1
|
Juvinao-Quintero DL, Künzel RG, Larrabure-Torrealva G, Duncan L, Kirschbaum C, Sanchez SE, Gelaye B. Characterization of hair cortisol concentration pre-conception and during pregnancy. Psychoneuroendocrinology 2024; 167:107089. [PMID: 38850884 DOI: 10.1016/j.psyneuen.2024.107089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/19/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The hypothalamic pituitary adrenal (HPA) axis is a system involved in stress and pregnancy regulation, and hair cortisol concentration (HCC) is a promising biomarker of its activity. Assessing factors that influence HCC in the prenatal period is critical to understand whether and how HPA axis (dys-)regulation influences maternal health and child development, particularly in high-risk populations from low- and middle-income countries (LMICs). AIMS This study aimed at characterizing preconception and pregnancy HCC with respect to multiple sociodemographic, pregnancy-related, and hair-related factors. METHODS In a sample of N = 2581 pregnant women in Perú, participants from two cohort studies provided a 6 cm scalp hair sample at three prenatal timepoints. Each hair sample was cut into two segments of 3 cm that represent cortisol secretion at four times: preconception, first-, second- and third trimester of pregnancy. Hair cortisol was extracted using liquid chromatography tandem mass spectrometry (LC-MS/MS). Spearman correlations, paired t-tests, and ANOVA were used to assess differences in log-transformed values of HCC (logHCC) across maternal sociodemographic, pregnancy-related, and hair-related factors. Multivariable linear regressions were used to examine independent associations of HCCs with selected correlates. RESULTS Mean logHCC values showed an increase across the four prenatal periods. Preconception BMI was consistently associated with HCC in all three trimesters, while difficulty accessing basic foods, education, hair dyeing, and infant sex showed time-specific associations with HCCs. In sensitivity analyses, we detected no substantial segment effects in the associations of HCCs with maternal characteristics. CONCLUSION This study is the largest to characterize HCC in pregnant women from a LMIC. Our findings provide a foundation for the use of HCC as a biomarker of prenatal HPA axis activity for future studies. This foundation may contribute to finding valid biomarkers of stress-response systems to promote maternal and child health.
Collapse
Affiliation(s)
- Diana L Juvinao-Quintero
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Kresge 500, Boston, MA 02115, USA
| | - Richard G Künzel
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Kresge 500, Boston, MA 02115, USA; Katholische Universität Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt 85072, Germany.
| | - Gloria Larrabure-Torrealva
- Instituto Nacional Materno Perinatal, Lima 15024, Peru; Universidad Nacional Mayor de San Marcos, Instituto de Investigaciones Clínicas, Lima 15081, Peru
| | - Laramie Duncan
- Stanford University, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305, USA
| | - Clemens Kirschbaum
- Technische Universität Dresden, Zellescher Weg 19, Dresden 01069, Germany
| | - Sixto E Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigacion, Lima 15024, Peru; Asociación Civil PROESA, Lima 15024, Peru
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Kresge 500, Boston, MA 02115, USA; Massachusetts General Hospital and Harvard Medical School, The Chester M. Pierce, M.D. Division of Global Psychiatry, 151 Merrimac Street, Boston, MA 02114, USA
| |
Collapse
|
2
|
Tartour AI, Chivese T, Eltayeb S, Elamin FM, Fthenou E, Seed Ahmed M, Babu GR. Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis. Psychoneuroendocrinology 2024; 166:107060. [PMID: 38677195 DOI: 10.1016/j.psyneuen.2024.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment. METHODS We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress. RESULTS Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures. CONCLUSION The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.
