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Rinne GR, Somers JA, Ramos IF, Ross KM, Coussons-Read M, Schetter CD. Increases in maternal depressive symptoms during pregnancy and infant cortisol reactivity: Mediation by placental corticotropin-releasing hormone. Dev Psychopathol 2023; 35:1997-2010. [PMID: 35983792 PMCID: PMC9938842 DOI: 10.1017/s0954579422000621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal depressive symptoms in pregnancy may affect offspring health through prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The biological mechanisms that explain the associations between maternal prenatal depressive symptoms and offspring HPA axis regulation are not yet clear. This pre-registered investigation examines whether patterns of maternal depressive symptoms in pregnancy are associated with infant cortisol reactivity and whether this association is mediated by changes in placental corticotropin-releasing hormone (pCRH). METHOD A sample of 174 pregnant women completed assessments in early, mid, and late pregnancy that included standardized measures of depressive symptoms and blood samples for pCRH. Infant cortisol reactivity was assessed at 1 and 6 months of age. RESULTS Greater increases in maternal depressive symptoms in pregnancy were associated with higher cortisol infant cortisol reactivity at 1 and 6 months. Greater increases in maternal depressive symptoms in pregnancy were associated with greater increases in pCRH from early to late pregnancy which in turn were associated with higher infant cortisol reactivity. CONCLUSIONS Increases in maternal depressive symptoms and pCRH over pregnancy may contribute to higher infant cortisol reactivity. These findings help to elucidate the prenatal biopsychosocial processes contributing to offspring HPA axis regulation early in development.
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Affiliation(s)
| | | | - Isabel F. Ramos
- Department of Chicano/Latino Studies. University of California, Irvine
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Panisch LS, Murphy HR, Wu Q, Brunner JL, Duberstein ZT, Arnold MS, Best M, Barrett ES, Miller RK, Qiu X, O’Connor TG. Adverse Childhood Experiences Predict Diurnal Cortisol Throughout Gestation. Psychosom Med 2023; 85:507-516. [PMID: 37199406 PMCID: PMC10524578 DOI: 10.1097/psy.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are associated with negative prenatal and perinatal health outcomes and may, via these pathways, have intergenerational effects on child health and development. We examine the impact of ACEs on maternal salivary cortisol, a key measure of prenatal biology previously linked with pregnancy-related health outcomes. METHODS Leveraging assessments across three trimesters, we used linear mixed-effects models to analyze the influence of ACEs on maternal prenatal diurnal cortisol patterns in a diverse cohort of pregnant women (analytic sample, n = 207). Covariates included comorbid prenatal depression, psychiatric medications, and sociodemographic factors. RESULTS Maternal ACEs were significantly associated with flatter diurnal cortisol slopes (i.e., less steep decline), after adjusting for covariates, with effects consistent across gestation (estimate = 0.15, standard error = 0.06, p = .008). CONCLUSIONS ACEs experienced before pregnancy may have a robust and lasting influence on maternal prenatal hypothalamic-pituitary-adrenal activity throughout gestation, a key biological marker associated with perinatal and child health outcomes. The findings suggest one route of intergenerational transmission of early adverse experiences and underscore the potential value of assessing prepregnancy adverse experiences for promoting perinatal and maternal and child health.
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Affiliation(s)
- Lisa S. Panisch
- Wayne State University School of Social Work, 5447 Woodward Ave., Detroit, MI, 48202, USA
| | - Hannah R. Murphy
- Translational Biomedical Science, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Qiuyi Wu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd., Box 630, Rochester, NY 14642
| | - Jessica L. Brunner
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Zoe T. Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
| | - Molly S. Arnold
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
| | - Meghan Best
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, New Jersey, 08854, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, New Jersey, 08854, USA
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Xing Qiu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd., Box 630, Rochester, NY 14642
| | - Thomas G. O’Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
- Neuroscience, University of Rochester, 601 Elmwood Avenue, Box 603, KMRB G.9602, Rochester, New York, 14642, USA
- Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, New York, 14642, USA
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Teoh AN, Kaur S, Shafie SR, Mohd Shukri NH, Ahmad Bustami N, Takahashi M, Shibata S. Chrononutrition is associated with melatonin and cortisol rhythm during pregnancy: Findings from MY-CARE cohort study. Front Nutr 2023; 9:1078086. [PMID: 36687684 PMCID: PMC9852999 DOI: 10.3389/fnut.2022.1078086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Chrononutrition has been suggested to have an entrainment effect on circadian rhythm which is crucial for metabolic health. Investigating how chrononutrition affects maternal circadian rhythm can shed light on its role during pregnancy. This study aims to determine chrononutrition characteristics of healthy primigravida during pregnancy and its association with melatonin and cortisol rhythm across gestation. A total of 70 healthy primigravidas were recruited from ten randomly selected government maternal and child clinics in Kuala Lumpur, Malaysia. During the second and third trimesters, chrononutrition characteristics including meal timing, frequency, eating window, breakfast skipping, and late-night eating were determined using a 3-day food record. Pregnant women provided salivary samples at five time-points over a 24 h period for melatonin and cortisol assay. Consistently across the second and third trimesters, both melatonin and cortisol showed a rhythmic change over the day. Melatonin levels displayed an increment toward the night whilst cortisol levels declined over the day. Majority observed a shorter eating window (≤12 h) during the second and third trimesters (66 and 55%, respectively). Results showed 23 and 28% skipped breakfast whereas 45 and 37% ate within 2 h pre-bedtime. During the third trimester, a longer eating window was associated with lower melatonin mean (β = -0.40, p = 0.006), peak (β = -0.42, p = 0.006), and AUCG (β = -0.44, p = 0.003). During both trimesters, a lower awakening cortisol level was observed in pregnant women who skipped breakfast (β = -0.33, p = 0.029; β = -0.29, p = 0.044). Only during the second trimester, breakfast-skipping was significantly associated with a greater cortisol amplitude (β = 0.43, p = 0.003). Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm. Dietary intervention targeting these characteristics may be useful in maintaining maternal circadian rhythm.
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Affiliation(s)
- Ai Ni Teoh
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia,*Correspondence: Satvinder Kaur,
| | - Siti Raihanah Shafie
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nurul Husna Mohd Shukri
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Normina Ahmad Bustami
- Faculty of Medicine and Health Sciences, School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, UCSI University, Kuala Lumpur, Malaysia
| | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Shigenobu Shibata
- Department of Electrical Engineering and Biosciences, School of Advanced Engineering and Sciences, Waseda University, Tokyo, Japan
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Khoury JE, Giles L, Kaur H, Johnson D, Gonzalez A, Atkinson L. Associations between psychological distress and hair cortisol during pregnancy and the early postpartum: A meta-analysis. Psychoneuroendocrinology 2023; 147:105969. [PMID: 36335755 DOI: 10.1016/j.psyneuen.2022.105969] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [- 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, NS Canada.
| | - Lauren Giles
- Department of Psychology, Mount Saint Vincent University, Halifax, NS Canada
| | - Hargun Kaur
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Dylan Johnson
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada; Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON Canada
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Murphy HR, Gu Y, Wu Q, Brunner J, Panisch LS, Best M, Arnold MS, Duberstein ZT, Putzig J, Carnahan J, Groth SW, Barrett ES, Qiu X, O'Connor TG. Prenatal diurnal cortisol: Normative patterns and associations with affective symptoms and stress. Psychoneuroendocrinology 2022; 143:105856. [PMID: 35797838 DOI: 10.1016/j.psyneuen.2022.105856] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis in pregnancy has attracted considerable research attention, in part, because it may be a mechanism by which diverse prenatal exposures alter perinatal and child health outcomes. Symptoms of affective disturbance and stress are among the most-studied prenatal factors associated with HPA axis alterations, but there remains uncertainty about the nature of the association because of the limitations to, and variability in, data collection and analytic approaches. The current study capitalized on a prospective, longitudinal pregnancy cohort that examined salivary diurnal cortisol, collected at 5 time points across the day, at each trimester in a diverse sample of women. Detailed data on affective symptoms and major life events were collected at each trimester, as were data on health behaviors, medication, and socio-demographics. Results indicated modest stability of individual differences in diurnal cortisol across pregnancy, which was evident for diurnal slope (ICC = .20) and measures of total output (area under the curve, ICC = .25); substantial gestation-related increases in total cortisol output across pregnancy was also observed (p < .001). Adjusting for health behaviors, medication, and socio-demographic covariates, elevated levels of depressive symptoms and major life events were significantly (p < .05) associated with a higher morning awakening value and flatter diurnal slope, which was evident across all trimesters. In addition to the normative gestation-related changes in cortisol production, our results demonstrate selective but robust associations between psychological symptoms, stressors, and the HPA axis across gestation, and suggest both methodological and mechanistic strategies for future study.
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Affiliation(s)
- Hannah R Murphy
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Yu Gu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Qiuyi Wu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Jessica Brunner
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Lisa S Panisch
- Wayne State University School of Social Work, 5447 Woodward Ave., Detroit, MI 48202, USA
| | - Meghan Best
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Molly S Arnold
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Zoe T Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA
| | - Jenelle Putzig
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Jennifer Carnahan
- Pediatrics Infectious Diseases, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA
| | - Susan W Groth
- School of Nursing, University of Rochester, 255 Crittenden Blvd., Rochester, NY, USA
| | - Emily S Barrett
- Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, NJ 08854, USA
| | - Xing Qiu
- Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Thomas G O'Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, NY 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY 14627, USA; Neuroscience, University of Rochester, 601 Elmwood Avenue, Box 603, KMRB G.9602, Rochester, NY 14642, USA; Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, NY 14642, USA.
