Impact of stress reduction instructions on stress and cortisol levels during pregnancy

The Role of Physical Fitness in Emotional Well-Being and Distress during Pregnancy: The GESTAFIT Project

Pregnancy involves various physiological, physical, and social changes that can impact the mental health of the woman, causing her to have a stressful experience. Physical fitness (PF) is postulated as a powerful marker of health in this population. Therefore, this longitudinal study examined the association of PF with maternal emotional well-being and ill-being outcomes at 16th and 34th gestational weeks (g.w.) in a sample of 158 pregnant women (32.9 ± 4.7 years old). Self-reported PF was assessed with the valid and feasible International Fitness Scale [i.e., overall PF, cardiorespiratory fitness (CRF), muscular strength, speed-agility, and flexibility]; positive and negative affect, emotional intelligence, and resilience were measured using validated questionnaires specifically designed for this purpose. The results showed that women with greater overall PF and its components showed higher positive affect and lower negative affect (all, p < 0.05); greater emotional intelligence (all, p < 0.05); and greater resilience (all, p < 0.05), with similar results both in the 16th and the 34th g.w. These findings underscore the pivotal role of PF in promoting emotional health and resilience during pregnancy, thereby highlighting the need for integrating PF enhancement strategies in prenatal care programs.

A Mixed-Methods Analysis of Coercive Control and COVID-19 Stress Among Black Women Experiencing Intimate Partner Violence During the COVID-19 Pandemic

OBJECTIVE

During times of crises, women are at elevated risk for intimate partner violence (IPV), but extant discourse fails to consider how this landscape amplifies disparities for Black women. This study examined the prevalence and associations of COVID-19 pandemic-specific coercive control and COVID-19-related stress among Black women experiencing IPV.

METHODS

Fifty-five Black women reporting past-year IPV participated in a prospective cohort study in 2020 and completed surveys on pandemic-specific coercive control, COVID-19-related stress, and sociodemographic characteristics. A subset of 15 participants completed semi-structured interviews in 2021. We conducted multivariable regression analyses to examine associations between coercive control and stress. We used interpretive phenomenological analysis to contextualize women's experiences of coercive control and stress during the pandemic.

RESULTS

In the past 3 months, 76% (42 of 55) of women had a partner blame them for exposing them to COVID-19, 74% (41 of 55) had a partner minimize their pandemic concerns, and 52% (29 of 55) had a partner prevent them from getting a COVID-19 test. A higher average of pandemic-specific coercive control was associated with greater severity of COVID-19-related traumatic stress (b [SE] = 0.033 [0.009]; P = .001) and socioeconomic consequences related to COVID-19 (b [SE] = 0.019 [0.008]; P = .03). We identified 3 superordinate themes that illustrated Black women's experiences: (1) coercive control, (2) pandemic-driven shifts in relational context, and (3) women's structural and psychosocial stressors.

CONCLUSIONS

Experiencing coercive control during the pandemic interfered with Black women's engagement in preventive behaviors, which exacerbated distress. Intersectional public health efforts should address sociostructural and relational factors to prevent coercive control and stress among Black women experiencing IPV.

Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review

BACKGROUND

Stress before conception and during pregnancy is associated with less favorable maternal and child health. Alterations in prenatal cortisol levels may serve as a central biological pathway linking stress to adverse maternal and child health. Research examining associations between maternal stress from childhood through pregnancy and prenatal cortisol has not been comprehensively reviewed.

METHOD

The current scoping review of 48 papers synthesizes studies reporting on associations between stress before conception and during pregnancy with maternal cortisol in pregnancy. Eligible studies measured childhood, the proximal preconception period, pregnancy, or lifetime stress based on stress exposures or appraisals and measured cortisol in saliva or hair during pregnancy.

RESULTS

Higher maternal childhood stress was associated with higher cortisol awakening responses and alterations in typical pregnancy-specific changes in diurnal cortisol patterns across studies. In contrast, most studies of preconception and prenatal stress reported null associations with cortisol and those reporting significant effects were inconsistent in direction. A few studies found that the associations between stress and cortisol during pregnancy varied as a function of several moderators including social support and environmental pollution.

CONCLUSIONS

Although many studies have evaluated effects of maternal stress on prenatal cortisol, this scoping review is the first to synthesize existing literature on this topic. The association between stress before conception and during pregnancy and prenatal cortisol may depend on the developmental timing of stress and several moderators. Maternal childhood stress was more consistently associated with prenatal cortisol than proximal preconception or pregnancy stress. We discuss methodological and analytic factors that may contribute to mixed findings.

A Novel Smart Belt for Anxiety Detection, Classification, and Reduction Using IIoMT on Students' Cardiac Signal and MSY

The prevalence of anxiety among university students is increasing, resulting in the negative impact on their academic and social (behavioral and emotional) development. In order for students to have competitive academic performance, the cognitive function should be strengthened by detecting and handling anxiety. Over a period of 6 weeks, this study examined how to detect anxiety and how Mano Shakti Yoga (MSY) helps reduce anxiety. Relying on cardiac signals, this study follows an integrated detection-estimation-reduction framework for anxiety using the Intelligent Internet of Medical Things (IIoMT) and MSY. IIoMT is the integration of Internet of Medical Things (wearable smart belt) and machine learning algorithms (Decision Tree (DT), Random Forest (RF), and AdaBoost (AB)). Sixty-six eligible students were selected as experiencing anxiety detected based on the results of self-rating anxiety scale (SAS) questionnaire and a smart belt. Then, the students were divided randomly into two groups: experimental and control. The experimental group followed an MSY intervention for one hour twice a week, while the control group followed their own daily routine. Machine learning algorithms are used to analyze the data obtained from the smart belt. MSY is an alternative improvement for the immune system that helps reduce anxiety. All the results illustrate that the experimental group reduced anxiety with a significant (p < 0.05) difference in group × time interaction compared to the control group. The intelligent techniques achieved maximum accuracy of 80% on using RF algorithm. Thus, students can practice MSY and concentrate on their objectives by improving their intelligence, attention, and memory.