Collapse
Affiliation(s)
- Angham Ibrahim Tartour
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Safa Eltayeb
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Fatima M Elamin
- Office of Research Ethics and Integrity, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Eleni Fthenou
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Mohammed Seed Ahmed
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Giridhara Rathnaiah Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| |
Collapse
|
3
|
Salazar-Granizo YE, Hueso-Montoro C, Caparros-Gonzalez RA. Lifestyles and Academic Stress in University Students of Health Sciences: A Mixed-Methodology Study. Healthcare (Basel) 2024; 12:1384. [PMID: 39057527 PMCID: PMC11276596 DOI: 10.3390/healthcare12141384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/23/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The global health emergency generated by the COVID-19 pandemic (caused by the SARS-CoV-2 virus) led to the implementation of extraordinary measures such as confinement and isolation in many countries to mitigate the spread of the virus. (1) This study analyzes the lifestyles and academic and perceived stresses of university students of health sciences during the period of online learning due to the COVID-19 pandemic. The relationship between lifestyles and academic stress was examined. (2) A parallel mixed-method convergent study was conducted, with a correlational non-experimental design. Quantitative and qualitative data were collected and analyzed in parallel, with parametric and nonparametric testing for quantitative data and Miles and Huberman's approach to qualitative analysis. The qualitative findings complemented the quantitative results. The number of students who participated in this study was 2734, from six programs in health, nursing, medicine, clinical laboratory, physiotherapy, dentistry, and clinical psychology at the University of Chimborazo, Ecuador. (3) Overall, the health science students had "Unhealthy or health-compromising lifestyles", medical students being the ones who have healthier lifestyles. However, more than 80% experienced and perceived stress during the period of online learning and social isolation due to the pandemic, women being the ones who experienced it at a higher level. (4) The online learning modality during the COVID-19 pandemic modified lifestyles and generated stress in health science students, due to changes in daily routines, sedentary lifestyle, and stress, as a result of social isolation. Therefore, the students prefer face-to-face teaching, perceived as enabling more enriching interactions with their teachers and peers and the opportunity to develop essential practical skills in their health practice.
Collapse
Affiliation(s)
- Yolanda E. Salazar-Granizo
- Doctorate Program in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs-GRANADA), 18071 Granada, Spain; (C.H.-M.); (R.A.C.-G.)
- School of Nursing, Faculty of Health Sciences, National University of Chimborazo, Riobamba 060101, Ecuador
| | - Cesar Hueso-Montoro
- Instituto de Investigación Biosanitaria (ibs-GRANADA), 18071 Granada, Spain; (C.H.-M.); (R.A.C.-G.)
- Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Center for Mind, Brain and Behavior Research (CIMCYC), 18071 Granada, Spain
| | - Rafael A. Caparros-Gonzalez
- Instituto de Investigación Biosanitaria (ibs-GRANADA), 18071 Granada, Spain; (C.H.-M.); (R.A.C.-G.)
- Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| |
Collapse
|
4
|
Sobol M, Błachnio A, Plucińska E, Hryhorchuk I, Meisner M, Wdowiak A, Wdowiak N, Szczepaniak P, Jankowski KS. Associations of couples' balanced time perspective with maternal prenatal hair cortisol concentration and perceived stress. Psychoneuroendocrinology 2024; 168:107115. [PMID: 39002452 DOI: 10.1016/j.psyneuen.2024.107115] [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: 02/20/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE The stress experienced by a woman during pregnancy not only has a negative impact on her well-being and physical health but also adversely affects the fetus. Stress is strongly linked with time perspective, defined as the tendency to focus on the past, present, or future. The study aimed to investigate how couples' balanced time perspective was related to maternal prenatal hair cortisol concentration and perceived stress in the first and third trimesters of pregnancy. METHOD The participants were pregnant women and their male partners (84 couples). Women completed online questionnaires: the Zimbardo Time Perspective Inventory (ZTPI), the Dark Future Scale (DFS), and the Perceived Stress Scale, while men completed online versions of the ZTPI and the DFS. These questionnaire measurements were conducted in the first and third trimesters. Maternal cortisol levels were measured in hair samples taken during gynecological visits, in the first and third trimesters. RESULTS The study revealed that the more unbalanced the partner's time perspective, the more unbalanced the pregnant woman's time perspective and, consequently, the higher the stress perceived by the pregnant woman. This effect was present in both the first (B = 1.06, SE =.36, p <.001, 95 % CI [.398, 1.826]) and the third trimesters (B =.98, SE =.36, p <.001, 95 % CI [.327, 1.774]). Moreover, the more unbalanced the partner's time perspective, the more unbalanced the woman's time perspective and, consequently, the lower the hair cortisol concentration in the first trimester (B = -.08, SE =.04, p <.05, 95 % CI [-.171, -.010]). Partner's unbalanced time perspective in the first trimester was also a predictor of stress perceived by the woman in the third trimester (t = 2.38, p <.05). CONCLUSIONS The results suggest the significance of the partner's time perspective for the pregnant woman's mental health. The partner's unbalanced, negative time perspective in the first trimester may increase the pregnant woman's stress in the third trimester. This effect can be even stronger than that of the woman's time perspective.