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Letourneau N, Aghajafari F, Bell RC, Deane AJ, Dewey D, Field C, Giesbrecht G, Kaplan B, Leung B, Ntanda H. The Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal study: cohort profile and key findings from the first three years. BMJ Open 2022; 12:e047503. [PMID: 35131812 PMCID: PMC8823238 DOI: 10.1136/bmjopen-2020-047503] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The objectives of the ongoing Canadian longitudinal cohort called the Alberta Pregnancy Outcomes and Nutrition (APrON) study are to: (1) determine the relationship between maternal nutrient intake and status before, during, after pregnancy, and (a) maternal mental health, (b) pregnancy and birth outcomes, and (c) infant/child neurodevelopment and behavior; (2) identify maternal mental health and nutrient predictors of child behaviour; and (3) establish a DNA biobank to explore genomic predictors of children's neurodevelopment and behavior. The purpose of this paper is to describe the participants, measures, and key findings on maternal and paternal mental health, maternal nutrition, and child outcomes to when children are 3 years of age. PARTICIPANTS Participants included mothers and their children (n=2189) and mothers' partners (usually fathers; n=1325) from whom data were collected during the period from pregnancy to when children were 3 years of age, in Alberta, Canada. More than 88% of families have been retained to take part in completed data collection at 8 years of age. FINDINGS TO DATE Data comprise: questionnaires completed by pregnant women/mothers and their partners on mothers', fathers' and children's health; dietary interviews; clinical assessments; linkage to hospital obstetrical records; and biological samples such as DNA. Key findings on mental health, nutrition and child outcomes are presented. APrON women who consumed more selenium and omega-3 were less likely to develop symptoms of perinatal depression. Higher prenatal consumption of choline rich foods such as eggs and milk were recommended as was vitamin D supplementation for both mothers and children to meet guidelines. Couples in which both mothers and fathers were affected by perinatal depression reported lower incomes and higher maternal prenatal depressive symptoms and lower support from fathers postnatally and their children presented with the most behavioural problems. Maternal experiences of early adversity predicted increased likelihood of perinatal depression and anxiety and children's behavioural problems. FUTURE PLANS The APrON cohort offers a unique opportunity to advance understanding of the developmental origins of health and disease. There is a planned follow-up to collect data at 12 years of age.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine (Departments of Paediatrics, Psychiatry & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Fariba Aghajafari
- Cumming School of Medicine (Family Medicine & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Rhonda C Bell
- Faculty of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea J Deane
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
| | - Catherine Field
- Faculty of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Gerald Giesbrecht
- Cumming School of Medicine (Pediatrics & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Kaplan
- Cumming School of Medicine (Pediatrics & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Brenda Leung
- Health Science - Public Health Program, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Henry Ntanda
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
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Riis JL, Cook SH, Letourneau N, Campbell T, Granger DA, Giesbrecht GF. Characterizing and Evaluating Diurnal Salivary Uric Acid Across Pregnancy Among Healthy Women. Front Endocrinol (Lausanne) 2022; 13:813564. [PMID: 35370953 PMCID: PMC8971544 DOI: 10.3389/fendo.2022.813564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Uric acid levels during pregnancy have been examined as a potential indicator of risk for gestational diabetes mellites, hypertension, and related adverse birth outcomes. However, evidence supporting the utility of serum uric acid levels in predicting poor maternal and fetal health has been mixed. The lack of consistent findings may be due to limitations inherent in serum-based biomeasure evaluations, such as minimal repeated assessments and variability in the timing of these assessments. To address these gaps, we examined repeated measurements of diurnal salivary uric acid (sUA) levels in a sample of 44 healthy women across early-mid and late pregnancy. We assessed potential covariates and confounds of sUA levels and diurnal trajectories, as well as associations between maternal weight gain and blood pressure during pregnancy and sUA concentrations. Using multilevel linear models, we found sUA increased across pregnancy and displayed a robust diurnal pattern with the highest concentrations at waking, a steep decline in the early morning, and decreasing levels across the day. Maternal pre-pregnancy BMI, age, prior-night sleep duration, and fetal sex were associated with sUA levels and/or diurnal slopes. Maternal blood pressure and gestational weight gain also showed significant associations with sUA levels across pregnancy. Our results expand upon those found with serum UA measurements. Further, they demonstrate the feasibility of using at-home, minimally-invasive saliva sampling procedures to track UA levels across pregnancy with potential applications for the long-term monitoring of maternal cardiometabolic risk.
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Affiliation(s)
- Jenna L. Riis
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Jenna L. Riis,
| | - Stephanie H. Cook
- Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Nicole Letourneau
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald F. Giesbrecht
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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8
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Oftedal A, Bekkhus M, Haugen G, Braithwaite E, Bollerslev J, Godang K, Thorsby PM, Kaasen A. Changes in maternal cortisol, cortisol binding globulin and cortisone levels following diagnosis of fetal anomaly. Psychoneuroendocrinology 2022; 135:105574. [PMID: 34741978 DOI: 10.1016/j.psyneuen.2021.105574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
The diagnosis of fetal anomaly can be a major stressor to the expectant mother. Current understanding of the relationship between psychological stress and cortisol in pregnancy is limited. This study examined: (1) differences in the ratio of serum cortisol to cortisol binding globulin (SC/CBG) and cortisone levels among women with and without a diagnosis of fetal anomaly, (2) the association between self-reported stress and cortisol from mid to late pregnancy, and (3) the agreement between two different techniques for analyzing cortisol: liquid chromatography-tandem mass spectrometry (LC-MS/MS) and radioimmunoassay (RIA). Thirty-six pregnant women with a diagnosis of fetal anomaly (study group) and 101 women with healthy pregnancies (comparison group) provided blood samples and completed self-report questionnaires at gestational weeks 18-24 (T1) and 30 (T2). In the comparison group, mean SC/CBG increased from 0.341 nmol/L at T1 to 0.415 at T2 (p < .001), whereas in the study group there was no change (0.342 nmol/L at T1, 0.343 at T2). There was no difference in cortisone levels between the groups at either timepoints. There was a negative association between both depression and traumatic stress at T1, and SC/CBG at T2 (p < .05). There was no association between general distress and SC/CBG. The two methods for analyzing cortisol gave similar results, but with LC-MS/MS showing a lower detection limit than RIA. Increased cortisol with advancing gestational age is expected, thus these findings indicate that under certain conditions of severe stress there may be a suppression of maternal cortisol increase from mid to late gestation. The discrepancy does not seem to be due to differences in the metabolization of cortisol, as indicated by the similar levels of cortisone. Further research is needed in order to understand the potential underlying mechanisms limiting the expression of cortisol in response to certain types of stress in pregnancy.
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Affiliation(s)
- Aurora Oftedal
- Oslo Metropolitan University, Faculty of Health Sciences, Norway.
| | - Mona Bekkhus
- Promenta Research Center, Department of Psychology, University of Oslo, Norway
| | - Guttorm Haugen
- Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway; University of Oslo, Institute of Clinical Medicine, Norway
| | | | - Jens Bollerslev
- University of Oslo, Institute of Clinical Medicine, Norway; Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Per M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Biochemical Endocrinology And Metabolism Research Group, Oslo University Hospital, Aker, Oslo, Norway
| | - Anne Kaasen
- Oslo Metropolitan University, Faculty of Health Sciences, Norway
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Ortega VA, Mercer EM, Giesbrecht GF, Arrieta MC. Evolutionary Significance of the Neuroendocrine Stress Axis on Vertebrate Immunity and the Influence of the Microbiome on Early-Life Stress Regulation and Health Outcomes. Front Microbiol 2021; 12:634539. [PMID: 33897639 PMCID: PMC8058197 DOI: 10.3389/fmicb.2021.634539] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
Stress is broadly defined as the non-specific biological response to changes in homeostatic demands and is mediated by the evolutionarily conserved neuroendocrine networks of the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system. Activation of these networks results in transient release of glucocorticoids (cortisol) and catecholamines (epinephrine) into circulation, as well as activation of sympathetic fibers innervating end organs. These interventions thus regulate numerous physiological processes, including energy metabolism, cardiovascular physiology, and immunity, thereby adapting to cope with the perceived stressors. The developmental trajectory of the stress-axis is influenced by a number of factors, including the gut microbiome, which is the community of microbes that colonizes the gastrointestinal tract immediately following birth. The gut microbiome communicates with the brain through the production of metabolites and microbially derived signals, which are essential to human stress response network development. Ecological perturbations to the gut microbiome during early life may result in the alteration of signals implicated in developmental programming during this critical window, predisposing individuals to numerous diseases later in life. The vulnerability of stress response networks to maladaptive development has been exemplified through animal models determining a causal role for gut microbial ecosystems in HPA axis activity, stress reactivity, and brain development. In this review, we explore the evolutionary significance of the stress-axis system for health maintenance and review recent findings that connect early-life microbiome disturbances to alterations in the development of stress response networks.
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Affiliation(s)
- Van A Ortega
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.,International Microbiome Centre, Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada
| | - Emily M Mercer
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.,International Microbiome Centre, Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Owerko Centre, The Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Marie-Claire Arrieta
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.,International Microbiome Centre, Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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10
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Teoh AN, Kaur S, Mohd Shukri NH, Shafie SR, Ahmad Bustami N, Takahashi M, Lim PJ, Shibata S. Psychological state during pregnancy is associated with sleep quality: preliminary findings from MY-CARE cohort study. Chronobiol Int 2021; 38:959-970. [PMID: 33779445 DOI: 10.1080/07420528.2021.1902338] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Ai Ni Teoh
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Nurul Husna Mohd Shukri
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Siti Raihanah Shafie
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Normina Ahmad Bustami
- School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Pei Jean Lim
- Waseda Bioscience Research Institute in Singapore, Waseda University, Helios, Singapore
| | - Shigenobu Shibata
- Department of Electrical Engineering and Biosciences, School of Advanced Engineering and Sciences, Waseda University, Tokyo, Japan
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11
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Joseph NT, Jiang Y, Zilioli S. Momentary emotions and salivary cortisol: A systematic review and meta-analysis of ecological momentary assessment studies. Neurosci Biobehav Rev 2021; 125:365-379. [PMID: 33662445 DOI: 10.1016/j.neubiorev.2021.02.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
An integrated view of the stress response requires consideration of both the emotional and hormonal sequelae of stress, which are regulated by the hypothalamic-pituitary-adrenal (HPA) axis. Understanding the extent of the association between emotions and cortisol at the momentary level can shed light on the biopsychological pathways linking stress to health. Research in this area has adopted heterogeneous approaches and produced mixed findings; thus, it is critical to conduct a systematic review and meta-analysis. Systematic searches in major databases identified 22 studies (negative emotions [k = 19; 38,418 momentary observations]; positive emotions [k = 15; 31,721 momentary observations]). Meta-analysis found a significant positive association between momentary negative emotions and cortisol (r = .06, p < .001) and a significant negative association between momentary positive emotions and cortisol (r = -.05, p = .003). No methodological differences moderated these associations. Our findings suggest that emotional states correlate with cortisol levels at the momentary level. We discuss the health implications of our findings and provide recommendations for advancing this area of research.
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Affiliation(s)
| | - Yanping Jiang
- Department of Psychology, Wayne State University, United States
| | - Samuele Zilioli
- Department of Psychology, Wayne State University, United States; Department of Family Medicine and Public Health Sciences, Wayne State University, United States.
