associations between prepartum-assessed
OXT concentrations and postpartum maternal adaptation.
The maternal plasma OXT level, measured during early and
late pregnancy, as well as in the first month postpartum,
predicted maternal behavior (mother’s gaze at infant, Figure 1 Flowchart of study participants.
motherese vocalizations and affectionate touch) in inter-
action with the child. A study assessing plasma OXT twice
during pregnancy showed higher postpartum maternal–fetal (d) a pre-pregnancy BMI below 32, (e) no smoking beyond
attachment-scores in women with a OXT rise between the the 10th week of gestation and (f) good knowledge of
first and third trimester compared with women with stable German language. Data for analyses of the present
or decreasing patterns of OXT (Levine et al, 2007). In non- paper were available for 73 participants, of which 16
pregnant women, OXT is known to promote interpersonal were characterized by at least one lifetime depressive
relationships and enhance feelings of love and trust episode. All lifetime episodes of depression occured more
(Heinrichs and Domes, 2008). than 2 years before participation in the study. A flowchart of
On the basis of current evidence, lower OXT levels study participants is displayed in Figure 1. Comparisons
in pregnancy could result in impaired emotional adaptation between the 73 women providing complete data and the 27
to motherhood, which is a major risk factor for PPD excluded women indicated no significant differences on age,
development and subsequently affects the quality of parity, socioeconomic status and PPD symptoms.
maternal behavior (Murray et al, 1993; Stein et al, 2010). Informed written consent was obtained from all partici-
Therefore, the aim of this study was to assess a pants. The study protocol was approved by the local ethics
potential association between OXT during pregnancy committee and is consistent with the revised Helsinki
and postpartum PPD symptoms in a sample of healthy Declaration of 1975.
pregnant women. We expected, that lower plasma OXT
levels during the third trimester of pregnancy would Blood Sampling and OXT Measurement
result in an increased risk for PPD, as assessed post-
partum. Results could help to elucidate the etiopathology All blood samples were obtained between the 30th and 34th
of PPD and provide new targets for prepartal prevention week of gestation. Participants visited the study centre for
of PPD. an experimental session, which included blood sampling
and other physiological assessments. The samples for the
OXT assessment were collected at the beginning of the
METHODS session, starting between 1300 hours and 1500 hours.
Participants were seated on a examination couch and a
Subjects
study nurse sampled 2.7 ml of blood into vacutainer tubes
Data were collected within a larger longitudinal study containing lithium heparin and 108 ml of Aprotinin
conducted with 100 pregnant women in the area of Basel, (BioChemica, Germany). Tubes were kept on ice and centri-
Switzerland. All participants were recruited between their fuged within 10 min at 6 1C at 3000 g for 10 min. Super-
21st and 32nd week of gestation. Recruitment methods natants were pipetted into safe-lock devices and stored at
included local newspaper announcements, promotion of the 80 1C until analysis.
study at local hospitals and a call for participants on local Samples were analyzed at the Department of Behavioural
TV. A detailed study description was given to all interested Neuroendocrinology, Max Plank Institute of Psychiatry,
women and, if any arised, questions were answered. Munich, Germany, using a radioimmunoassay, as described
All participants were screened for the following inclusion elsewhere (Landgraf et al, 1995). This assay was reported
criteria: (a) no current mental illness, (b) no severe medical to have an antiserum cross-reactivity of less than 0.7%, with
complications (acute or chronic physical diseases, such as a detection limit of 0.1 pg per sample. All samples were
gestational diabetes, metabolic diseases, hypertension and analyzed in duplicates. The intra-assay and inter-assay
thyroid dysfunction), (c) no signs of fetal malformation, coefficients of variability were 6–8 and 8–10%, respectively.