A Nested Case-Control Study of Allopregnanolone and Preterm Birth in the Healthy Start Cohort

Context

Chronic stress is a risk factor for preterm birth; however, objective measures of stress in pregnancy are limited. Maternal stress biomarkers may fill this gap. Steroid hormones and neurosteroids such as allopregnanolone (ALLO) play important roles in stress physiology and pregnancy maintenance and therefore may be promising for preterm birth prediction.

Objective

We evaluated maternal serum ALLO, progesterone, cortisol, cortisone, pregnanolone, and epipregnanolone twice in gestation to evaluate associations with preterm birth.

Methods

We performed a nested case-control study using biobanked fasting serum samples from the Healthy Start prebirth cohort. We included healthy women with a singleton pregnancy and matched preterm cases with term controls (1:1; N = 27 per group). We used a new HPLC-tandem mass spectrometry assay to quantify ALLO and five related steroids. We used ANOVA, Fisher exact, χ², t test, and linear and logistic regression as statistical tests.

Results

Maternal serum ALLO did not associate with preterm birth nor differ between groups. Mean cortisol levels were significantly higher in the preterm group early in pregnancy (13w0d-18w0d; P < 0.05) and higher early pregnancy cortisol associated with increased odds of preterm birth (at 13w0d; odds ratio, 1.007; 95% CI, 1.0002-1.014). Progesterone, cortisone, pregnanolone, and epipregnanolone did not associate with preterm birth.

Conclusion

The findings from our pilot study suggest potential utility of cortisol as a maternal serum biomarker for preterm birth risk assessment in early pregnancy. Further evaluation using larger cohorts and additional gestational timepoints for ALLO and the other analytes may be informative.

The Cisnormative Blindspot Explained: Healthcare Experiences of Trans Men and Non-Binary Persons and the accessibility to inclusive sexual & reproductive Healthcare, an integrative review

Trans men and non-binary persons assigned female at birth (AFAB) often encounter resistance and reluctance pertaining to their healthcare needs. As a result of patriarchal-based decision-making and cis-heteronormative ideologies, the trans and gender diverse (TGD) population is routinely left out of representation in research, education, and healthcare. The aim of this integrative literature review is to describe the experiences of trans men and non-binary persons AFAB in healthcare interactions and their sexual and reproductive healthcare needs. A total of 32 articles were analyzed, synthesized, and reconceptualized through joint inductive and deductive analysis with a transfeminist and intersectional lens. From these papers, two broader concepts emerged with five sub-concepts that portrayed underlying barriers to care (primed with fear, onus of self-advocacy, and call for competence) and internalized ideologies (pregnancy incompatibility and presumptive care). A multidisciplinary approach is essential to employ in implementation efforts involving improved standards of care and in achieving desired family planning. As this is not as linear as addressing a knowledge gap, but one of deeper set intrinsic ideologies, instruction on the necessary impact of continued education and peer learning within the context of in-group dynamics can help the efficiency of designated change agents within the healthcare systems themselves.

Maternal mental distress and cortisol levels in pregnancies with congenital heart disease

OBJECTIVES

Prenatal maternal stress is associated with adverse offspring outcomes, which may be mediated by maternal stress hormones. However, evidence supporting the association between maternal stress and cortisol levels in high-risk pregnancies is limited. This study aims to determine the relationship between self-reported maternal mental distress and maternal salivary cortisol levels in pregnancies complicated by foetal CHD compared with healthy pregnancies.

METHODS

We recruited women with pregnancies complicated by foetal CHD and healthy pregnancies. Maternal saliva was collected between 22 and 40 gestational weeks. Standardized questionnaires measuring stress, depression, and anxiety were completed by patients. Generalized estimating equation was used to evaluate associations between maternal mental distress scales and cortisol levels.

RESULTS

We studied 165 women (55 CHD, 110 controls) and collected 504 cortisol samples (160 CHD, 344 controls). Women carrying CHD foetuses had higher stress, anxiety, and depression scores compared to women carrying healthy foetuses. However, maternal cortisol levels did not significantly differ in CHD and controls. Cortisol levels were higher in women carrying foetuses with functionally single-ventricle versus two-ventricle CHD. In both CHD and controls, there was no significant association between maternal stress, depression or anxiety scores and cortisol levels.

CONCLUSION

Our data suggest that self-reported maternal stress, anxiety, and depression are not associated with maternal salivary cortisol levels in CHD and healthy pregnancies. The impact of maternal mental distress on foetal health may be through other mediating pathways other than maternal cortisol concentrations.

Understanding and Reducing Persistent Racial Disparities in Preterm Birth: a Model of Stress-Induced Developmental Plasticity

Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal-fetal-placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.