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12
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Conde A, Costa R, Figueiredo B. Anxiety and depressive symptoms effects on cortisol trajectories from pregnancy to postpartum: Differences and similarities between women and men. Horm Behav 2021; 128:104917. [PMID: 33387466 DOI: 10.1016/j.yhbeh.2020.104917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023]
Abstract
Anxiety and depressive symptoms may influence cortisol trajectories in women and men during pregnancy and the postpartum period. Using a multilevel approach, anxiety and depressive symptoms effects on 24-hour urinary free cortisol trajectories from the 2nd trimester to 3-months postpartum were examined in a sample of 66 women and 65 men with no known psychosocial or medical risk (N = 131; 33 (50%) of them were couples that participated in the same assessment waves). Results showed that both anxiety and depressive symptoms influence women's and men's cortisol trajectories from mid-pregnancy to 3-months postpartum. Women with high depressive symptoms and men with high anxiety or high depressive symptoms exhibited less accentuated variations in the 24-hour urinary free cortisol trajectories compared with women with low depressive symptoms and men with low anxiety or depressive symptoms, respectively. These effects were significant for women's cortisol trajectories from the 2nd to the 3rd pregnancy trimester and for men's cortisol trajectories throughout the entire period. The effect of anxiety and depressive symptoms on HPA axis functioning and cortisol production during pregnancy and postpartum, seems to be sex-specific. Reproductive-related alterations (associated with gestation, parturition and lactation) in women's HPA axis functioning may explain these sex-specific effects.
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Affiliation(s)
- Ana Conde
- INPP - Portucalense Institute for Human Development, Portucalense University, Porto, Portugal; Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal.
| | - Raquel Costa
- Universidade Europeia, Lisboa, Portugal; EPIUnit, ISPUP - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Bárbara Figueiredo
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
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13
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Psychological stress and cortisol during pregnancy: An ecological momentary assessment (EMA)-Based within- and between-person analysis. Psychoneuroendocrinology 2020; 121:104848. [PMID: 32927180 PMCID: PMC7895320 DOI: 10.1016/j.psyneuen.2020.104848] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although the linkage between psychological stress and cortisol is believed to mediate the association of stress with health outcomes, several studies have been unable to demonstrate this association. We suggest this inability may be a consequence of limitations in the measurement approach and/or reliance on analytic strategies that focus on associations across, rather than within individuals. The link between psychological stress and cortisol is of particular interest in the context of pregnancy and fetal development. Using an ecological momentary assessment (EMA) design, we examined the association between psychological stress and cortisol at the between- and the within-person level. METHODS 152 participants completed a 4-day long EMA protocol serially in early, mid and late pregnancy to provide momentary stress appraisals (average of 150 measures/subject) and saliva samples (average of 55 samples/subject) for quantification of cortisol. The association between stress and cortisol was estimated using linear mixed models. RESULTS After accounting for the effects of key determinants of variation in cortisol, momentary stress was significantly and positively associated with cortisol at the within-person level (B = .030, p = .031), but not at the between-person level. No association was evident for traditional retrospective measures of stress with cortisol at either the between- or the within-person level. CONCLUSIONS Our study highlights the value of EMA methods and linear mixed-modeling approaches in linking maternal psychological and physiological states across pregnancy. These findings may have important implications for the development of personalized risk identification and "just-in-time" intervention strategies to optimize maternal and child health.
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14
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Bang KS, Lee I, Kim S, Yi Y, Huh I, Jang SY, Kim D, Lee S. Relation between Mother's Taekyo, Prenatal and Postpartum Depression, and Infant's Temperament and Colic: A Longitudinal Prospective Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7691. [PMID: 33096813 PMCID: PMC7589274 DOI: 10.3390/ijerph17207691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/04/2022]
Abstract
This longitudinal cohort correlational study aimed to confirm the relation among taekyo or traditional prenatal practice, prenatal depression, postpartum depression, maternal-fetal interaction, and infant temperament and colic using a prospective design. We recruited 212 women 16-20 weeks pregnant from July 2017 to September 2018; they were followed up until six months postpartum. Data from 97 participants were used in the final analysis. We used the Edinburgh Postnatal Depression Scale, Cranley's Maternal-Fetal Attachment Scale, and What My Baby Is Like as measurement tools. We observed a significant correlation between prenatal maternal depression in the first to third trimesters and 6-8 weeks and six months postpartum. In addition, infant temperament at six months old showed a significant negative correlation with prenatal and postpartum depression: the higher the prenatal and postpartum depression level, the more difficult the infant's temperament. Taekyo practice was significantly related to maternal-fetal attachment (r = 0.45-0.68, p < 0.001). Difficult infants showed more colic episodes than any other type of infant (χ2 = 18.18, p < 0.001). Prenatal and postnatal maternal depression affected infants' temperament and colic episodes. The management of mothers' mental health before and after pregnancy is important for infants' and mothers' health.
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Affiliation(s)
- Kyung-Sook Bang
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Insook Lee
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Sungjae Kim
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Yunjeong Yi
- Department of Nursing, Kyung-In Women’s University, Incheon 21041, Korea;
| | - Iksoo Huh
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Sang-Youn Jang
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
| | - Dasom Kim
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
| | - Sujin Lee
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
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15
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Ross KM, Letourneau N, Climie E, Giesbrecht G, Dewey D. Perinatal Maternal Anxiety and Depressive Symptoms and Child Executive Function and Attention at Two-years of Age. Dev Neuropsychol 2020; 45:380-395. [PMID: 33081504 DOI: 10.1080/87565641.2020.1838525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective was to investigate whether perinatal maternal anxiety and depressive symptoms predicted child attention and executive function (EF). Mothers (N = 614) reported pregnancy and three-months postnatal anxiety and depressive symptoms. Attention and EF were measured at two-years-of-age. Covariates were demographics, alcohol use, mood disorder history, and pregnancy factors. Higher prenatal anxiety, b(SE) =.020(.005), p<.001, and postnatal depressive symptoms, b(SE) =.009(.004), p=.04, predicted poorer child attention. A prenatal-by-postnatal depressive symptom interaction emerged, b(SE) = -.005(.003), p=.04: When pregnancy depressive symptoms were low, higher postnatal symptoms predicted poorer attention. No distress variables predicted EF, p's>.22. Perinatal distress timing, kind, and change were important for child attention.
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Affiliation(s)
- Kharah M Ross
- Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, Department of Paediatrics, and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute and Werklund School of Education, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics, Department of Community Health Sciences, And Hotchkiss Brain Institute, University of Calgary , Calgary, Canada
| | - Nicole Letourneau
- Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, Department of Paediatrics, and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute and Werklund School of Education, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics, Department of Community Health Sciences, And Hotchkiss Brain Institute, University of Calgary , Calgary, Canada
| | - Emma Climie
- Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, Department of Paediatrics, and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute and Werklund School of Education, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics, Department of Community Health Sciences, And Hotchkiss Brain Institute, University of Calgary , Calgary, Canada
| | - Gerald Giesbrecht
- Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, Department of Paediatrics, and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute and Werklund School of Education, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics, Department of Community Health Sciences, And Hotchkiss Brain Institute, University of Calgary , Calgary, Canada
| | - Deborah Dewey
- Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Faculty of Nursing, Department of Paediatrics, and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute and Werklund School of Education, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics and Department of Community Health Sciences, University of Calgary , Calgary, Canada.,Owerko Centre, Alberta Children's Hospital Research Institute, Department of Paediatrics, Department of Community Health Sciences, And Hotchkiss Brain Institute, University of Calgary , Calgary, Canada
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16
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Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev 2020; 117:26-64. [DOI: 10.1016/j.neubiorev.2017.07.003] [Citation(s) in RCA: 438] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/09/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023]
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17
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Leff-Gelman P, Flores-Ramos M, Carrasco AEÁ, Martínez ML, Takashima MFS, Coronel FMC, Labonne BF, Dosal JAZ, Chávez-Peón PB, Morales SG, Camacho-Arroyo I. Cortisol and DHEA-S levels in pregnant women with severe anxiety. BMC Psychiatry 2020; 20:393. [PMID: 32758184 PMCID: PMC7409431 DOI: 10.1186/s12888-020-02788-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance; several studies have reported increased cortisol levels during chronic stress and a weak counter-regulation by DHEA-S. During pregnancy, scarce information about this system is available, although cortisol and DHEA-S play an important role in the initiation and acceleration of labor. We conducted the present study in order to determine both cortisol and DHEA-S levels during the last trimester of pregnancy in patients exhibiting severe anxiety. METHODS Pregnant women during the 3rd trimester of pregnancy were evaluated by using the self-reported version of the Hamilton Anxiety Rating Scale (HARS). According to the scores obtained from the psychometric scale, participants were divided into two groups: 1) patients exhibiting a cutoff score > 15 were considered with severe anxiety (ANX) (n = 101), and control pregnant subjects (CTRL) (n = 44) with a cutoff score < 5. Morning cortisol, DHEA-S and Cortisol/DHEA-S index were measured in all participants. Comparisons between groups were performed; additionally, correlations between clinical variables, biochemical data and HARS were calculated. RESULTS Cortisol levels were significantly higher in the ANX group (p < 0.001), whereas those of DHEA-S were significantly lower in the same group (p < 0.01) when compared to healthy pregnant subjects. An increased cortisol/DHEA-S index was observed in the ANX group (p < 0.05). A significant association between cortisol and HARS scores (p = 0.03), was observed even after adjusting by gestational weeks (p = 0.004). CONCLUSIONS Our data support that the cortisol/DHEA-S index is higher in pregnant women with high anxiety levels as compared with healthy pregnant women.
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Affiliation(s)
| | - Mónica Flores-Ramos
- grid.419154.c0000 0004 1776 9908Instituto Nacional de Psiquiatría, 14370 CDMX Mexico City, Mexico ,grid.418270.80000 0004 0428 7635Consejo Nacional de Ciencia y Tecnología/CONACyT, 03940 CDMX Mexico City, Mexico
| | | | - Margarita López Martínez
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | | | - Fausto Manuel Cruz Coronel
- grid.414716.10000 0001 2221 3638Hospital General de México, Dr. Eduardo Liceaga, 06720 CDMX Mexico City, Mexico
| | - Blanca Farfán Labonne
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | | | | | - Saul Garza Morales
- grid.419218.70000 0004 1773 5302Instituto Nacional de Perinatología, 11000 CDMX Mexico City, Mexico
| | - Ignacio Camacho-Arroyo
- grid.9486.30000 0001 2159 0001Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, 04510 CDMX Mexico City, Mexico
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18
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Asselmann E, Kunas SL, Wittchen HU, Martini J. Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy. J Affect Disord 2020; 263:480-490. [PMID: 31969281 DOI: 10.1016/j.jad.2019.11.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet. METHODS A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery. RESULTS Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy. LIMITATIONS Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased. CONCLUSIONS Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.