Collapse
Affiliation(s)
- Małgorzata Sobol
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, Warsaw 00-183, Poland.
| | - Agata Błachnio
- John Paul II Catholic University of Lublin, al. Raclawickie 14, Lublin 20-950, Poland
| | | | - Inna Hryhorchuk
- Żywiec Hospital, ul. Pola Lisickich 80, Żywiec 34-300, Poland
| | - Michał Meisner
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, Warsaw 00-183, Poland
| | - Artur Wdowiak
- Medical University of Lublin, Al. Racławickie 1, Lublin 20-059, Poland
| | - Natalia Wdowiak
- Medical University of Lublin, Al. Racławickie 1, Lublin 20-059, Poland
| | | | - Konrad S Jankowski
- Department of Psychology, University of Warsaw, ul. Stawki 5/7, Warsaw 00-183, Poland
| |
Collapse
|
5
|
Becene I, Rinne GR, Schetter CD, Hollenbach JP. Prenatal stress and hair cortisol in a sample of Latina women. Psychoneuroendocrinology 2024; 164:107017. [PMID: 38503196 DOI: 10.1016/j.psyneuen.2024.107017] [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] [Received: 08/15/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Stress during pregnancy adversely impacts maternal and infant health. Dysregulation of the hypothalamic pituitary axis is a mediator of the relationship between stress and health. Evidence supporting an association between prenatal chronic stress and cortisol is limited, and the majority of research published has been conducted amongst White participants, who experience less chronic stress than people of color. AIM This study investigated associations between various measures of prenatal stress and hair cortisol concentrations which is a biomarker of the integrated stress response in a sample of Latina participants during the third trimester of pregnancy. METHOD Pregnant women (n=45) were surveyed with scales measuring chronic stress, perceived stress, pregnancy-related and pregnancy-specific anxiety. Hair samples were collected as an objective neuroendocrine measure of chronic stress. Linear regression analyses were performed to assess associations between stress measures and hair cortisol. Pre-pregnancy BMI, smoking during pregnancy, and steroid use during pregnancy were used as covariates in adjusted models. RESULTS Chronic stress, operationalized as maternal reports of neighborhood/housing strain, daily activities and relationship strain, discrimination, and financial strain, was significantly associated with higher hair cortisol concentrations. No significant associations were found between hair cortisol and perceived stress, pregnancy-related anxiety, nor pregnancy-specific anxiety in adjusted models. CONCLUSION Chronic stress may be a more robust correlate of physiological stress, as measured by hair cortisol in pregnancy, than other common measures of prenatal stress and anxiety.