Psychological state during pregnancy is associated with sleep quality: preliminary findings from MY-CARE cohort study

Psychological distress during pregnancy may increase the risk of adverse maternal and infant outcomes. Past studies have demonstrated the association between circadian disturbances with psychological health. However, the roles of chronotype and social jetlag on psychological state during pregnancy are yet to be identified. We aimed to examine the psychological state in pregnant women and its relations to chronotype, social jetlag (SJL), sleep quality and cortisol rhythm. The current study included a subsample of participants from an ongoing cohort study. A total of 179 primigravidas (mean age 28.4 ± 4.0 years) were recruited. Chronotype and sleep quality during the second trimester were assessed using the Morning-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI), respectively. SJL was calculated based on the difference between mid-sleep on workdays and free days. Psychological state of participants was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Subsamples (n = 70) provided salivary samples at 5 time points over a 24 h period during the second trimester for cortisol assay. A higher proportion of pregnant women experienced moderate to severe anxiety symptoms (n = 77, 43.0%), followed by depressive (n = 17, 9.5%) and stress (n = 14, 7.8%) symptoms. No association was observed between chronotype and psychological distress during pregnancy. There was no significant difference in cortisol rhythms in relation to psychological distress. SJL and sleep quality were significantly associated with stress symptoms among pregnant women in the second trimester. Poor sleep quality, particularly daytime dysfunction (β = 0.37, p = .006) and sleep disturbances (β = 0.23, p = .047), were significantly associated with psychological distress (depressive, anxiety and stress symptoms) during the second trimester. The findings suggest that sleep is a potential modifiable lifestyle factor that can be targeted to improve psychological health among pregnant women.

Changes in the cortisol and oxytocin levels of first-time pregnant women during interaction with an infant: a randomized controlled trial

Background

During pregnancy, physiological, psychological, and social changes affect pregnant women’s childcare anxiety and childrearing behavior. However, there are scarce reports on hormonal evaluation related to such anxiety and behavior. Herein, we evaluated changes in salivary cortisol (primary outcome) and oxytocin (secondary outcome) levels of first-time pregnant women when interacting with an infant and discussed the relation of these changes to the women’s stress level.

Methods

This was a two-arm randomized controlled trial. Participants were randomly assigned using a web-based randomization system. The experimental group involved interaction with an infant for 30 min. The control group involved watching a DVD movie of an infant for 30 min. Saliva samples were collected at preintervention and postintervention. Saliva samples were assayed, and all data were compared between and within the groups using independent t-test and paired t-test with a two-sided 5% significance level. This study was approved by the Research Ethics Committee of St. Luke’s International University.

Results

A total of 102 women were randomly assigned to the experimental (n = 51) and control (n = 51) groups. Finally, 38 women in the experimental group and 42 women in the control group were analyzed. The salivary cortisol level significantly decreased after the interventions in both groups (t = 4.57, p = 0.00; t = 5.01, p = 0.00). However, there were no significant differences in the salivary cortisol (t = 0.349, p = 0.73) and oxytocin (t = − 1.945, p = 0.58) levels between the two groups.

Conclusions

The salivary cortisol level of first-time pregnant women significantly decreased in the experimental and control groups postintervention, although no significant difference was found between the two groups. Such decrease indicates stress reduction and release among these women. The absence of a significant increase in salivary oxytocin level in both groups may be related to the limitations of an insufficient number of samples that could be analyzed owing to the small saliva volume in some samples and the lack of adequate tactile stimulation of the intervention protocol. These results and procedural limitations provide useful insights into approaching subsequent studies aiming at continuously optimizing detection procedures.

Trial registration

UMIN000028471 (Clinical Trials Registry of University Hospital Information Network. July 31, 2017- Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03609-8.

Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum-A randomized controlled trial

Background

Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum.

Methods

In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test.

Findings

During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96).

Conclusion

Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.

Investigation of the effectiveness of psychiatric interventions on the mental health of pregnant women in Kashan City - Iran: A clinical trial study

AIM

Pregnancy is one of the most sensitive periods in a person's life; therefore maternal mental illness during pregnancy increases the risk for adverse developmental outcomes in children (Jha et al., 2018). The aim of this study was to determine the effectiveness of psychiatric interventions in the mental health of pregnant women in Kashan, Iran.

METHODS

The purpose of this clinical trial was to evaluate an integrated model of mental health during pregnancy over the period of 2015-2018 in Kashan. Subjects consisted in 202 pregnant women (101 in the intervention group and 101 in the control group) who were referred to Kashan Health Centers in the 6th to 10th weeks of pregnancy. The General Health Questionnaire-28, Golombok Rust Inventory of Marital State, an interview on psychiatric symptoms, and a review of the history of the mental health of the mother and first-degree relatives were utilized for data collection. In the intervention group, psychiatric measures and predictive drug treatments were presented.

RESULTS

Overall, from among 102 pregnant mothers, 39 women (37.14%) were identified as at-risk and high-risk. The highest number of mothers identified as at-risk and high-risk were in the first trimester of pregnancy and in the 6th to 10th weeks of care (64%). With the start of psychiatric interventions in the intervention group, the subscale of physical complaints and anxiety showed a significant decrease compared to the control group (P < 0.01). Mental health improvement was achieved in 95% of expectant mothers through Level I predictive measures, and only 5% of participants required the specialist level of intervention.

CONCLUSION

By identifying psychiatric disorders in pregnant mothers during the first level of pregnancy care services and taking suitable measures, an integrated model for mental health services in primary health care for pregnant women can help managers, policymakers, and decision-makers to improve health and reduce the costs in the health system in order to achieve the Sustainable Development Goals.

The effect of relaxation exercises on sleep quality in pregnant women in the third trimester: A randomized controlled trial

OBJECTIVE

To assess the effects of relaxation exercises on subjective sleep quality of in third-trimester pregnant women.

MATERIALS AND METHODS

The pretest posttest randomized controlled trial recruited 84 pregnant women in the third trimester. Following random assignment of subjects, the treatment group (n = 46) performed relaxation exercises for four weeks and the control group (n = 46) received standart cares. At baseline and after the intervention sleep quality was assessed. Data obtained were analyzed in SPSS.