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Affiliation(s)
- E Asselmann
- Department of Psychology, Faculty of Life Sciences, Humboldt University of Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - S L Kunas
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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19
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Walsh K, McCormack CA, Webster R, Pinto A, Lee S, Feng T, Krakovsky HS, O'Grady SM, Tycko B, Champagne FA, Werner EA, Liu G, Monk C. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc Natl Acad Sci U S A 2019; 116:23996-24005. [PMID: 31611411 PMCID: PMC6883837 DOI: 10.1073/pnas.1905890116] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY 10461
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Clare A McCormack
- Center for Science and Society, Columbia University, New York, NY 10027
| | - Rachel Webster
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Anita Pinto
- Data Science, Columbia University, New York, NY 10027
| | - Seonjoo Lee
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Tianshu Feng
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - H Sloan Krakovsky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Sinclaire M O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ 07110
| | - Frances A Champagne
- Department of Psychiatry, Columbia University, New York, NY 10032
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Elizabeth A Werner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Grace Liu
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032;
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
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20
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Schlotz W. Investigating associations between momentary stress and cortisol in daily life: What have we learned so far? Psychoneuroendocrinology 2019; 105:105-116. [PMID: 30503527 DOI: 10.1016/j.psyneuen.2018.11.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/23/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Abstract
Since cortisol measurement in saliva has been established, it has been used as an indicator of stress-related hypothalamic-pituitary-adrenocortical axis activity. Concurrent development of methodological frameworks such as ambulatory assessment, ecological momentary assessment, and experience sampling have provided opportunities to combine both approaches in daily life research. The current review provides a summary of basic methodological principles and recommendations, as well as abstracts of findings of studies investigating momentary associations between stress and cortisol in daily life with an emphasis on within-subject associations (i.e. average covariance in repeated momentary assessments of stress and cortisol, and individual-specific deviations from the average covariance). Methodological challenges related to stress measurement, sampling principles, and appropriate statistical modeling are discussed, followed by a description of the historical development of studies on within-subject associations between momentary daily life stress and cortisol. The review concludes with a discussion of controversial methodological characteristics of these studies regarding operationalizations of stress, compliance, timing and frequency of stress and cortisol sampling, and reporting of effect sizes. Future research in this area would benefit from automated cortisol assessment, broadening of the scope of stress response measures, use of advanced statistical models that better account for dynamics in the stress process in daily life, and attempts to replicate findings. While previous studies of momentary stress and concurrent cortisol assessments have reliably confirmed some fundamental predictions from stress theory in daily life, future studies should aim at providing progress by testing innovative research questions and utilizing new technological developments.
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Affiliation(s)
- Wolff Schlotz
- Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany; Institute of Psychology, Goethe University, Frankfurt am Main, Germany.
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21
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Spicer J, Giesbrecht GF, Aboelela S, Lee S, Liu G, Monk C. Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents. Psychosom Med 2019; 81:464-476. [PMID: 31090671 PMCID: PMC6715293 DOI: 10.1097/psy.0000000000000698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes. METHODS Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13-16, 24-27, and 34-37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records. RESULTS After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = -0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed. CONCLUSIONS These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.
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Affiliation(s)
- Julie Spicer
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai
| | - Gerald F. Giesbrecht
- Departments of Pediatrics & Community Health Sciences,
University of Calgary, AB, Canada
| | | | - Seonjoo Lee
- Department of Psychiatry, Columbia University
| | - Grace Liu
- Department of Psychiatry, Columbia University
| | - Catherine Monk
- Department of Psychiatry, Columbia University
- Department of Obstetrics and Gynecology, Columbia
University
- New York State Psychiatric Institute
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22
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O'Connor SG, Habre R, Bastain TM, Toledo-Corral CM, Gilliland FD, Eckel SP, Cabison J, Naya CH, Farzan SF, Chu D, Chavez TA, Breton CV, Dunton GF. Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study. BMC Public Health 2019; 19:253. [PMID: 30819155 PMCID: PMC6396454 DOI: 10.1186/s12889-019-6583-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Disproportionately high rates of maternal overweight and obesity among the Hispanic population before, during, and after pregnancy pose serious health concerns for both mothers (e.g., preeclampsia, gestational diabetes, weight retention) and children (e.g., elevated lifelong obesity risk). A growing body of evidence implicates environmental exposures (e.g., air pollution, metals) and social stressors (e.g., poverty, violence) in contributing to obesity-related biobehavioral processes, such as physical activity, dietary intake, perceived stress, and cortisol regulation. However, current understanding of the role of environmental exposures and social stressors on obesity-related biobehavioral processes is limited by infrequent, inter-individual measurement, and lack of personal exposure monitoring. Methods The “Maternal and Developmental Risks from Environmental and Social Stressors” (MADRES) real-time and personal sampling study examines the within-subject day-level effects of environmental and social stressors on maternal pre- and post-partum obesity-related biobehavioral responses. Among a cohort of 65 low-income, Hispanic women in urban Los Angeles, this study uses innovative personal, real-time data capture strategies (e.g., ecological momentary assessment [EMA], personal exposure monitoring, geolocation monitoring, accelerometry) to repeatedly assess obesity-related processes during the 1st and 3rd trimester, and at 4–6 months postpartum. Day-level effects of environmental exposures and social stressors on women’s physical activity, diet, perceived stress and salivary cortisol measured across repeated days will be tested using multilevel modeling. Discussion Hispanic women of childbearing age bear a disproportionately high burden of obesity, and this population is also unduly exposed to numerous obesogenic settings. By using innovative real-time data capture strategies, the current study will uncover the daily impacts of environmental and social stressor exposures on women’s obesity-related biobehavioral responses, which over time can lead to excessive gestational weight gain, postpartum weight retention and can pose serious consequences for both mother and child. Findings from the real-time and personal sampling study will identify key mechanistic targets for policy, clinical, and programmatic interventions, with the potential for broad-reaching public health impacts.
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Affiliation(s)
- Sydney G O'Connor
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Rima Habre
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Theresa M Bastain
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Claudia M Toledo-Corral
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.,Department of Health Sciences, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA, 91330, USA
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Jane Cabison
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Christine H Naya
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Shohreh F Farzan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Daniel Chu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Thomas A Chavez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Carrie V Breton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | - Genevieve F Dunton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA. .,Department of Psychology, University of Southern California, 3620 South McClintock Ave, Los Angeles, CA, 90089, USA.
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23
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Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnancy Childbirth 2019; 19:60. [PMID: 30732571 PMCID: PMC6367798 DOI: 10.1186/s12884-019-2185-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM. Methods A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM. Results The search strategies identified 14′419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight. Conclusion This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis. Electronic supplementary material The online version of this article (10.1186/s12884-019-2185-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.
| | - Justine Gross
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Stefano Lanzi
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Jardena Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010, Lausanne, Switzerland.,Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
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24
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Graham AM, Rasmussen JM, Entringer S, Ben Ward E, Rudolph MD, Gilmore JH, Styner M, Wadhwa PD, Fair DA, Buss C. Maternal Cortisol Concentrations During Pregnancy and Sex-Specific Associations With Neonatal Amygdala Connectivity and Emerging Internalizing Behaviors. Biol Psychiatry 2019; 85:172-181. [PMID: 30122286 PMCID: PMC6632079 DOI: 10.1016/j.biopsych.2018.06.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/06/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Maternal cortisol during pregnancy has the potential to influence rapidly developing fetal brain systems that are commonly altered in neurodevelopmental and psychiatric disorders. Research examining maternal cortisol concentrations across pregnancy and offspring neurodevelopment proximal to birth is needed to advance understanding in this area and lead to insight into the etiology of these disorders. METHODS Participants were 70 adult women recruited during early pregnancy and their infants born after 34 weeks gestation. Maternal cortisol concentrations were assessed serially over 4 days in early, mid, and late gestation. Resting state functional connectivity magnetic resonance imaging of the neonatal amygdala was examined. Mothers reported on children's internalizing behavior problems at 24 months of age. RESULTS Maternal cortisol concentrations during pregnancy were significantly associated with neonatal amygdala connectivity in a sex-specific manner. Elevated maternal cortisol was associated with stronger amygdala connectivity to brain regions involved in sensory processing and integration, as well as the default mode network in girls, and with weaker connectivity to these brain regions in boys. Elevated maternal cortisol was associated with higher internalizing symptoms in girls only, and this association was mediated by stronger neonatal amygdala connectivity. CONCLUSIONS Normative variation in maternal cortisol during pregnancy is associated with the coordinated functioning of the amygdala soon after birth in a sex-specific manner. The identified pathway from maternal cortisol to higher internalizing symptoms in girls via alterations in neonatal amygdala connectivity may be relevant for the etiology of sex differences in internalizing psychiatric disorders, which are more prevalent in women.
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Affiliation(s)
- Alice M. Graham
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, United States
| | - Jerod M. Rasmussen
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, California, 92697, United States
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, California, 92697, United States;,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Medical Psychology
| | | | - Marc D. Rudolph
- Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, Chapel Hill, North Carolina, 27599
| | - John H. Gilmore
- Department of Psychiatry, University of North Carolina, 333 South Columbia Street, Chapel Hill, North Carolina, 27514
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, 333 South Columbia Street, Chapel Hill, North Carolina, 27514
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, California, 92697, United States
| | - Damien A. Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, United States;,Advanced Imaging Research Center, Oregon Health & Science University
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, California, 92697, United States;,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Medical Psychology
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25
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van den Heuvel MI, van Assen MALM, Glover V, Claes S, Van den Bergh BRH. Associations between maternal psychological distress and salivary cortisol during pregnancy: A mixed-models approach. Psychoneuroendocrinology 2018; 96:52-60. [PMID: 29902667 DOI: 10.1016/j.psyneuen.2018.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Maternal psychological distress during pregnancy is related to adverse child behavioral and emotional outcomes later in life, such as ADHD and anxiety/depression. The underlying mechanisms for this, however, are still largely unknown. The hypothalamic-pituitary-adrenal (HPA)-axis, with its most important effector hormone cortisol, has been proposed as a mechanism, but results have been inconsistent. The current study investigated the association between maternal psychological distress (i.e. anxiety and depressive symptoms) and maternal cortisol levels during pregnancy using a mixed models approach. METHOD During three pregnancy trimesters, mothers (N = 170) collected four salivary samples for two consecutive days. Mothers reported symptoms of anxiety and depression three times during pregnancy (at 13.3 ± 1.1, 20.2 ± 1.5, and 33.8 ± 1.5 weeks of pregnancy, respectively) using the anxiety subscale of the Symptom Checklist (SCL-90), the Spielberger State and Trait Anxiety Inventory (STAI), and the Edinburgh Postnatal Depression Scale (EPDS). Specific fears and worries during pregnancy were measured with the short version of the Pregnancy Related Anxiety Questionnaire (PRAQ-R). RESULTS We found a significant effect of SCL-90 anxiety subscale on cortisol levels at awakening (p = .008), indicating that mothers with higher anxiety showed lower cortisol at awakening. Maternal psychological variables explained 10.5% of the variance at the person level in awakening cortisol level, but none in the overall diurnal cortisol model. CONCLUSION More research is necessary to unravel the underlying mechanisms of the association between maternal psychological distress and cortisol and the search for mechanisms other than the HPA-axis should be continued and extended.