Neuropsychopharmacology
 Oxytocin and postpartum depression
M Skrundz et al
1888
Assessment of Demographic and Psychological analyzed using SPSS 16.0.2 for Mac OS X. The level of
Characteristics significance for all analyses was set at a ¼ 0.05.
After inclusion, participants were interviewed for assessing
possible present, recent or life-time depression and anxiety RESULTS
disorders using the German translation of corresponding
sections of the Computer Assisted Personal Interview Sample and Group Characteristics
(CAPI) version of the Composite International Diagnostic Demographic and pregnancy-related sample and group
Interview (Wittchen et al, 1998; Wittchen and Pfister, 1997; characteristics are displayed in Table 1. A group variable
World Health Organization, 1990) and general socioeco- was introduced according to the postpartum EPDS score. In
nomic data. all, 14 participants were identified as having a postpartum
Depressive symptoms were assessed within 2 weeks after EPDS score of 10 or more and were assigned to the rPPD
delivery using the Edinburgh Postnatal Depression Scale group, representing a higher risk for the development of
(EPDS), a scale originally developed as a screening measure PPD. The remaining 59 participants were assigned to the
for depression, showing good reliability (split-half: 0.82; nPPD group. Groups were tested for significant differences
standardized a ¼ 0.81) (Bergant et al, 1998). A total of regarding sociodemographic and birth characteristics.
10 items, dealing with typical PPD symptoms are answered Groups differed only in length of gestation. Participants in
on a 4-point scale. As a control variable, the prepartal EPDS the rPPD group had a significantly shorter length of gesta-
score was assessed between the 32nd and 34th week of tion (M ¼ 39.02 weeks) compared with participants in the
gestation. nPPD group (M ¼ 39.73 weeks) (T (71) ¼ 2.049; Po0.05).
Information on length of gestation and birth outcome Therefore length of gestation was included as a potential
were collected from medical records. mediator in further analysis of the relationship between
OXT and PPD symptoms.
Data Analyses
Pre and Postpartal EPDS Scores
All variables were checked for normal distribution, missing
data and outliers (defined as more than two standard Postpartal EPDS scores did not differ between nursing and
deviations below or above the mean) by the Kolmogorov– not nursing mothers (T (69) ¼ 0.025; P ¼ 0.98). Prepartal
Smirnof test and visual inspection. Outliers were checked EPDS scores (Range 0–17) were significantly correlated with
for validity and excluded if reasonable. If necessary, postpartal EDPS scores (Range 0–22) (r ¼ 0.232; p ¼ 0.048).
variables were subjected to transformation by natural Mean prepartal and postpartal total EPDS scores were
logarithm before further analyses. Differences on demo- 4.77 and 5.85 respectively.
graphic, biological and psychological characteristics bet-
ween included and excluded study participants were tested Plasma OXT Concentrations
by t and w2 tests. Participants were divided into a risk-for
PPD group (rPPD) and a no-risk-for PPD group (nPPD), Plasma OXT concentrations had a range of 14.39–245.71 pg/ml
according to the respective postpartum EPDS score. On the and mean OXT concentration for the overall sample was
basis of the proposals of Bergant et al. (1998) and Jardri 80.81 pg/ml (SD ¼ 48.81 pg/ml). Three outliers with OXT
et al. (2006), the chosen cut-off score for being at risk for values above 200 pg/ml were identified. Information on these
PPD was 10 or more within the first 2 weeks postpartum. three subjects did not provide a clear reason for exclusion of
T and w2 tests were computed between the groups, to these cases or any indication for invalidity of assessments.
identify possible confounders among the demographical Therefore, they were retained in the analyses. All further
and medical variables. Descriptive statistics of EPDS scores analyses were conducted with the log-transformed OXT
and OXT values are reported. The postpartal EPDS scores of concentrations to assure normal distribution. The bivariate
nursing and not nursing mothers were compared using the correlation between prepartal EPDS scores and OXT concen-
t-test. The bivariate correlation was computed between the trations was not significant (r ¼ 0.086; p ¼ 0.467).
pre- and postpartal EPDS score. The association between
OXT and PPD symptoms was tested by conducting a binary
The Association between OXT Concentration in
logistic regression analysis with the group variable as
Pregnancy and Postpartum PPD Symptoms
outcome variable and OXT concentration as the potential
predictor in the first run. In a second run the prepartal The test statistics of the logistic regression analyses, with
EPDS score was added, to control for potential confounding OXT predicting PPD symptoms are displayed in Table 2.
by previous depressive symptoms. Further analyses were Plasma OXT level significantly predicted PPD symptoms
computed including OXT concentration as the first (Exp (b) ¼ 0.290; po0.05). The coefficient of association
predictor and other potential predictors, identified through between OXT concentration and PPD was below one,
previous group comparisons. Because of the expected, indicating lower OXT levels in the rPPD group and higher
unequal group sizes, every logistic regression analysis was OXT levels in the nPPD group. The addition of the prepartal
conducted with not more than two predictors, of which the EPDS score as a further covariate in a second analysis
first one was always OXT concentration. Because accurate did not improve the model fit (Dw2 (1) ¼ 0.302; P40.05).
classification of participants is difficult when groups are not According to the results of descriptive statistics, length of
evenly split, primary emphasis was placed on prediction gestation was tested as a potential mediator in a third
rather than classification of being at risk for PPD. Data were analysis. Length of gestation did not predict PPD symptoms