RESULTS

The mean score of the global Pittsburgh Sleep Quality Index was 7.12 ± 3.66. It was determined that relaxation exercises improved some sleep quality subscales including subjective sleep quality, sleep latency, sleep duration and habitual sleep efficiency, sleep disturbances, daytime dysfunction and global sleep quality. The difference between the two groups was found to be statistically significant (p < 0.05).

CONCLUSION

A four -week compact disc guide relaxation exercises program can be effective in improving sleep quality.

Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It?

Gestational stress is believed to increase the risk of pregnancy failure and perinatal and adult morbidity and mortality in both the mother and her child or children. However, some contradictions might arise from methodological issues or even from differences in the philosophical grounds that guide the studies on gestational stress. Biased perspectives could lead us to use and/or design inadequate/incomplete panels of biochemical determinations and/or psychological instruments to diagnose it accurately during pregnancy, a psychoneuroimmune-endocrine state in which allostatic loads may be significant. Here, we review these notions and propose a model to evaluate and diagnose stress during pregnancy.

Efficacy of an internet-based cognitive behavioral stress management training in women with idiopathic preterm labor: A randomized controlled intervention study

OBJECTIVE

This randomized controlled trial aimed at evaluating the efficacy of an internet-based cognitive behavioral stress management program (IB-CBSM) for pregnant women with preterm labor (PTL) on birth outcome and stress-related psychological and biological parameters.

METHODS

93 pregnant women with PTL (gestational age 18-32) were assigned to either the IB-CBSM (n=50) or a control group (CG) based on distraction (n=43). Participants in both groups worked through six weekly modules. Birth outcome measures included gestational age, neonatal weight and length at birth and the rate of preterm birth (PTB). Questionnaires assessed psychological wellbeing and the activity of the HPA-axis was measured with the cortisol awakening reaction (CAR), both before (T1) and after the intervention (T2).

RESULTS

Birth outcome and psychological wellbeing did not differ between IB-CBSM and CG. However, psychological wellbeing was higher after both interventions (PSS: η_p²=0.455, STAIX1: η_p²=0.455, STAIX2: η_p²=0.936, PRAT: η_p²=0.465, EPDS: η_p²=0.856). Cortisol levels were stable and did not alter differently between groups from T1 to T2. Higher cortisol levels were associated with lower gestational age at birth, whereas no significant correlations were found between weight and length at birth.

CONCLUSIONS

Although there were no significant differences between the two groups and birth outcome, psychological and biological parameters, both interventions (CBSM and CG) showed equivalent effects and proved to be beneficial with regard to psychosocial distress and well-being. Further research is needed to investigate CBSM and distraction interventions for pregnant women at risk for PTB together with a non-intervention control condition.

Mood management effects of brief unsupported internet interventions

BACKGROUND

Most users of unsupported Internet interventions visit that site only once, therefore there is a need to create interventions that can be offered as a single brief interaction with the user.

OBJECTIVE

The main goal of this study was to compare the effect of a one-session unsupported Internet intervention on participants' clinical symptoms (depressive and anxiety symptoms) and related variables (mood, confidence and motivation).

METHOD

A total of 765 adults residing in the United States took part in a randomized controlled trial. Participants were randomly assigned to one of five brief plain text interventions lasting 5-10 min. The interventions designed to address depressive symptoms were: thoughts (increasing helpful thoughts), activities (increasing activity level), sleep hygiene, assertiveness (increasing assertiveness awareness), Own Methods (utilizing methods that were previously successful). They were followed-up one week after consenting.

RESULTS

A main effect of time was observed for both depression (F(1, 563) = 234.70, p < 0.001) and anxiety (F(1, 551) = 170.27, p < 0.001). In all cases, regardless of assigned condition and Major Depressive Episode status, mean scores on both positive outcomes (mood, confidence and motivation) and negative outcome scores (depression and anxiety) improved over time.

CONCLUSIONS

Brief unsupported Internet interventions can improve depressive symptoms at one-week follow-up. Further outcome data and research implications will be discussed.

The effect of fetal growth and nutrient stresses on steroid pathways

The early life environment is a crucial time for establishing the trajectory of future health. Low birthweight is considered a marker of an adverse in utero environment and predisposes to cardio-metabolic disease later in life. It has been proposed that this is mediated by glucocorticoids, with life-long activation of the HPA axis. Here we review the evidence to support this hypothesis, with particular emphasis on the effects of fetal growth and nutrient stresses in utero on steroid pathways of the HPA axis. A better understanding of the mechanisms underlying these processes could help to optimize in utero health, and identify individuals at greatest risk of future disease.

The comparative effects of group prenatal care on psychosocial outcomes

To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p < 0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p < 0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.

Stress During Pregnancy

High levels of stress during pregnancy are associated with a number of adverse psychological and physiological outcomes for mother and child. These effects seem to be transmitted in part by one of the major stress-responsive systems, namely the hypothalamic-pituitary-adrenal (HPA) axis, which includes the hormone cortisol. However, as inconsistent study results indicate, methodology poses a substantial challenge to the investigation of stress during pregnancy. For example, although measures of maternal psychological stress and stress hormones are independently related to adverse pregnancy outcome, they seldom have been found to correlate with one another directly. Repeated measurement of psychological and biological responses to acute standardized stress challenges appears to reveal stronger associations. This article reviews the literature on experienced stress and stress hormones in pregnant women and presents studies that used standardized stress challenges (e.g., the Trier Social Stress Test, the cortisol response to morning awakening) to examine maternal stress reactivity more systematically. This review also takes a look at the few studies that examined the protective effects of psychological and psychosocial resources or stress interventions on experienced stress and stress hormones in pregnant women. Overall, results indicate that baseline stress hormone levels advance incrementally during gestation, presumably to prepare mother and fetus for delivery, while responses to acute stress appear to be increasingly attenuated. Moreover, the acute maternal stress response seems to be predictive of neonatal birth outcome and maternal well-being postpartum. Preliminary findings also suggest that much can be done toward coping with stress during pregnancy. Further research and a closer collaboration between science and clinical practice are required.

Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study

BACKGROUND

Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery.

METHODS

In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires.

RESULTS

Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related.

LIMITATION

Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care.

CONCLUSION

Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders.

Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program

To examine whether a cognitive-behavioral group program among pregnant women with elevated levels of anxiety or depression may reduce anxious and depressive symptoms and has a positive impact on risk factors for anxiety disorders and depression. A total of 753 participants were recruited. After completion of the clinical standardized interview, 160 participants were randomized to an intervention group or a control condition. Psychometric assessments took place at T1 (preintervention), T2 (antenatal follow-up), and T3 (3 months postpartum). Analyses included women who took part in all 3 assessments (intervention group, N = 21; control group, N = 53). The subjective program evaluation by the participants was highly positive, but with the exception of a short-term effect on the quality of an intimate partnership (F1/67 = 4.056; P < .05], intervention effects on anxiety or depressive symptoms were not found. However, there was an intervention effect 3 months postpartum for participants with high depressive symptoms at T1 (Edinburgh Postnatal Depression Scale score of ≥10) (F1/69 = 5.410; P < .05). The results argue against a general efficacy of a cognitive-behavioral group program for pregnant women with rather low levels of anxiety and depression. For women with higher depressive symptoms during pregnancy, a cognitive-behavioral group program may have a positive impact on the course of depressive symptoms during the postpartum period.

Optimizing benefits of influenza virus vaccination during pregnancy: potential behavioral risk factors and interventions

Pregnant women and infants are at high risk for complications, hospitalization, and death due to influenza. It is well-established that influenza vaccination during pregnancy reduces rates and severity of illness in women overall. Maternal vaccination also confers antibody protection to infants via both transplacental transfer and breast milk. However, as in the general population, a relatively high proportion of pregnant women and their infants do not achieve protective antibody levels against influenza virus following maternal vaccination. Behavioral factors, particularly maternal weight and stress exposure, may affect initial maternal antibody responses, maintenance of antibody levels over time (i.e., across pregnancy), as well as the efficiency of transplacental antibody transfer to the fetus. Conversely, behavioral interventions including acute exercise and stress reduction can enhance immune protection following vaccination. Such behavioral interventions are particularly appealing in pregnancy because they are safe and non-invasive. The identification of individual risk factors for poor responses to vaccines and the application of appropriate interventions represent important steps towards personalized health care.

The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms

Perinatal depression impacts maternal and child health, and little is known about effective interventions. The effects of prenatal Hatha yoga on cortisol, affect and depressive symptoms were investigated in 51 women. Twice during pregnancy, yoga group participants reported on affect and provided a saliva sample before and after a 90-min prenatal Hatha yoga session. Corresponding measures were obtained from yoga and control group participants on days of usual activity. Depressive symptoms were assessed in pregnancy and post partum. Cortisol was lower (p < .01) and positive affect higher (p < .001) on yoga compared to usual activity days. Negative affect and contentment (p < .05) improved more in response to the yoga session. Yoga group participants showed fewer postpartum (p < .05) but not antepartum depressive symptoms than control group participants. Findings indicate that prenatal Hatha yoga may improve current mood and may be effective in reducing postpartum depressive symptoms.

Prenatal stress and risk of behavioral morbidity from age 2 to 14 years: the influence of the number, type, and timing of stressful life events

The maternal experience of stressful events during pregnancy has been associated with a number of adverse consequences for behavioral development in offspring, but the measurement and interpretation of prenatal stress varies among reported studies. The Raine Study recruited 2900 pregnancies and recorded life stress events experienced by 18 and 34 weeks' gestation along with numerous sociodemographic data. The mother's exposure to life stress events was further documented when the children were followed-up in conjunction with behavioral assessments at ages 2, 5, 8, 10, and 14 years using the Child Behavior Checklist. The maternal experience of multiple stressful events during pregnancy was associated with subsequent behavioral problems for offspring. Independent (e.g., death of a relative, job loss) and dependent stress events (e.g., financial problems, marital problems) were both significantly associated with a greater incidence of mental health morbidity between age 2 and 14 years. Exposure to stressful events in the first 18 weeks of pregnancy showed similar associations with subsequent total and externalizing morbidity to events reported at 34 weeks of gestation. These results were independent of postnatal stress exposure. Improved support for women with chronic stress exposure during pregnancy may improve the mental health of their offspring in later life.

Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France

Background

Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.

Methods

A multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.

Results

A difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T₂ (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).

Conclusions

The decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.

Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes

Overexposure of the developing fetus to glucocorticoids is hypothesised to be one of the key mechanisms linking early life development with later life disease. The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes dramatic changes during pregnancy and postpartum. Although cortisol levels rise threefold by the third trimester, the fetus is partially protected from high cortisol by activity of the enzyme 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2). Maternal HPA axis activity and activity of HSD11B2 may be modified by maternal stress and disease allowing greater transfer of glucocorticoids from mother to fetus. Here we review emerging data from human studies linking dysregulation of the maternal HPA axis to outcomes in both the mother and her offspring. For the offspring, greater glucocorticoid exposure is associated with lower birth weight and shorter gestation at delivery. In addition, evidence supports longer term consequences for the offspring including re-setting of the HPA axis and susceptibility to neurodevelopmental problems and cardiometabolic disease. For the mother, the changes in the HPA axis, particularly in the postpartum period, may increase vulnerability to mood disturbances. Further understanding of the changes in the HPA axis during pregnancy and the impact of these changes may ultimately allow early identification of those most at risk of future disease.

Transmitting biological effects of stress in utero: implications for mother and offspring

The developing foetus makes adaptations to an adverse in utero environment which may lead to permanent changes in structure and physiology, thus 'programming' the foetus to risk of ill health in later life. Epidemiological studies have shown associations between low birth weight, a surrogate marker of an adverse intrauterine environment, and a range of diseases in adult life including cardiometabolic and psychiatric disease. These associations do not apply exclusively to low birth weight babies but also to newborns within the normal birth weight range. Early life stress, including stressors in the prenatal and early postnatal period, is a key factor that can have long-term effects on offspring health. Animal studies show this is mediated through changes in the maternal and foetal hypothalamic-pituitary-adrenal axes resulting in foetal exposure to excess glucocorticoids. Data in humans are more limited but support that the biological effects of stress in utero may be transmitted through changes in glucocorticoid action or metabolism. Common contemporary physical and social stressors of maternal obesity and socio-economic deprivation impact on the maternal response to pregnancy and the prevailing hormonal milieu that the developing foetus will be exposed to. Prenatal stress may also be compounded by early postnatal stresses such as childhood maltreatment with resultant adverse effects for the offspring. Understanding of the mechanisms whereby these stressors are transmitted from mother to foetus will not only improve our knowledge of normal foetal development but will also help identify novel pathways for early intervention either in the periconceptional, pregnancy or the early postpartum period.

Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology

The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.

Relaxation during pregnancy: what are the benefits for mother, fetus, and the newborn? A systematic review of the literature

Previous studies have reported associations between maternal stress during pregnancy and obstetric outcomes as well as fetal development and neonatal adaptation. These findings highlight the importance of identifying pregnant women who experience severe stress and the need for interventions that commence early in pregnancy. The aim of this study was to review studies that investigated the effects of relaxation techniques during pregnancy, including maternal, fetal, and neonatal outcomes. In addition, studies examining maternal endocrine and physiological alterations were reviewed. PubMed was searched using the following key words: maternal well-being, maternal stress, relaxation techniques, pregnancy, fetal neurobehavior, fetal heart rate, neonatal adaptation, and neonatal behavior. (1) Relaxation had a positive impact on women's emotional state. (2) Pregnancy outcomes improved with fewer admissions to the hospital, fewer obstetric complications, longer gestation, reduction of caesarean sections, and fewer postpartum complications. (3) Fetal heart rate and fetal motor activity were reduced as a result of relaxation and therefore interpreted as improved result. (4) Higher-birth-weight and improved performance on the Neonatal Behavioral Assessment Scale was related to relaxation. (5) Relaxation training was associated with reductions in maternal physiological and endocrine measures. Relaxation during pregnancy is associated with salutogenic effects that include regulation of emotional states and physiology. Relaxation is also associated with positive effects both on fetal behavior and on obstetric and neonatal outcomes. Identifying pregnant women at risk and instituting treatment early in pregnancy could improve obstetric and developmental outcomes for both the mother and her fetus.

Mediators of adverse birth outcomes among socially disadvantaged women

BACKGROUND

Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes.

METHODS

Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data.

RESULTS

Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy.

CONCLUSIONS

The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.

Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants

Recent findings suggest that elevated stress levels during the pre- and postpartum period are related to poor maternal and infant health outcomes; yet, few studies have prospectively examined the efficacy of stress management interventions on regulating stress levels among mothers and their infants. The current study examined whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol (a biological marker of stress) and self-reported stress levels among mothers and their infants at six and 18 months postpartum, relative to two control groups. Our sample was comprised of predominantly Spanish-speaking, low-income women (80%; mean age=25±5 years) who were screened for depression during their second trimester of pregnancy (M=16±5 weeks of gestation). Women at high risk for depression [i.e., having either a past history of major depression or current elevated symptoms of depression (≥16 on CES-D)] were randomized to either a CBSM group (n=24) or a usual care (UC) group (n=33), while a low risk comparison (LRC) group (n=29) was comprised of women not meeting either depression criteria. ANCOVA analyses demonstrated that: (1) infants of women in the CBSM and LRC groups had significantly lower cortisol levels than infants of women in the UC group at six months postpartum (p<.001); and (2) women in the CBSM group had lower cortisol levels than women in the UC group at 18 months postpartum (p<.01). These results suggest that prenatal CBSM interventions may be efficacious in regulating biological markers of stress among mothers and their infants, thereby decreasing their risk for developing health complications over time.

Salivary cortisol in pregnant women suffering from blood and injection phobia

Stress and/or anxiety during pregnancy affect maternal and fetal well-being and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress, including anxiety and sometimes panic attacks, during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim of this study was to investigate whether pregnant women suffering from blood and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared with healthy controls. The sample consisted of 110 pregnant women with blood and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in weeks 25 and 36 for the assay of cortisol. In gestational week 25, when blood was drawn for the mandatory blood testing, extra blood was taken to analyze corticotrophin-releasing factor, adrenocorticotropic hormone, and cortisol in serum. The diurnal decline in salivary cortisol as well as increased cortisol levels were observed during pregnancy. Pregnant women suffering from blood and injection phobia had a higher output of cortisol compared with women without the phobia (F = 6.25, df = 1, p = 0.014), but no marked difference in the diurnal cortisol rhythm was found between groups. Our findings indicate that untreated blood and injection phobia during pregnancy increases cortisol concentrations. Blood and injection phobia is treatable, and cognitive behavioral therapy can be used. Women with blood and injection phobia during pregnancy therefore need to be recognized and offered treatment without delay in early pregnancy.