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Affiliation(s)
| | - Marcel A L M van Assen
- Department of Methodology and Statistics, Tilburg University, The Netherlands; Department of Sociology, Utrecht University, The Netherlands
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, UK
| | - Stephan Claes
- Department of Neurosciences, University of Leuven (KU Leuven), Leuven, Belgium
| | - Bea R H Van den Bergh
- Health Psychology, University of Leuven (KU Leuven), Leuven, Belgium; Department of Welfare, Public Health and Family, Flemish Government, Brussels, Belgium.
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26
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The effect of gestational period on the association between maternal prenatal salivary cortisol and birth weight: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 94:49-62. [PMID: 29754005 DOI: 10.1016/j.psyneuen.2018.04.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies exploring the relations between maternal stress and fetal development show an association between increased maternal stress and adverse birth outcomes. A frequently proposed mechanism linking maternal prenatal stress and adverse birth outcomes is heightened concentrations of maternal cortisol. To date, studies exploring this association have reported conflicting results because of the diverse approaches taken to measuring cortisol and the wide variety of possible birth outcomes explored. To add clarity to the growing body of literature, this systematic review and meta-analysis reports empirical findings on the association between maternal prenatal salivary cortisol and newborn birth weight. METHODS Searches for relevant papers published up until November 2017 were run in MEDLINE, EMBASE, PsycINFO, and CINAHL. Non-English language papers were included and experts were contacted when necessary. We included data from human observational studies that were designed or had an underlying intention to measure maternal prenatal salivary cortisol and newborn birth weight. We only included data from measurements of salivary cortisol to prevent rendering of the review unsuitable for meta-analysis. Two independent reviewers assessed study eligibility and quality. For every maternal-fetal dyad, an area under the curve with respect to ground (AUCg) of maternal cortisol was calculated to determine a Pearson's correlation coefficient with a continuous measure of newborn birth weight. Correlation coefficients were then pooled across all stages of gestation. To examine if there are critical gestational periods in which the fetus may be more susceptible to elevated concentration of maternal salivary cortisol, a meta-analysis was performed on separate correlations calculated from gestational trimesters. RESULTS Nine studies with a total of 1606 maternal-fetal dyads demonstrated a negative correlation between pooled maternal salivary cortisol and birth weight (-0.24, 95% CI -0.28 to -0.20), but there was a high degree of heterogeneity between studies (I2 = 88.9%). To investigate heterogeneity, subgroup analysis by trimester of the pooled correlation between salivary cortisol and birth weight was performed with the following correlations found: first trimester, -0.18 (95% CI -0.32 to -0.03, I2 = 97.3%); second trimester, -0.20 (95% CI -0.28 to -0.12, I2 = 98.3%); and third trimester, -0.30 (95% CI -0.33 to -0.26, I2 = 85.4%). DISCUSSION A consistently negative association was observed between maternal cortisol and infant birth weight. The review highlights specific gaps in the literature on the relationship between maternal prenatal salivary cortisol and newborn birth weight. Although a significant negative correlation was found, substantial heterogeneity of effects and the likelihood of publication bias exist. The third trimester was revealed as a possible critical gestational period for heightened maternal cortisol concentration to affect birth weight. Challenges faced in this body of research and recommendations for future research are discussed.
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27
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Gilles M, Otto H, Wolf IAC, Scharnholz B, Peus V, Schredl M, Sütterlin MW, Witt SH, Rietschel M, Laucht M, Deuschle M. Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant's anthropometric measures at birth. Psychoneuroendocrinology 2018; 94:152-161. [PMID: 29783163 DOI: 10.1016/j.psyneuen.2018.04.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal maternal stress might be a risk for the developing fetus and may have long-lasting effects on child and adult vulnerability to somatic and psychiatric disease. Over-exposure of the unborn to excess glucocorticoids and subsequent alteration of fetal development is hypothesized to be one of the key mechanisms linking prenatal stress with negative child outcome. METHODS In this prospective longitudinal study, mothers-to-be (n = 405) in late pregnancy (36.8 ± 1.9 weeks of gestational age) and their singleton neonates were studied. We investigated the impact of different prenatal stress indices derived from six stress variables (perceived stress, specific prenatal worries, negative life events, symptoms of depression, trait anxiety, neuroticism) and diurnal maternal saliva cortisol secretion on gestational age and anthropometric measures at birth. RESULTS Maternal prenatal distress during late gestation was associated with significant reduction in birth weight (-217 g; p = .005), birth length (-1.2 cm; p = .005) and head circumference (-0.8 cm; p = .001). Prenatal stress was modestly but significantly associated with altered diurnal cortisol pattern (flattened cortisol decline and higher evening cortisol), which in turn was significantly related to reduced length of gestation. No evidence for a profound interaction between maternal cortisol level in late pregnancy and infant's anthropometric measures at birth (i.e., birth weight, length, head circumference) was found. CONCLUSION Prenatal stress is associated with flattened circadian saliva cortisol profiles and reduced infant's anthropometric measures at birth. HPA system activity during pregnancy may be related to low gestational age. The effect of prenatal stress might be partly mediated by maternal-placental-fetal neuroendocrine mechanisms especially the dysregulation of diurnal cortisol profile.
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Affiliation(s)
- Maria Gilles
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Henrike Otto
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Isabell A C Wolf
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Barbara Scharnholz
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Verena Peus
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Michael Schredl
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marc W Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Manfred Laucht
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychology, University of Potsdam, Potsdam, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research. Addict Behav 2018; 83:5-17. [PMID: 29174666 DOI: 10.1016/j.addbeh.2017.11.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.
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29
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Orta OR, Tworoger SS, Terry KL, Coull BA, Gelaye B, Kirschbaum C, Sanchez SE, Williams MA. An evaluation of distal hair cortisol concentrations collected at delivery. Stress 2018; 21:355-365. [PMID: 29614892 PMCID: PMC6132258 DOI: 10.1080/10253890.2018.1458088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Distal hair segments collected at delivery may allow for the assessment of maternal cortisol secretion in early pregnancy, an important time window for fetal development. Therefore, an investigation of the validity of distal hair cortisol concentrations is warranted. We examined the concordance between proximal and distal hair cortisol concentrations (HCC), both representing the first trimester of pregnancy. The study population was comprised of a random sample of 97 women participating in the Pregnancy Outcomes Maternal and Infant Study, a prospective cohort study of pregnant women attending prenatal clinics in Lima, Peru. Each participant provided two hair samples: once at enrollment [mean gestational age (GA) = 13.1 weeks] and again at full-term delivery (mean GA = 39.0 weeks). Hair segments reflecting the first trimester were: 3 cm hair segments closest to the scalp on the first hair sample (proximal) and 6-9 cm from the scalp on the second hair sample (distal). HCC was determined using Luminescence Immunoassay. A subset (N = 28) had both hair segments additionally analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS). HCC values were log-transformed (logHCC), and proximal-distal differences tested using paired sample t-tests. Concordance was evaluated within and across assay types. LogHCC, measured using immunoassay, in distal hair segments was lower compared to proximal hair segments (1.35 versus 1.64 respectively; p = .02). No difference was observed using LC-MS/MS (1.99 versus 1.83, respectively; p=.33). Proximal-distal concordance was low within assay (immunoassay: Pearson = 0.27 and κ = 0.10; LC-MS/MS: Pearson = 0.37 and κ = 0.07). High correlation was observed across assays for both distal (Pearson = 0.78, p < .001; κ = 0.64) and proximal segments (Pearson = 0.96, p < .001; κ = 0.75). In conclusion, distal first-trimester hair segments collected at delivery have lower absolute HCC compared to HCC in proximal first trimester hair segments collected in early pregnancy, and are poorly concordant with HCC in proximal segments. Findings may inform the design of future studies.
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Affiliation(s)
- Olivia R. Orta
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
- Corresponding author postal address: , 677 Huntington Ave, Harvard T.H. Chan School of Public Health Room Kresge 500, Harvard University, Boston, Massachusetts 02115
| | - Shelley S. Tworoger
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kathryn L. Terry
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brent A. Coull
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
| | | | - Sixto E. Sanchez
- Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
- Asociacion Civil Proyectos en Salud (PROESA), Lima, Peru
| | - Michelle A. Williams
- Harvard T.H. Chan School of Public Health, Harvard University, Massachusetts, USA
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Thomas JC, Magel C, Tomfohr-Madsen L, Madigan S, Letourneau N, Campbell TS, Giesbrecht GF. Adverse childhood experiences and HPA axis function in pregnant women. Horm Behav 2018; 102:10-22. [PMID: 29630895 DOI: 10.1016/j.yhbeh.2018.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Jenna C Thomas
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Chantelle Magel
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Department of Pediatrics, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Faculty of Nursing, & Cumming School of Medicine (Pediatrics, Psychiatry & Community Health Sciences), University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Department of Pediatrics, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada.