Collapse
Affiliation(s)
- Iris Becene
- Yale University School of Medicine, New Haven CT 06510, United States
| | - Gabrielle R Rinne
- UCLA Department of Psychology, Los Angeles CA 90095-1563, United States
| | | | - Jessica P Hollenbach
- CT Children's Medical Center, Hartford, CT 06016; Department of Pediatrics, University of Connecticut Health Center, School of Medicine, Farmington CT 06030, United States.
| |
Collapse
|
6
|
Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [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] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
Collapse
Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
Collapse
Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
Collapse
Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
| |
Collapse
|
8
|
Howland MA. Recalibration of the stress response system over adult development: Is there a perinatal recalibration period? Dev Psychopathol 2023; 35:2315-2337. [PMID: 37641984 PMCID: PMC10901284 DOI: 10.1017/s0954579423000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.
Collapse
Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
9
|
Juvinao-Quintero DL, Künzel RG, Larabure-Torrealva G, Duncan L, Kirschbaum C, Sanchez SE, Gelaye B. Correlates of preconception and pregnancy hair cortisol concentrations. RESEARCH SQUARE 2023:rs.3.rs-3349003. [PMID: 37790441 PMCID: PMC10543434 DOI: 10.21203/rs.3.rs-3349003/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Assessing factors that influence chronic stress biomarkers like hair cortisol concentrations (HCCs) in pregnancy is critical to prevent adverse pregnancy outcomes. Thus, we aimed to identify correlates of HCC preconception and during pregnancy. 2,581 pregnant women participated in the study. HCC was available at four time periods: pre-pregnancy (0-3 months preconception, n = 1,023), and in the first (1-12 weeks, n = 1,734), second (13-24 weeks, n = 1,534), and third (25-36 weeks, n = 835) trimesters. HCC was assessed using liquid chromatography tandem mass spectrometry (LC-MS/MS). Sociodemographic, pregnancy- and hair-related characteristics, and measures of psychosocial stress, were interrogated as potential correlates of HCC. Spearman correlations, paired t-tests, and ANOVA were used to assess differences in log-transformed values of HCC (logHCC) across maternal characteristics. Multivariable linear regressions were used to identify the correlates of HCCs after adjusting for confounders. Mean logHCC values increased across the four prenatal periods (P < 0.001). In multivariable analyses, pre-pregnancy BMI was consistently associated with all HCCs, while gestational age, economic hardship, hair dyeing, and depression, showed time-specific associations with HCC. In conclusion, this study showed evidence of factors influencing HCC levels before and during pregnancy. The most consistent association was seen with pre-pregnancy BMI. Depression was also associated with HCC concentrations.
Collapse
Affiliation(s)
| | - Richard G Künzel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | | | - Laramie Duncan
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | | | - Sixto E Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigacion
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| |
Collapse
|
10
|
Rinne GR, Hartstein J, Guardino CM, Dunkel Schetter C. Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review. Psychoneuroendocrinology 2023; 153:106115. [PMID: 37119659 PMCID: PMC10936734 DOI: 10.1016/j.psyneuen.2023.106115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Stress before conception and during pregnancy is associated with less favorable maternal and child health. Alterations in prenatal cortisol levels may serve as a central biological pathway linking stress to adverse maternal and child health. Research examining associations between maternal stress from childhood through pregnancy and prenatal cortisol has not been comprehensively reviewed. METHOD The current scoping review of 48 papers synthesizes studies reporting on associations between stress before conception and during pregnancy with maternal cortisol in pregnancy. Eligible studies measured childhood, the proximal preconception period, pregnancy, or lifetime stress based on stress exposures or appraisals and measured cortisol in saliva or hair during pregnancy. RESULTS Higher maternal childhood stress was associated with higher cortisol awakening responses and alterations in typical pregnancy-specific changes in diurnal cortisol patterns across studies. In contrast, most studies of preconception and prenatal stress reported null associations with cortisol and those reporting significant effects were inconsistent in direction. A few studies found that the associations between stress and cortisol during pregnancy varied as a function of several moderators including social support and environmental pollution. CONCLUSIONS Although many studies have evaluated effects of maternal stress on prenatal cortisol, this scoping review is the first to synthesize existing literature on this topic. The association between stress before conception and during pregnancy and prenatal cortisol may depend on the developmental timing of stress and several moderators. Maternal childhood stress was more consistently associated with prenatal cortisol than proximal preconception or pregnancy stress. We discuss methodological and analytic factors that may contribute to mixed findings.