Neuropsychopharmacology
 Oxytocin and postpartum depression
M Skrundz et al
1889
Table 1 Sample and Group Characteristics and Tests for Group Differences

Total sample nPPD group rPPD group Test between nPPD

M (SD)/% M (SD)/% M (SD)/% and rPPD
(N ¼ 73) (n ¼ 59) (n ¼ 14) P-value

Maternal age (years) 31.05 (4.70) 31.22 (4.69) 30.36 (4.88) 0.541a

Income category 0.928b

Low 8.70 8.90 7.70
Average/high 73.90 73.20 76.90
Very high 17.40 17.90 15.40

Pre-pregnancy BMI 22.31 (3.47) 22.10 (3.26) 23.32 (4.40) 0.292a

Parity
Primiparae 74.0 71.20 85.70
Multiparae 26.0 28.80 14.30

Length of gestation (weeks) 39.6 (1.2) 39.7 (1.1) 39.1 (1.4) 0.044a

Birth mode
Cesarean section 23.3 23.70 21.40

Mother is nursing 90.0 89.7 92.3

Infant birth weight (g) 3338.56 (378.44) 3345.93 (359.21) 3307.50 (465.02) 0.735a

Infant sex
Female 46.6 50.8 28.6
Male 53.4 49.2 71.4

Monthly income categories low ¼ 0–3750 swiss franks, average/high ¼ 3750–11250 swiss franks, very high ¼ above 11250 swiss franks; nPPD ¼ no risk for postpartum
depression; rPPD ¼ at risk for postpartum depression; BMI ¼ body mass-index.
a
t-test.
b 2
w -test

Table 2 Binary Logistic Regression Analysis Fort he Prediction of Being at Risk for Postpartal Depression

Model statistics Predictor statistics

v2 (df) P R2NK 2 LL Wald’s v2 (df) p Exp(b) 95% CI for Exp(b)

First analysis 6.195 (1) 0.013 0.130 65.169

Plasma oxytocin 5.555 (1) 0.018 0.290 0.103–0.812
Second analysis 6.497 (2) 0.039 0.137 64.867
Plasma oxytocin 5.366 (1) 0.021 0.294 0.105–0.828
Prepartal EPDS score 0.299 (1) 0.584 1.254 0.557–2.828
Change of model fit compared with first analysis: Dw2 (1) ¼ 0.302; p ¼ 0.583

Third analysis 9.702 (2) 0.008 0.200 61.662

Plasma oxytocin 5.250 (1) 0.022 0.294 0.103–0.838
Length of gestation 3.447 (1) 0.063 0.931 0.864–1.004
2
Change of model fit compared with first analysis: Dw (1) ¼ 3.507; p ¼ 0.061

R2NK ¼ Nagelkerke R2; 2 LL ¼ 2 log likelihood (deviance); EPDS ¼ Edinburgh Postnatal Depression Scale.

(Exp (b) ¼ 0.931; p40.05) and the model fit did not Repeating the analyses, excluding the three cases with
improve either (Dw2 (1) ¼ 3.507; P40.05). outlying OXT concentrations, did not change the results.
With OXT as predictor of PPD symptoms, 83.6% of the
sample was classified correctly into the nPPD and rPPD
DISCUSSION
group. To visualize the difference in OXT values between
the groups, mean OXT concentrations are displayed in In line with our hypothesis, we could show that OXT during
Figure 2. pregnancy was negatively associated with a positive screen