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Cortisol, cortisone, and BDNF in amniotic fluid in the second trimester of pregnancy: Effect of early life and current maternal stress and socioeconomic status. Dev Psychopathol 2018; 30:971-980. [PMID: 29576035 DOI: 10.1017/s0954579418000147] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prenatal environment shapes the offspring's phenotype; moreover, transgenerational stress and stress during pregnancy may play a role. Brain-derived neurotrophic factor (BDNF) and glucocorticoids influence neurodevelopment during pregnancy, and there is evidence that BDNF in amniotic fluid is mainly of fetal origin, while the source of glucocorticoids is maternal. We tested the hypothesis that maternal early life stress, psychiatric diagnoses, anxiety, perceived stress, and socioeconomic status influence BDNF and glucocorticoid concentrations in amniotic fluid in the second trimester. We studied 79 pregnant women who underwent amniocentesis in the early second trimester and analyzed BDNF, cortisol, and cortisone concentrations in amniotic fluid. The endocrine data were related to maternal early life adversities (Childhood Trauma Questionaire), perceived stress (Perceived Stress Scale), anxiety, socioeconomic status (family income), and the presence of psychiatric diseases. We found BDNF in amniotic fluid to be positively related to maternal early adversity (Childhood Trauma Questionaire). Low family income (socioeconomic status) was related to high amniotic fluid glucocorticoid concentrations. Neither glucocorticoid concentrations nor hydroxy steroid dehydrogenase (HSD2) activity could be related to BDNF concentrations in amniotic fluid. Early maternal adverse events may be reflected in the fetal BDNF regulation, and it should be tested whether this relates to differences in neurodevelopment.
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Horsch A, Gilbert L, Lanzi S, Gross J, Kayser B, Vial Y, Simeoni U, Hans D, Berney A, Scholz U, Barakat R, Puder JJ. Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial, a randomised controlled trial. BMJ Open 2018; 8:e020462. [PMID: 29487077 PMCID: PMC5855393 DOI: 10.1136/bmjopen-2017-020462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) carries prenatal and perinatal risk for the mother and her offspring as well as longer-term risks for both the mother (obesity, diabetes, cardiovascular disease) and her child (obesity, type 2 diabetes). Compared with women without GDM, women with GDM are twice as likely to develop perinatal or postpartum depression. Lifestyle interventions for GDM are generally limited to physical activity and/or nutrition, often focus separately on the mother or the child and take place either during or after pregnancy, while their results are inconsistent. To increase efficacy of intervention, the multifactorial origins of GDM and the tight link between mental and metabolic as well as maternal and child health need to be heeded. This calls for an interdisciplinary transgenerational approach starting in, but continuing beyond pregnancy. METHODS AND ANALYSIS This randomised controlled trial will assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention aimed at improving the metabolic and mental health of 200 women with GDM and their offspring. Women with GDM at 24-32 weeks gestational age who understand French or English, and their offspring and partners can participate. The intervention components will be delivered on top of usual care during pregnancy and the first year postpartum. Metabolic and mental health outcomes will be measured at 24-32 weeks of pregnancy, shortly after birth and at 6-8 weeks and 1 year after childbirth. Data will be analysed using intention-to-treat analyses. The MySweetHeart Trial is linked to the MySweetHeart Cohort (clinicaltrials.gov/ct2/show/NCT02872974). ETHICS AND DISSEMINATION We will disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02890693; Pre-results.
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Affiliation(s)
- Antje Horsch
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Leah Gilbert
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Service of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yvan Vial
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Rheumatology Service, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Consultation Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Lausanne, Switzerland
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jardena J Puder
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
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Thayer ZM. Dark shadow of the long white cloud: Neighborhood safety is associated with self-rated health and cortisol during pregnancy in Auckland, Aotearoa/New Zealand. SSM Popul Health 2017; 3:75-80. [PMID: 29349206 PMCID: PMC5768991 DOI: 10.1016/j.ssmph.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/04/2016] [Accepted: 11/21/2016] [Indexed: 12/25/2022] Open
Abstract
Auckland, Aotearoa/New Zealand is a culturally and ethnically diverse city. Despite popular global conceptions regarding its utopian nature, the lived experience for many individuals in Auckland attests to the substantial social, economic, and health inequalities that exist there. In particular, rapidly rising home prices constrain housing decisions and force individuals to live in less desirable neighborhoods, with potential impacts on individual health. One of the pathways through which adverse neighborhood conditions could impact health is through alterations in the functioning of the hypothalamic pituitary adrenal (HPA)-axis, which regulates the physiological stress response. This paper evaluates the relationship between perceived neighborhood safety, self-rated health, and cortisol, an end product of HPA-axis activation, among women in late pregnancy. Pregnant women living in neighborhoods where they were concerned about safety of their property had poorer self-rated health and elevated morning cortisol, even after adjusting for maternal age, material deprivation, and ethnicity. However, fear of personal safety was unrelated to self-rated health and cortisol. These results suggest that maternal health in pregnancy is sensitive to perceptions regarding neighborhood safety. Such findings are important since higher cortisol levels in pregnancy could not only influence maternal health, but also the health and development of women's children.
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Braithwaite EC, Murphy SE, Ramchandani PG, Hill J. Associations between biological markers of prenatal stress and infant negative emotionality are specific to sex. Psychoneuroendocrinology 2017; 86:1-7. [PMID: 28888992 PMCID: PMC5667634 DOI: 10.1016/j.psyneuen.2017.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Fetal programming is the idea that environmental stimuli can alter the development of the fetus, which may have a long-term effect on the child. We have recently reported that maternal prenatal cortisol predicts infant negative emotionality in a sex-dependent manner: high prenatal cortisol was associated with increased negative emotionality in females, and decreased negative emotionality in males. This study aims to test for this sex-specific effect in a different cohort, and investigate whether sex differences in fetal programming may be specific to glucocorticoid mechanisms by also examining a maternal salivary alpha-amylase (sAA) by sex interaction. METHODS 88 pregnant women (mean gestational age=27.4 weeks, SD=7.4) collected saliva samples at home over two working days to be assayed for the hormone cortisol (range=0.13-88.22nmol/l) and the enzyme alpha-amylase (range=4.57-554.8units/ml). Samples were collected at waking, 30-min post-waking and 12h post-waking. Two months after birth participants reported infant negative emotionality using the distress to limits subscale of the Infant Behavior Questionnaire. RESULTS The interaction between maternal prenatal cortisol and infant sex to predict distress to limits approached significance (p=0.067). In line with our previous finding there was a positive association between prenatal cortisol and negative emotionality in females, and a negative association in males. The interaction between sAA and sex to predict distress was significant (p=0.025), and the direction of effect was the same as for the cortisol data; high sAA associated with increased negative emotionality in females and reduced negative emotionality in males. CONCLUSIONS In line with our previous findings, this research adds to an emerging body of literature, which suggests that fetal programming mechanisms may be sex-dependent. This is the first study to demonstrate that maternal prenatal sAA may be an important biomarker for infant behavior, and the findings have implications for understanding sex differences in developmental psychopathology.
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Affiliation(s)
- Elizabeth C Braithwaite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK; Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford, UK.
| | - Susannah E Murphy
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| | - Paul G Ramchandani
- The Centre for Psychiatry, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 ONN, UK.
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
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Howland MA, Sandman CA, Glynn LM. Developmental origins of the human hypothalamic-pituitary-adrenal axis. Expert Rev Endocrinol Metab 2017; 12:321-339. [PMID: 30058893 PMCID: PMC6334849 DOI: 10.1080/17446651.2017.1356222] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The developmental origins of disease or fetal programming model predicts that intrauterine exposures have life long consequences for physical and psychological health. Prenatal programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis is proposed as a primary mechanism by which early experiences are linked to later disease risk. Areas covered: This review describes the development of the fetal HPA axis, which is determined by an intricately timed cascade of endocrine events during gestation and is regulated by an integrated maternal-placental-fetal steroidogenic unit. Mechanisms by which stress-induced elevations in hormones of maternal, fetal, or placental origin influence the structure and function of the emerging fetal HPA axis are discussed. Recent prospective studies documenting persisting associations between prenatal stress exposures and altered postnatal HPA axis function are summarized, with effects observed beginning in infancy into adulthood. Expert commentary: The results of these studies are synthesized, and potential moderating factors are discussed. Promising areas of further research highlighted include epigenetic mechanisms and interactions between pre and postnatal influences.
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Affiliation(s)
- Mariann A. Howland
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA
| | - Curt A. Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA
| | - Laura M. Glynn
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA
- Department of Psychology, Chapman University, Orange, CA, USA
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Letourneau NL, Kozyrskyj AL, Cosic N, Ntanda HN, Anis L, Hart MJ, Campbell TS, Giesbrecht GF. Maternal sensitivity and social support protect against childhood atopic dermatitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2017; 13:26. [PMID: 28559916 PMCID: PMC5446757 DOI: 10.1186/s13223-017-0199-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many studies have identified associations between qualities of maternal-child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal-infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. METHODS We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. RESULTS Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. CONCLUSIONS Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal-infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.
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Affiliation(s)
- Nicole L. Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Anita L. Kozyrskyj
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Nela Cosic
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Henry N. Ntanda
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Lubna Anis
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Martha J. Hart
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Gerald F. Giesbrecht
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - The APrON Team
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
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Lebel C, Walton M, Letourneau N, Giesbrecht GF, Kaplan BJ, Dewey D. Prepartum and Postpartum Maternal Depressive Symptoms Are Related to Children's Brain Structure in Preschool. Biol Psychiatry 2016; 80:859-868. [PMID: 26822800 DOI: 10.1016/j.biopsych.2015.12.004] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Perinatal maternal depression is a serious health concern with potential lasting negative consequences for children. Prenatal depression is associated with altered brain gray matter in children, though relations between postpartum depression and children's brains and the role of white matter are unclear. METHODS We studied 52 women who provided Edinburgh Postnatal Depression Scale (EPDS) scores during each trimester of pregnancy and at 3 months postpartum and their children who underwent magnetic resonance imaging at age 2.6 to 5.1 years. Associations between maternal depressive symptoms and magnetic resonance imaging measures of cortical thickness and white matter structure in the children were investigated. RESULTS Women's second trimester EPDS scores negatively correlated with children's cortical thickness in right inferior frontal and middle temporal regions and with radial and mean diffusivity in white matter emanating from the inferior frontal area. Cortical thickness, but not diffusivity, correlations survived correction for postpartum EPDS. Postpartum EPDS scores negatively correlated with children's right superior frontal cortical thickness and with diffusivity in white matter originating from that region, even after correcting for prenatal EPDS. CONCLUSIONS Higher maternal depressive symptoms prenatally and postpartum are associated with altered gray matter structure in children; the observed white matter correlations appear to be uniquely related to the postpartum period. The reduced thickness and diffusivity suggest premature brain development in children exposed to higher maternal perinatal depressive symptoms. These results highlight the importance of ensuring optimal women's mental health throughout the perinatal period, because maternal depressive symptoms appear to increase children's vulnerability to nonoptimal brain development.