Collapse
Affiliation(s)
- Gabrielle R Rinne
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Jenna Hartstein
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
11
|
Abdul Jafar NK, Tham EKH, Eng DZH, Yeo S, Rifkin-Graboi A, Gooley JJ, Loy SL, Eriksson JG, Chong YS, Tan KH, Chan JKY, Chen H, Shek LPC, Gluckman PD, Yap F, Meaney MJ, Broekman BFP, Kee MZL, Cai S. Preconception sleep quality moderates the association between preconception hair cortisol levels and mental health in pregnant women. J Affect Disord 2023; 334:187-196. [PMID: 37150222 DOI: 10.1016/j.jad.2023.04.129] [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: 06/30/2022] [Revised: 03/17/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Poor sleep quality may elevate cortisol levels and affect prenatal mental health through altered HPA axis functioning. This study aims to examine whether subjective sleep quality during preconception moderates the association between preconception hair cortisol levels and mental health from preconception to pregnancy trimesters. METHODS Women from a prospective cohort study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) questionnaires during preconception (T0) and at each pregnancy trimesters (T1, T2, and T3). We analyzed 266 of these women who conceived and had fully completed measures at preconception for hair cortisol, sleep quality and either EPDS or STAI-state. Changes in EPDS and STAI-state scores were derived (i.e., T1-T0, T2-T0, T3-T0). Johnson-Neyman technique identified PSQI scores with significant moderation of cortisol on mental health. RESULTS After adjusting for potential covariates, there was a significant positive correlation between preconception hair cortisol levels and depressive symptom at the second trimester (rs (144) = 0.22, p = 0.008), but not the first and third trimesters (all ps > 0.05). The positive association between preconception hair cortisol and change in depressive symptoms between third trimester and preconception was significant only among women with poor preconception sleep quality (PSQI ≥ 7). LIMITATIONS Sleep quality and prenatal mood were derived from self-reported questionnaires, which may be more susceptible to bias. CONCLUSIONS The positive association between preconception hair cortisol and change in prenatal depressive symptoms is significant among women who reported poor sleep quality during preconception. Improving preconception sleep quality can potentially mitigate the association between preconception hair cortisol and depressive symptoms during pregnancy.
Collapse
Affiliation(s)
- Nur K Abdul Jafar
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Maternal Fetal Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Elaine K H Tham
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Derric Z H Eng
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Sherwynn Yeo
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Anne Rifkin-Graboi
- Centre for Research in Child Development, Office of Educational Research, National Institute of Education, Nanyang Technological University, Singapore
| | - Joshua J Gooley
- Program in Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Johan G Eriksson
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok Hian Tan
- Department of Reproductive Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore; Paediatrics Academic Clinical Programme, Duke-NUS Medicine School, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Helen Chen
- Department of Psychological Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter D Gluckman
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael J Meaney
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Canada
| | - Birit F P Broekman
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Psychiatry, OLVG and Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program Amsterdam, the Netherlands
| | - Michelle Z L Kee
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Shirong Cai
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
12
|