Predictors and patterns of participant adherence to a cortisol collection protocol

BACKGROUND

Cortisol, a stress-related hormone, has been measured in many psychoimmunological studies via collection of saliva; however, patterns of participant adherence to protocol procedures are rarely described in the literature.

OBJECTIVES

In this paper we examine adherence to a cortisol morning rise collection protocol and explore its associations with demographic predictors and fatigue.

METHOD

Participants included 262 breast cancer survivors enrolled in a National Institute of Nursing Research funded longitudinal intervention study (5R01NR010190, M. Mishel, P.I.). Self-reported times of salivary cortisol collection were recorded for each of 12 saliva samples. Adherence was assessed with respect to various demographic factors and fatigue. Participants were categorized as having high, moderate, or low adherence to the saliva collection protocol.

RESULTS

Overall, 117 (45%) participants had high adherence to the protocol, 117 (45%) participants had moderate adherence, and 28 (∼11%) participants had low adherence. Tests for proportionality for the polytomous logistic regression indicated that demographic predictors in our model had a similar association with each level of participant adherence. Women who did not adhere to the saliva collection were more likely to be African American (OR .50, CI .29-.88) and to report a high impact of fatigue on their behaviors (OR .88, CI .79-.98). Though other predictors in the model were not statistically significant (working full-time and living with at least one child under 18 years of age), the overall model was significant (χ(2)(4)=17.35, p<.01).

DISCUSSION

To our knowledge, this is the first study to examine profiles of participant adherence to a cortisol sampling protocol over multiple timepoints. By conceptualizing adherence as a polytomous outcome, future studies may give us insights into adherence trends in other populations with the aim of promoting adherence and designing more informed saliva collection protocols.

Fetal response to abbreviated relaxation techniques. A randomized controlled study

BACKGROUND

stress during pregnancy can have adverse effects on the course of pregnancy and on fetal development. There are few studies investigating the outcome of stress reduction interventions on maternal well-being and obstetric outcome.

AIMS

this study aims (1) to obtain fetal behavioral states (quiet/active sleep, quiet/active wakefulness), (2) to investigate the effects of maternal relaxation on fetal behavior as well as on uterine activity, and (3) to investigate maternal physiological and endocrine parameters as potential underlying mechanisms for maternal-fetal relaxation-transferral.

STUDY DESIGN

the behavior of 33 fetuses was analyzed during laboratory relaxation/quiet rest (control group, CG) and controlled for baseline fetal behavior. Potential associations between relaxation/quiet rest and fetal behavior (fetal heart rate (FHR), FHR variation, FHR acceleration, and body movements) and uterine activity were studied, using a computerized cardiotocogram (CTG) system. Maternal heart rate, blood pressure, cortisol, and norepinephrine were measured.

RESULTS

intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in fetal behavior. The intervention groups had higher long-term variation during and after relaxation compared to the CG (p=.039). CG fetuses had more FHR acceleration, especially during and after quiet rest (p=.027). Women in the PMR group had significantly more uterine activity than women in the GI group (p=.011) and than CG women. Maternal heart rate, blood pressure, and stress hormones were not associated with fetal behavior.

CONCLUSIONS

this study indicates that the fetus might participate in maternal relaxation and suggests that GI is superior to PMR. This could especially be true for women who tend to direct their attention to body sensations such as abdominal activity.

Effects of relaxation on psychobiological wellbeing during pregnancy: a randomized controlled trial

Prenatal maternal stress is associated with adverse birth outcomes and may be reduced by relaxation exercises. The aim of the present study was to compare the immediate effects of two active and one passive 10-min relaxation technique on perceived and physiological indicators of relaxation. 39 healthy pregnant women recruited at the outpatient department of the University Women's Hospital Basel participated in a randomized controlled trial with an experimental repeated measure design. Participants were assigned to one of two active relaxation techniques, progressive muscle relaxation (PMR) or guided imagery (GI), or a passive relaxation control condition. Self-reported relaxation on a visual analogue scale (VAS) and state anxiety (STAI-S), endocrine parameters indicating hypothalamic-pituitary-adrenal (HPA) axis (cortisol and ACTH) and sympathetic-adrenal-medullary (SAM) system activity (norepinephrine and epinephrine), as well as cardiovascular responses (heart rate, systolic and diastolic blood pressure) were measured at four time points before and after the relaxation exercise. Between group differences showed, that compared to the PMR and control conditions, GI was significantly more effective in enhancing levels of relaxation and together with PMR, GI was associated with a significant decrease in heart rate. Within the groups, passive as well as active relaxation procedures were associated with a decline in endocrine measures except epinephrine. Taken together, these data indicate that different types of relaxation had differential effects on various psychological and biological stress systems. GI was especially effective in inducing self-reported relaxation in pregnant women while at the same time reducing cardiovascular activity.

