Elevated Serum Cortisol Levels and associated Factors among Postpartum Mothers in Mbarara district, rural south western Uganda

Background: Serum cortisol is often elevated in postpartum mothers, but data on its prevalence and associated factors remain limited in many settings. The current study aimed at examining the factors associated with elevated serum cortisol levels among postpartum mothers in Mbarara district, rural southwestern Uganda. Methods: We conducted a facility based cross sectional study among mothers between 6 weeks and 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health Center IV, a county level health facility in rural southwestern Uganda. Postpartum depression (PPD) was diagnosed using the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5). The blood cortisol levels were measured using a chemiluminiscence with the use of a standard, commercially available competitive immunoassay (Diagnostic Products Corp. Nichols Institute Diagnostics, San Juan Capistrano, CA). The normal range was 5 to 25 mcg/dL. Results: We enrolled 309 postpartum mothers, and the prevalence of elevated serum cortisol levels was 26.2% (95% CI: 22.0-31.4). Elevated serum cortisol levels were significantly associated with PPD, health facility level attended by the mother, pre-diabetes and diabetes mellitus status, and decreased involvement in physical activity. Conclusion: In this study of postpartum depression was significantly associated with elevated serum cortisol levels, attending a rural healthcare facility, having pre-diabetes or diabetes mellitus status, and reduced physical activity. These findings underscore the need for targeted holistic interventions addressing both physical and mental health challenges in postpartum women.