Juvinao-Quintero DL, Larrabure-Torrealva GT, Sanchez SE, Kirschbaum C, Williams MA, Gelaye B. Maternal hair cortisol concentrations and its association with increased insulin resistance in midpregnancy. Ann Epidemiol 2023; 81:14-23.e8. [PMID: 36841381 PMCID: PMC10204096 DOI: 10.1016/j.annepidem.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE Stress and elevated maternal glycemia have negative effects on pregnancy. We evaluated the association of hair cortisol concentrations (HCC), a marker of chronic stress, with insulin resistance and gestational diabetes (GDM). METHODS In total, 527 women from Lima, Peru, provided a hair sample in the second trimester of their pregnancy to measure HCC using liquid chromatography-tandem mass spectrometry. Each 6 cm of hair captured HCC in early (T1=1-12 weeks) and midpregnancy (T2 = 13-24 weeks). GDM diagnosis was conducted in midpregnancy. Multivariable regression models adjusted for putative risk factorsincluding maternal sociodemographic factors, diabetes history, and hair characteristics, were used to estimate the association of HCC with GDM and various glycemic traits. RESULTS GDM was diagnosed in 122 (23%) women. Mean HCC across pregnancy was T1 = 3.7 (±3.4) pg/mg and T2 = 4.8 (±3.4) pg/mg. HCC was associated with increased log-transformed units of fasting insulin (T1 = 0.15 [0.03, 0.27], T2 = 0.17 [0.04, 0.30]), homeostasis model assessment for insulin resistance (T1 = 0.14 [0.01, 0.26], T2 = 0.17 [0.03, 0.30]), and homeostasis model assessment for β-cell function (T1 = 0.20 [0.05, 0.34], T2 = 0.20 [0.04, 0.36]), but not with GDM (T1 = 0.95 [0.63, 1.40], T2 = 1.11 [0.74, 1.67]). CONCLUSIONS Elevated maternal HCC was associated with abnormal insulin homeostasis in pregnancy. Dysregulation of the hypothalamic-pituitary-adrenal axis, as reflected by high HCC, may also contribute to insulin resistance syndrome in pregnancy.
Collapse
Affiliation(s)
| | - Gloria T Larrabure-Torrealva
- Departamento Académico de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto Nacional Materno Perinatal, Lima, Perú
| | - Sixto E Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigación, Lima, Perú; Asociación Civil PROESA, Lima, Perú
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston; Center for Bioethics, Harvard Medical School, Boston, MA
| |
Collapse
|
13
|
Kelsall NC, Sanchez SE, Rondon MB, Valeri L, Juvinao-Quintero D, Kirschbaum C, Koenen KC, Gelaye B. Association between trauma exposure and glucocorticosteroid concentration in hair during pregnancy. Psychoneuroendocrinology 2023; 151:106072. [PMID: 36893558 PMCID: PMC10095305 DOI: 10.1016/j.psyneuen.2023.106072] [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] [Received: 08/02/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Traumatic events, including child abuse and intimate partner violence, are highly prevalent among women of child-bearing age. These traumatic experiences may impact maternal and offspring physical and mental health. A proposed mechanism for these effects is maternal hypothalamic-pituitary-adrenal (HPA) axis dysregulation which can be measured using hair corticosteroid levels. AIMS This study aims to examine the association of child abuse and intimate partner violence exposure with HPA axis functioning, as measured by hair corticosteroid levels in a cohort of pregnant women. METHODS We included data from 1822 pregnant women (mean gestational age 17 weeks) attending a prenatal clinic in Lima, Peru. We extracted cortisol and cortisone concentrations from hair samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Each participant provided 6-cm hair samples: 3 cm hair segment closest to the scalp reflecting HCC in early pregnancy (first three months), and 3-6 cm from the scalp reflecting HCC in pre-pregnancy (three months prior to conception). Multivariable linear regression procedures were used to assess the association between maternal trauma exposure and hair corticosteroid levels. RESULTS Overall, women who experienced child abuse on average had higher levels of cortisol (p < 0.01) and cortisone (p < 0.0001) after adjustment for age, race, adult access to basic foods and hair treatments. For the hair segment reflecting early pregnancy, presence of child abuse was associated with a 0.120 log unit increase in cortisol and a 0.260 log unit increase in cortisone (p < 0.001). For the hair segment reflecting pre-pregnancy, a history of child abuse was associated with a 0.100 log unit increase in cortisol and a 0.180 log unit increase in cortisone (p < 0.01). Results also suggested an impact of intimate partner violence on HPA regulation; however, associations were not statistically significant after controlling for child abuse. CONCLUSIONS These results underscore the long-lasting impacts of exposure to adversity and trauma during early life. Our study findings will have implications for research investigating HPA axis function and long-term effects of violence on corticosteroid regulation.