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Affiliation(s)
- Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Department of Child & Adolescent Imaging Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Matthew Walton
- Department of Medical Sciences Program, University of Calgary, Calgary, Alberta, Canada; Department of Child & Adolescent Imaging Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Department of Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie J Kaplan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Tomfohr-Madsen LM, Campbell TS, Giesbrecht GF, Letourneau NL, Carlson LE, Madsen JW, Dimidjian S. Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial. Trials 2016; 17:498. [PMID: 27737714 PMCID: PMC5064936 DOI: 10.1186/s13063-016-1601-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/14/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy. METHODS A randomized controlled trial (RCT) design with repeated measures will be used to evaluate the effectiveness of MBCT to treat psychological distress in pregnancy. A sample of 60 consenting pregnant women aged 18 years and above will be enrolled and randomized to the experimental (MBCT) or control (treatment as usual) condition. Primary (e.g., symptoms of stress, depression, and anxiety), secondary (cortisol, blood pressure (BP), heart rate variability (HRV), and sleep) and other outcome data (e.g., psychological diagnoses) will be collected via a combination of laboratory visits and at-home assessments from both groups at baseline (T1), immediately following the intervention (T2), and at 3 months postpartum (T3). Descriptive statistics will be used to describe sample characteristics. Data will be analyzed using an intention-to-treat approach. Hierarchical linear models will be used to test intervention effects on primary and secondary outcomes. DISCUSSION The trial is expected to improve knowledge about evidence-based treatments for psychological distress experienced in pregnancy and to evaluate the potential impact of mindfulness-based interventions on maternal physiology. TRIAL REGISTRATION ClinicalTrials.gov: NCT02214732 , registered on 7 August 2014. Protocol Version 2.0., 5 September 2016.
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Affiliation(s)
- Lianne M. Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Oncology, University of Calgary, Calgary, AB Canada
| | - Gerald F. Giesbrecht
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Nicole L. Letourneau
- Faculties of Nursing and Medicine (Pediatrics), University of Calgary, Calgary, AB Canada
- Alberta Children’s Hospital Research Foundation, Calgary, AB Canada
| | - Linda E. Carlson
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Oncology, University of Calgary, Calgary, AB Canada
| | - Joshua W. Madsen
- Department of Psychology, University of Calgary, Calgary, AB Canada
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO USA
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Impact of maternal prenatal and parental postnatal stress on 1-year-old child development: results from the OTIS antidepressants in pregnancy study. Arch Womens Ment Health 2016; 19:835-43. [PMID: 26957509 DOI: 10.1007/s00737-016-0624-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/29/2016] [Indexed: 02/03/2023]
Abstract
Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcomes. We aimed to assess the impact of perinatal stress on infant development at 1 year of age. We recruited pregnant women calling North American Teratogen Information Services or attending outpatient clinics at CHU Sainte Justine (Montreal) between 2008 and 2010 and their spouses. To be part of our study, women had to be (1) >18 years of age, (2) <15 weeks of gestational age at recruitment, (3) living within 250-km radius of Montreal, and (4) taking antidepressants or non-teratogenic drugs. Stress was assessed using the telephone-administered four-item perceived stress scale during pregnancy in mothers and at 2 months postpartum in both parents. Child development at 1 year of age was evaluated with the Bayley III scales. Socio-demographic and potential confounders were collected through telephone interviews. Multivariable linear regression models were built to assess the association between perinatal parental stress and child development. Overall, 71 couples and their infants were included. When adjusted for potential confounders, maternal prenatal stress was positively associated with motor development (adjusted β = 1.85, CI 95 % (0.01, 3.70)). Postpartum maternal and paternal stresses were negatively associated with motor and socio-emotional development, respectively (adjusted β = -1.54, CI 95 % (-3.07, -0.01) and adjusted β = -1.67, CI 95 % (-3.25, -0.10), respectively). Maternal and paternal postnatal stress seems to be harmful for the motor and socio-emotional development in 1-year-old children. No association was demonstrated between parental stress and cognitive, language, and adaptive behavioral development. However, prenatal maternal stress appears to improve motor skills.
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Immediate stress reduction effects of yoga during pregnancy: One group pre–post test. Women Birth 2016; 29:e82-e88. [DOI: 10.1016/j.wombi.2016.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 01/19/2023]
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Sexually dimorphic and interactive effects of prenatal maternal cortisol and psychological distress on infant cortisol reactivity. Dev Psychopathol 2016; 29:805-818. [PMID: 27426858 DOI: 10.1017/s0954579416000493] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In utero exposure to maternal psychological distress is a risk factor for developmental psychopathology, and these effects are believed to partially occur via dysregulation of the maternal and fetal hypothalamus-adrenal-pituitary axes. Nevertheless, only a few human studies have directly assessed the effects of prenatal cortisol exposure on infant cortisol reactivity, and none have investigated sex differences or potential interactions between prenatal cortisol and psychological distress. Here we report on a prospective longitudinal investigation (N = 236) of in utero exposure to maternal cortisol and distress in a relatively high socioeconomic status and low-risk population to determine whether these exposures interact in their effects on infant (M age = 3.0 months, range = 2.3-5.0 months, 51.9% male) cortisol reactivity and whether there are sex differences in these effects. Results revealed both sexually dimorphic and interactive effects of prenatal cortisol and distress, even after controlling for postnatal distress. In general, blunted reactivity in females was associated with exposure to high maternal distress and flattened patterns of diurnal maternal cortisol, whereas blunted reactivity in males was associated with exposure to steeper morning increases and daytime decreases in maternal cortisol. The findings suggest that sex differences in the effects of prenatal cortisol and distress on infant cortisol reactivity are a plausible mechanism by which maternal experiences during pregnancy contribute to sex differences in the development of psychopathology.
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Seth S, Lewis AJ, Galbally M. Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth 2016; 16:124. [PMID: 27245670 PMCID: PMC4886446 DOI: 10.1186/s12884-016-0915-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 05/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. METHOD A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. RESULTS In total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. DISCUSSION AND CONCLUSION Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.
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Affiliation(s)
- Sunaina Seth
- School of Psychology, Deakin University, Melbourne, 3125, Australia
| | - Andrew J Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, 6150, Australia. .,Harry Perkins South Medical Research Institute, Perth, Western Australia, 6009, Australia.
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, 6150, Australia.,School of Medicine, University of Notre Dame, Perth, Western Australia, 6959, Australia.,Fiona Stanley Hospital, Perth, 6150, Australia.,Harry Perkins South Medical Research Institute, Perth, Western Australia, 6009, Australia
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43
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Horsch A, Kang JS, Vial Y, Ehlert U, Borghini A, Marques-Vidal P, Jacobs I, Puder JJ. Stress exposure and psychological stress responses are related to glucose concentrations during pregnancy. Br J Health Psychol 2016; 21:712-29. [PMID: 27169679 DOI: 10.1111/bjhp.12197] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 04/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The role of stress in the development of gestational diabetes mellitus (GDM) has so far been neglected. We investigated the impact of stress exposure (pregnancy-related and pregnancy-unrelated major life events), psychological stress responses (perceived stress, subjective experience of stress, anxiety, depression, sleep), and physiological stress responses (salivary cortisol, plasma copeptin levels) on glucose concentrations during pregnancy. DESIGN Cross-sectional study, including 203 pregnant women at the maternity department of a Swiss university hospital. METHODS All women underwent routine screening for GDM with a 75-g oral glucose-tolerance test at 24-30 weeks of gestation. Pregnancy-related and pregnancy-unrelated major life events, perceived stress, general psychological distress, anxiety, depression, and amount of sleep were assessed by validated self-report questionnaires. Cortisol was measured using fasting and bedtime saliva samples, and copeptin using fasting plasma. All data were collected before communication of the screening test results. RESULTS Significant positive associations were found between the number of pregnancy-related major life events and fasting glucose, while there was no association with pregnancy-unrelated major life events. More anxiety and depressive symptoms, a higher general level of distress, and a shorter duration of sleep were related to fasting glucose, although the latter two were no longer significant when age and BMI were controlled for. However, physiological stress responses were not associated with glucose concentrations. When testing for unique associations with fasting glucose, more general distress and shorter duration of sleep independently accounted for higher fasting glucose levels. Finally, when comparing women with and without GDM, we found that women who subsequently received the diagnosis of GDM reported more pregnancy-related life events. CONCLUSIONS Some indicators of stress exposure and psychological stress responses were associated with fasting glucose concentrations in pregnant women, thus representing important risk factors for GDM development. Statement of contribution What is already known on this subject? Only approximately half of women with gestational diabetes mellitus (GDM) report any known risk factors. Women after GDM diagnosis reported more major life events compared to healthy pregnant controls. What does this study add? Stress exposure and psychological stress responses were associated with fasting glucose concentrations in pregnant before women were aware of their GDM diagnosis. These represent important risk factors for GDM development and potential targets for intervention.
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Affiliation(s)
- Antje Horsch
- Department of Obstetrics and Gynaecology, University Hospital Lausanne, Switzerland.,Neonatology Service, University Hospital Lausanne, Switzerland.,Endocrinology, Diabetes & Metabolism Service, University Hospital Lausanne, Switzerland
| | - Ji Seon Kang
- Institute of Nursing Education and Research, University Hospital Lausanne, Switzerland
| | - Yvan Vial
- Department of Obstetrics and Gynaecology, University Hospital Lausanne, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Switzerland
| | - Ayala Borghini
- Department of Child and Adolescent Psychiatry, University Hospital Lausanne, Switzerland
| | | | | | - Jardena J Puder
- Endocrinology, Diabetes & Metabolism Service, University Hospital Lausanne, Switzerland.,Division of Pediatric Endocrinology, Diabetology and Obesity, Department of Pediatric Medicine & Surgery, University Hospital Lausanne, Switzerland
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Bublitz MH, Bourjeily G, Vergara-Lopez C, Stroud LR. Momentary stress, cortisol, and gestational length among pregnant victims of childhood maltreatment: a pilot study. Obstet Med 2016; 9:73-7. [PMID: 27512497 DOI: 10.1177/1753495x16636264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/07/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pregnant victims of childhood maltreatment are more likely to deliver preterm. The mechanisms explaining this relationship are unclear. The goal of the current pilot study was to investigate whether momentary stress and cortisol serve as mechanisms linking maltreatment history to gestational length. METHODS Seventeen women enrolled in the study (35% maltreated). Women completed two study sessions at 27 and 34 weeks gestation. Following each session, at four times/day over two days, women reported their momentary stress levels by text message and provided corresponding salivary cortisol samples. Gestational length was determined by medical chart review. RESULTS Higher reports of momentary stress were associated with shortened gestational length. High stress predicted lower cortisol concentrations for women with maltreatment histories but higher concentrations among women without maltreatment. CONCLUSION Results from this pilot study provide preliminary evidence for understanding mechanisms explaining increased risk for preterm birth among childhood maltreatment victims.