Neuropsychopharmacology
 Oxytocin and postpartum depression
M Skrundz et al
1890
our results also match reports of OXT acting as anxiolytic
and enhancing positive emotional affiliation in non-preg-
nant humans (Uvnas-Moberg, 1998). There is also evidence
for decreased plasma OXT concentrations in individuals
suffering from major depression or reporting increased
depressive symptoms (Frasch et al, 1995; Ozsoy et al, 2009;
Scantamburlo et al, 2007).
The herein observed prevalence of subjects above cutoff
resembles to those of other studies using the same screening
instrument. Here, we identified 19.18% of the sample having
an EPDS score of 10 or more. Other comparable studies
found a rate of 20% at 5 days postpartum (Bergant et al,
1998) and 16% at 2 months postpartum (Yim et al, 2009).
Group comparisons revealed a significantly shorter
gestation among women within the rPPD group. In women
with lower OXT availability in pregnancy, the oxytocinergic
inhibition of the HPA axis could be decreased. Decreased
HPA axis inhibition would enhance the exponential increase
of placental corticotropin-releasing factor that promotes the
onset of labor (Smith, 1998). However, the length of
gestation variable did not reach significance in the following
prediction of PPD symptoms. It remains to be elucidated
whether length of gestation has a mediating role in the
relationship between OXT and PPD in samples including
Figure 2 Graph shows individual oxytocin concentrations in the two premature deliveries.
groups and group means. Oxytocin values are shown on a logarithmic scale. The range of OXT concentrations found in the present
sample, is in line with those of previous studies (Dawood
et al, 1979; De Geest et al, 1985). One often-mentioned issue
on the EPDS at greater than or equal to 10, indicating a concerning OXT assessment in human samples is that
higher risk for the development of PPD. This suggests central OXT release is not necessarily related to peripheral
an increased occurrence of depressive symptoms in the OXT release, and therefore associations between centrally
first 2 weeks after delivery in individuals with low plasma regulated psychological variables and peripheral measured
OXT concentrations during pregnancy. The relationship OXT should be handled with caution (Jones et al, 1983;
persisted after controlling for prepartal EPDS scores. Landgraf and Neumann, 2004). However, in animals, there
Our findings are in agreement with the only human study are also studies accounting for joint control mechanisms of
addressing the link between plasma OXT during pregnancy central and peripheral OXT release in context of fear-related
and postpartal maternal behavior. Plasma OXT concentra- stress responses (Wotjak et al, 1998), and for autostimula-
tions during pregnancy were found to be positively tory effects at the level of the hypothalamus, in terms of
associated with a set of maternal bonding behaviors, such peripheral OXT release activation by centrally released OXT
as positive affect and gaze in interactions, as well as cogni- (McKenzie et al, 1995; Neumann et al, 1994). Given the
tive attachment representations towards the newborn in the current evidence from animal studies and the difficulties in
early postpartum period (Feldman et al, 2007). In women the determination of central OXT release in humans, it
suffering from PPD the same behaviors are impaired, seems justifiable to revert to peripheral OXT assessment.
accompanied by feelings of overload and difficulties in This is supported by several findings reporting relations
emotional attachment development towards their child between peripheral OXT in humans and various psycho-
(Beck, 2006; Martins and Gaffan, 2000). Correspondingly logical constructs, all representing aspects of human
studies with rodents report deficits in maternal behavior, affiliation and attachment (Feldman et al, 2007; Light
such as less protective behavior and less pup-licking, and et al, 2004; Tops et al, 2007; Wismer Fries et al, 2005).
longer latencies in postpartal onset of maternal behavior in The mechanisms behind the observed association be-
animals with decreased central OXT availability (Pedersen tween OXT and PPD symptoms remain to be elucidated.
et al, 2006; van Leengoed et al, 1987). Non-human primate Although we cannot rule out residual confounding by
mothers show increased maternal affiliation towards off- unknown factors, the prospective design and the inclusion
spring when central OXT is enhanced (Holman and Goy, of pre-pregnancy EPDS scores as a covariate make a causal
1995). The present findings are also in agreement with relationship imaginable. There already exists evidence that
human studies reporting relationships between plasma OXT concentrations are lower in mothers characterized by
OXT, assessed in the 2nd and 6th month postpartum and depressive symptoms and negative affect during pregnancy,
affectionate maternal behavior during mother–child inter- when assessed postpartum (Light et al, 2004). Further, OXT
actions (Gordon et al, 2010). Again, mothers’ OXT concen- is known to reduce psychological and physiological stress
trations were positively correlated with the behavioral responses (Heinrichs et al, 2003) and to inhibit hyperactive
indicators of attachment, such as motherese vocalization, fear-responses of the amygdala (Labuschagne et al, 2010).
affectionate touch and positive affect. As anxiety and exces- There is also evidence that the properties of endocrine
sive preoccupation are other important symptoms of PPD, systems during pregnancy have programming functions for