Collapse
Affiliation(s)
- Nora Clancy Kelsall
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sixto E Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigación, Lima, Peru; Asociaciòn Civil Proyectos en Salud, Lima, Peru
| | | | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Feng SV, van den Boom W, De Iorio M, Thng GJ, Chan JKY, Chen HY, Tan KH, Kee MZL. Joint modelling of mental health markers through pregnancy: a Bayesian semi-parametric approach. J Appl Stat 2023; 51:388-405. [PMID: 38283054 PMCID: PMC10810649 DOI: 10.1080/02664763.2022.2154329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/23/2022] [Indexed: 01/14/2023]
Abstract
Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy.
Collapse
Affiliation(s)
| | - Willem van den Boom
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Maria De Iorio
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Statistical Science, University College London, London, UK
| | - Gladi J. Thng
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Jerry K. Y. Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Helen Y. Chen
- Duke-NUS Medical School, Singapore, Singapore
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michelle Z. L. Kee
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| |
Collapse
|
15
|
Wiley KS, Camilo C, Gouveia G, Euclydes V, Panter-Brick C, Matijasevich A, Ferraro AA, Fracolli LA, Chiesa AM, Miguel EC, Polanczyk GV, Brentani H. Maternal distress, DNA methylation, and fetal programing of stress physiology in Brazilian mother-infant pairs. Dev Psychobiol 2023; 65:e22352. [PMID: 36567654 PMCID: PMC9792831 DOI: 10.1002/dev.22352] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
Maternal prenatal psychosocial stress is associated with adverse hypothalamic-pituitary-adrenal axis (HPAA) function among infants. Although the biological mechanisms influencing this process remain unknown, altered DNA methylation is considered to be one potential mechanism. We investigated associations between maternal prenatal psychological distress, infant salivary DNA methylation, and stress physiology at 12 months. Mother's distress was measured via depression and anxiety in early and late pregnancy in a cohort of 80 pregnant adolescents. Maternal hair cortisol was collected during pregnancy. Saliva samples were collected from infants at 12 months to quantify DNA methylation of three stress-related genes (FKBP5, NR3C1, OXTR) (n = 62) and diurnal cortisol (n = 29). Multivariable linear regression was used to test for associations between prenatal psychological distress, and infant DNA methylation and cortisol. Hair cortisol concentrations in late pregnancy were negatively associated with two sites of FKBP5 (site 1: B = -22.33, p = .003; site 2: B = -15.60, p = .012). Infants of mothers with elevated anxiety symptoms in late pregnancy had lower levels of OXTR2 CpG2 methylation (B = -2.17, p = .03) and higher evening salivary cortisol (B = 0.41, p = .03). Furthermore, OXTR2 methylation was inversely associated with evening cortisol (B = -0.14, p-value ≤ .001). Our results are, to our knowledge, the first evidence that the methylation of the oxytocin receptor may contribute to the regulation of HPAA during infancy.