Psychological and psychophysiological considerations regarding the maternal-fetal relationship

The earliest relationship does not begin with birth. Pregnant women construct mental representations of the fetus, and feelings of affiliation or "maternal-fetal attachment" generally increase over the course of gestation. While there is a fairly substantial literature on the development and moderation of psychological features of the maternal-fetal relationship, including the role of ultrasound imaging, relatively little is known about the manner in which maternal psychological functioning influences the fetus. Dispositional levels of maternal stress and anxiety are modestly associated with aspects of fetal heart rate and motor activity. Both induced maternal arousal and relaxation generate fairly immediate alterations to fetal neurobehaviors; the most consistently observed fetal response to changes in maternal psychological state involves suppression of motor activity. These effects may be mediated, in part, by an orienting response of the fetus to changes in the intrauterine environment. Conversely, there is evidence that fetal behaviors elicit maternal physiological responses. Integration of this finding into a more dynamic model of the maternal-fetal dyad, and implications for the postnatal relationship are discussed. Research on the period before birth affords tremendous opportunity for developmental scientists to advance understanding of the origins of human attachment.

Fetal motor activity and maternal cortisol

The contemporaneous association between maternal salivary cortisol and fetal motor activity was examined at 32 and 36 weeks gestation. Higher maternal cortisol was positively associated with the amplitude of fetal motor activity at 32 weeks, r(48) = .39, p < .01, and 36 weeks, r(77) = .27, p < .05, and the amount of time fetuses spent moving at 32 weeks during the 50 min observation period, r(48) = 33, p < .05. Observation of periods of unusually intense fetal motor activity were more common in fetuses of women with higher cortisol, Mann-Whitney U = 58.5. There were no sex differences in fetal motor activity, but the associations between maternal cortisol and fetal motor amplitude and overall movement were significantly stronger for male than female fetuses.

Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial

To determine whether a Nurse-Community Health Worker (CHW) home visiting team, in the context of a Medicaid enhanced prenatal/postnatal services (EPS), would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial resources (mastery, self-esteem, social support) when compared with usual Community Care (CC) that includes Medicaid EPS delivered by professionals. Greatest program benefits were expected for women who reported low psychosocial resources, high stress, or both at the time of enrollment. Medicaid eligible pregnant women (N = 613) were randomly assigned to either usual CC or the Nurse-CHW team. Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessments. Compared to usual CC, assignment to the Nurse-CHW team resulted in significantly fewer depressive symptoms, and as hypothesized, reductions in depressive symptoms were most pronounced for women with low psychosocial resources, high stress, or both high stress and low resources. Outcomes for mastery and stress approached statistical significance, with the women in the Nurse-CHW group reporting less stress and greater mastery. Women in the Nurse-CHW group with low psychosocial resources reported significantly less perceived stress than women in usual CC. No differences between the groups were found for self-esteem and social support. A Nurse-CHW team approach to EPS demonstrated advantage for alleviating depressive symptoms in Medicaid eligible women compared to CC, especially for women at higher risk.

The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress

OBJECTIVE

To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress.

DESIGN

Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention.

SETTING

The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction.

PARTICIPANTS

Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment.

METHODS

Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests.

RESULTS

Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety.

CONCLUSIONS

Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy.

Functions of health fatalism: fatalistic talk as face saving, uncertainty management, stress relief and sense making

Much research on fatalism assumes that fatalistic statements represent a global outlook that conflicts with belief in the efficacy of health behaviours. Other scholars have suggested a more contextual approach, suggesting that fatalism fulfils personal and social functions. This study analyses 96 in-depth lay interviews in the US, most with low-income members of the general public, about four diseases: heart disease, lung cancer, diabetes and depression. Within these interviews, fatalistic statements always occurred alongside statements endorsing the utility of behaviours for protecting health. This usage pattern suggests that these statements may have useful functions, rather than being simply a repudiation of the utility of health choices. We examine four functions that are suggested by previous researchers or by the participants' comments: stress relief, uncertainty management, sense making and (less strongly) face saving. As these themes indicate, individuals often make fatalistic statements to express an understanding of locally or broadly limiting factors for health efficacy, including genes, spiritual agents, prior behaviours, personality, and other factors.

The interaction between chronic stress and pregnancy: preterm birth from a biobehavioral perspective

Women's health care providers are increasingly aware that chronic stressors--such as poverty, ongoing perceived stress and anxiety, intimate partner violence, and experiences of racism--are associated with an increased incidence of preterm birth in the United States. It is important to increase our understanding of the explanatory pathways involved in these associations. This article discusses the concepts of stress, chronic stress response, allostatic load, the physiology of labor initiation, and the pathophysiologic interactions that may contribute to the occurrence of chronic stress-related preterm birth. Implications for future research and interventions are explored.

Diurnal rhythm of cortisol during late pregnancy: associations with maternal psychological well-being and fetal growth

Maternal psychological functioning during pregnancy affects both maternal and fetal well-being. The hypothalamic-pituitary-adrenal (HPA) axis provides one mechanism through which maternal psychosocial factors may be transduced to the fetus. However, few studies have examined maternal psychological factors or birth outcomes in relation to the diurnal pattern of cortisol across the day. The current study examined maternal psychological well-being, parity status, and birth weight in relation to the maternal cortisol diurnal rhythm in a group of 98 low-risk pregnant women (51 primiparae). At 36 weeks gestation, participants completed both pregnancy-specific and general self-report measures of psychological functioning and provided saliva samples at 8:00, 12:00, and 16:00 h on 2 consecutive working days for the assay of cortisol. The expected diurnal decline in salivary cortisol was observed. Higher trait anxiety was associated with a flatter afternoon decline for all mothers. For primiparae, steeper morning cortisol declines were associated with lower infant birth weight. The findings suggest that regulation of the HPA axis may differ by parity status with downstream implications for fetal growth and development.