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Affiliation(s)
- Margaret H Bublitz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Chrystal Vergara-Lopez
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Laura R Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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45
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Scheyer K, Urizar GG. Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Arch Womens Ment Health 2016; 19:317-28. [PMID: 26275372 PMCID: PMC4754170 DOI: 10.1007/s00737-015-0563-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/30/2015] [Indexed: 12/29/2022]
Abstract
Postpartum depression (PPD) has been associated with a number of negative maternal and infant health outcomes. Despite these adverse health effects, few studies have prospectively examined patterns of pre- and postnatal stress that may increase a woman's risk for PPD. The current study examined whether the timing of altered salivary cortisol patterns and perceived stress levels during pregnancy and at 3 months postpartum was associated with PPD symptoms among 100 low-income mothers. Higher levels of PPD were found among women with a lower cortisol awakening response (first and second trimester), lower average daily cortisol (second trimester), a flatter diurnal cortisol pattern (second and third trimester and at 3 months postpartum), and a less abrupt drop in both cortisol and perceived stress from the third trimester to 3 months postpartum. These results support the need for early screening and regulation of stress levels to promote depression prevention efforts in at-risk populations.
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Affiliation(s)
- Kathryn Scheyer
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA
| | - Guido G Urizar
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA.
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46
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Rouleau CR, Tomfohr-Madsen LM, Campbell TS, Letourneau N, O'Beirne M, Giesbrecht GF. The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension. Biol Psychol 2016; 117:32-42. [PMID: 26868182 DOI: 10.1016/j.biopsycho.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 01/20/2023]
Abstract
Reduced cardiac vagal control, indexed by relatively lower high-frequency heart rate variability (HF-HRV), is implicated in depressed mood and hypertensive disorders among non-pregnant adults whereas research in pregnancy is limited. This study examined whether maternal HF-HRV during pregnancy mediates the association between depressed mood and gestational hypertension. Depressive symptoms (Edinburgh Depression Scale) and HF-HRV were measured during early (M=14.9 weeks) and late (M=32.4 weeks) pregnancy in 287 women. Gestational hypertension was determined by chart review. Depressive symptoms were associated with less HF-HRV (b=-0.02, p=.001). There was an indirect effect of depressed mood on gestational hypertension through late pregnancy HF-HRV (b=0.04, 95% CI 0.0038, 0.1028) after accounting for heart rate. These findings suggest cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension, though causal ordering remains uncertain.
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Affiliation(s)
- Codie R Rouleau
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Paediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada.
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47
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Oaks BM, Laugero KD, Stewart CP, Adu-Afarwuah S, Lartey A, Ashorn P, Vosti SA, Dewey KG. Late-Pregnancy Salivary Cortisol Concentrations of Ghanaian Women Participating in a Randomized Controlled Trial of Prenatal Lipid-Based Nutrient Supplements. J Nutr 2016; 146:343-52. [PMID: 26764321 DOI: 10.3945/jn.115.219576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND High circulating cortisol is associated with miscarriage, preterm birth, and low birth weight. Research in nonpregnant individuals suggests that improved nutrition may lower cortisol concentrations. It is unknown whether nutritional supplementation during pregnancy lowers cortisol. OBJECTIVE Our objective was to determine whether women receiving a lipid-based nutrient supplement (LNS) throughout pregnancy would have lower salivary cortisol at 36 wk gestation compared with women receiving other nutrient supplements. METHODS We conducted a randomized controlled trial in 1320 pregnant Ghanaian women at ≤20 wk gestation who were assigned to receive daily throughout pregnancy: 1) 60 mg iron + 400 μg folic acid (IFA), 2) multiple micronutrients (MMNs), or 3) 20 g LNS (containing 118 kcal, 22 micronutrients, and protein). Morning salivary cortisol was collected from a subsample at baseline and at 28 and 36 wk gestation. RESULTS A total of 758 women had cortisol measurements at 28 or 36 wk gestation. Salivary cortisol at 36 wk gestation did not differ between groups and was (mean ± SE) 7.97 ± 0.199 in the IFA group, 7.84 ± 0.191 in the MMN group, and 7.77 ± 0.199 nmol/L in the LNS group, when adjusted for baseline cortisol, time of waking, and time between waking and saliva collection (P = 0.67). There was an interaction between supplementation group and women's age (continuous variable, P-interaction = 0.03); and when age was dichotomized by the median, significant differences in salivary cortisol concentrations between groups were seen in women ≤26 y of age (IFA = 8.23 ± 0.284 nmol/L, MMN = 8.20 ± 0.274 nmol/L, and LNS = 7.44 ± 0.284 nmol/L; P = 0.03) but not in women >26 y old (IFA = 7.71 ± 0.281 nmol/L, MMN = 7.50 ± 0.274 nmol/L, and LNS = 8.08 ± 0.281 nmol/L; P = 0.13). CONCLUSIONS We conclude that supplementation with LNSs or MMNs during pregnancy did not affect the cortisol concentration in the study population as a whole, in comparison with IFA, but that LNS consumption among younger women may lead to lower cortisol at 36 wk gestation. This trial was registered at clinicaltrials.gov as NCT00970866.
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Affiliation(s)
| | | | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Per Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland; and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Stephen A Vosti
- Agricultural and Resource Economics, University of California Davis, Davis, CA
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Costa-Martins JM, Moura-Ramos M, Cascais MJ, da Silva CF, Costa-Martins H, Pereira M, Coelho R, Tavares J. Adult attachment style and cortisol responses in women in late pregnancy. BMC Psychol 2016; 4:1. [PMID: 26754482 PMCID: PMC4709978 DOI: 10.1186/s40359-016-0105-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023] Open
Abstract
Background Recent research has documented the association between attachment and cortisol rhythms. During pregnancy, when attachment patterns are likely to be activated, elevated levels of cortisol are associated with negative effects for the mother and the foetus. The aim of the present study was to examine the association of adult attachment style and cortisol rhythms in pregnant women. Methods Eighty women in the third trimester of pregnancy participated in the study. Adult attachment was assessed using the Adult Attachment Scale – Revised (AAS-R). Participants collected 4 samples of salivary cortisol at two different days; 3 samples were collected in the morning immediately after wakeup and one sample was collected by bedtime. Results Results found group significant differences in the cortisol diurnal oscillation (F(1,71) = 26.46, p < .001,), with secure women reporting a steep decrease in cortisol from awakening to bedtime, while women with fearful avoidant attachment reported no changes. No group differences were found regarding the cortisol awakening response. Conclusions These results highlight the importance of considering attachment patterns during pregnancy, suggesting fearful avoidant attachment style as a possible risk factor for emotional difficulties and dysregulation of the neuroendocrine rhythms.
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Affiliation(s)
- José Manuel Costa-Martins
- Department of Anaesthesiology, Maternity Hospital Alfredo da Costa, Rua Viriato, 1069-089, Lisbon, Portugal.
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Maria João Cascais
- Clinical Pathology, Biochemistry, Maternity Hospital Alfredo da Costa, Rua Viriato, 1069-089, Lisbon, Portugal
| | | | | | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Rui Coelho
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Jorge Tavares
- Anaesthesiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
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Braithwaite EC, Murphy SE, Ramchandani PG. Effects of prenatal depressive symptoms on maternal and infant cortisol reactivity. Arch Womens Ment Health 2016; 19:581-90. [PMID: 26940835 PMCID: PMC4963445 DOI: 10.1007/s00737-016-0611-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/15/2016] [Indexed: 12/11/2022]
Abstract
Prenatal depression is associated with adverse offspring outcomes, and the prevailing mechanistic theory to account for mood-associated effects implicates alterations of the maternal and foetal hypothalamic-pituitary adrenal (HPA) axes. Recent research suggests that depression may be associated with a failure to attenuate cortisol reactivity during early pregnancy. The aim of the current study is to investigate whether this effect continues into mid and late gestation. A further aim is to test whether maternal prenatal cortisol reactivity directly predicts infant cortisol reactivity. One hundred three pregnant women were recruited during either the second or third trimester. Depressive symptoms were assessed by self-report, and maternal salivary cortisol responses to a stressor (infant distress film) were measured. Approximately 2 months after birth, mothers (n = 88) reported postnatal depression and infant salivary cortisol responses to inoculation were measured. Prenatal depression was not associated with cortisol reactivity to acute stress in mid and late pregnancy. Similarly, neither prenatal depression nor maternal prenatal cortisol reactivity predicted infant cortisol reactivity to inoculation at 2 months. If the effects of prenatal depression on foetal and infant development are mediated by alterations of the maternal and foetal HPA axes, then early pregnancy may be a particularly vulnerable period. Alternatively, changes to HPA reactivity may not be as central to this association as previously thought.
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Affiliation(s)
- Elizabeth C. Braithwaite
- Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford, OX1 3UD UK
| | - Susannah E. Murphy
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Paul G. Ramchandani
- Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
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50
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Symptoms of prenatal depression are associated with raised salivary alpha-amylase levels. Psychoneuroendocrinology 2015; 60:163-72. [PMID: 26150358 DOI: 10.1016/j.psyneuen.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Prenatal depression increases risk for a number of adverse offspring outcomes, however the biological mechanisms underlying this association remain unclear. It has been suggested that maternal glucocorticoids may mediate this link, though supporting evidence has been mixed. An alternative mechanism of effect may be via depression-induced changes in maternal sympathetic nervous system (SNS) function. We examined this hypothesis by determining the relationship between symptoms of maternal prenatal depression and diurnal salivary alpha-amylase (sAA) levels. METHODS 76 pregnant women were recruited during either the second or third trimester of pregnancy. Participants self-reported depressive symptoms using the Edinburgh postnatal depression scale. Saliva samples, to be assayed for alpha-amylase activity, were collected at home over two working days. RESULTS Participants with depressive symptoms in later pregnancy had elevated awakening sAA levels compared with non-depressed controls (t(73) = -2.737, p = 0.008), and continued to have raised sAA throughout the day (F(1) = 10.924, p = 0.002). CONCLUSIONS Our findings highlight that symptoms of depression during late pregnancy are associated with increased maternal SNS activity. Thus, changes in maternal SNS function, which may include increased vasoconstriction and reduced foetal blood flow, could, in part, mediate associations between prenatal depression and adverse offspring outcomes.
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