Neuropsychopharmacology
 Oxytocin and postpartum depression
M Skrundz et al
1891
the postpartal period (Meinlschmidt et al, 2010; Pop et al, use of the EPDS within a period of 2 weeks postpartum does
1993). In our study, an interplay between low OXT and not provide information on the diagnosis of PPD, which
effects on amygdala reactivity and the HPA axis in requires the presence of symptoms for at least 2 weeks.
pregnancy could indicate an increased reactivity to stressful Moreover, heightened EPDS scores in this early postpartum
stimuli at that time and promote the development of period may still be picking up the tail end of postpartum
depressive symptoms after birth, when mothers are blues, which itself is a risk factor for the development of
challenged by a bulk of potentially stressful new conditions. PPD. Finally, future studies should clarify, if the association
Additionally, expectations of the social environment and the between prepartal OXT and depressive symptoms during
growing demands of the child may promote feelings of fear the postpartum period remains stable beyond the first 2
and insecurity. Notably, a study comparing the symptoma- weeks up to several months postpartum, and if this
tology of postpartum and non-postpartum depression relationship holds true for individuals with diagnosed
found more anxious features among the investigated PPD episodes of PPD, as not all women with increased depressive
group (Hendrick et al, 2000). As we know from animal symptoms after delivery develop a full-blown affective
studies, besides the general importance of OXT in the disorder.
formation of social bonds in females (Insel, 1997), the In summary, our findings suggest that OXT is involved in
positive feedback mechanism of the oxytocinergic system is the etiology of depressive symptoms during the postpartum
supposed to provide long-lasting stimulation of maternal period, and need to be further elaborated in studies
behaviors after parturition (DaCosta et al, 1996). It may be assessing neuroendocrinological aspects of PPD. If repli-
less efficient, if OXT availability is diminished. Adopted to cated, the presented results will have important clinical
human mothers, this would be reflected by the difficulties relevance. Prepartal identification of subjects at risk for
depressed mothers have in implementing maternal beha- PPD could allow for early preventive interventions and
viors and forming a relationship with their child (Beck, minimize adverse effects for the physiological and psycho-
1995; Cooper and Murray, 1998). Considering the profound logical wellbeing of mother and child.
physiological challenge caused by endocrinological changes
over the course of gestation and the following abrupt shift
after parturition, it is not possible to form a biological ACKNOWLEDGEMENTS
model for PPD development, that accounts for all con-
tributing factors yet. Future studies should try to experi- This work is part of the National Centre of Competence in
mentally modify OXT concentrations in mid-pregnancy, to Research (NCCR) Swiss Etiological Study of Adjustment
verify, whether OXT during pregnancy contributes to the and Mental Health (sesam). The Swiss National Science
generation of depressive symptoms during the postpartum Foundation (SNF) (project no. 51A240-104890), the Uni-
period. versity of Basel, the Hoffmann-La Roche Corp. and the Basel
There are some limitations of the study. First, our finding Scientific Society provided core support for the NCCR
needs to be confirmed in future studies with more than one sesam. We are grateful to the Max Planck Institute of
OXT assessment over the course of pregnancy to clarify, if Psychiatry, Munich, Germany for the biochemical analyses.
the relationship is specific to OXT concentrations between Further, we thank Andrea H Meyer, PhD, for his statistical
the 30th and 34th week of gestation. Studies assessing OXT support.
at different stages of gestation suggest individually different
patterns of OXT fluctuations over time, indicating that there
might be a functional difference between women with stable DISCLOSURE
OXT levels and those with rising ones (Dawood et al, 1979;
The authors declare no conflict of interest.
Levine et al, 2007). But high intra-individual stability of
values has also been reported (Feldman et al, 2007; Leake
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