Collapse
Affiliation(s)
- Kyle S. Wiley
- Department of Anthropology, University of California, Los Angeles, Los Angeles, California, USA
| | - Caroline Camilo
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Gisele Gouveia
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Verônica Euclydes
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alexandre Archanjo Ferraro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lislaine Aparecida Fracolli
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Anna Maria Chiesa
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Euripedes Constantino Miguel
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Guilherme V. Polanczyk
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Helena Brentani
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Horan H, Cheyney M, Torres EG, Eick G, Bovbjerg M, Snodgrass JJ. Maternal hair cortisol concentrations across pregnancy and the early postpartum period in a Puerto Rican sample. Am J Hum Biol 2022; 34:e23718. [PMID: 35001460 DOI: 10.1002/ajhb.23718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Hair cortisol is a noninvasive, long-term biomarker of human stress. Strengths and weaknesses of this biomarker as a proxy measure of perinatal stress are not yet well understood. Hair cortisol data were collected from pregnant women in Puerto Rico to investigate maternal cortisol level variance across pregnancy. METHODS In 2017, we recruited 86 pregnant women planning to birth at a large urban hospital. We aimed to collect four hair samples from each participant, one in each trimester and one in the postpartum period. RESULTS Median cortisol in the first trimester (n = 82) was 5.7 picograms/milligram (pg/mg) (range: 1.0-62.4). In the second, third, and postpartum periods, the medians were 6.8 pg/mg (1.0-69.5), (n = 46), 20.1 pg/mg (5.6-89.0), (n = 30), and 14.1 pg/mg (1.7-39.8), (n = 9), respectively. These medians disguise a 10-fold and 50-fold variability for two participants. Our sample sizes declined sharply when Hurricane Maria caused major disruptions in services and participants' lives. CONCLUSION Maternal hair cortisol concentrations were lower in the first and second trimester than the third trimester and early postpartum period. We also observed a wide range of variation in cortisol levels throughout pregnancy and in the postpartum period.
Collapse
Affiliation(s)
- Holly Horan
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA.,Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Geeta Eick
- Department of Anthropology, Global Health Biomarker Laboratory, University of Oregon, Corvallis, Oregon, USA
| | - Marit Bovbjerg
- Epidemiology Program, Oregon State University, Corvallis, Oregon, USA
| | - James Josh Snodgrass
- Department of Anthropology, Global Health Biomarker Laboratory, University of Oregon, Corvallis, Oregon, USA
| |
Collapse
|
18
|
Bruinhof N, Vacaru SV, van den Heuvel MI, de Weerth C, Beijers R. Prenatal hair cortisol concentrations during the COVID-19 outbreak: Associations with maternal psychological stress and infant temperament. Psychoneuroendocrinology 2022; 144:105863. [PMID: 35868205 PMCID: PMC9270179 DOI: 10.1016/j.psyneuen.2022.105863] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternal psychological stress during pregnancy, including stress resulting from disasters and trauma, has been linked to temperamental difficulties in offspring. Although heightened cortisol concentrations are often hypothesized as an underlying mechanism, evidence supporting this mechanism is not consistent, potentially because of methodological issues and low stress in the population. AIM To address these issues, this preregistered study investigated the following associations between: 1) prenatal psychological stress and hair cortisol, as a biomarker for chronic stress, during the COVID-19 outbreak (i.e., as a major worldwide psychological stressor), and 2) maternal hair cortisol during the COVID-19 outbreak and later infant temperamental negative affectivity and orienting/regulation. Additionally, we explored whether associations were different for women with low versus high socioeconomic status (SES; maternal education and annual household income) and at different stages of pregnancy. METHOD Pregnant women (N = 100) filled out online questionnaires during the first COVID-19 lockdown. Six months later, when most mothers were still pregnant or had just given birth, maternal hair samples were collected during home visits. When infants were six months old, mothers reported on their infant's temperament. RESULTS Although hierarchical regression analyses revealed no associations between prenatal COVID-19 psychological stress and hair cortisol during the COVID-19 outbreak, SES proved to be a moderator in this association. Only pregnant women with higher levels of SES, not lower levels, showed a positive association between work-related and social support-related COVID-19 worries and hair cortisol. Finally, prenatal hair cortisol was not associated with later infant temperamental negative affectivity and orienting/regulation. CONCLUSION Although the COVID-19 outbreak proved to be a major psychological stressor worldwide, the physiological impact of the crisis might be different for pregnant women with higher SES as compared to lower SES.
Collapse
Affiliation(s)
- Nina Bruinhof
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9010, 6500 GL Nijmegen, the Netherlands.
| | - Stefania V. Vacaru
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9010, 6500 GL Nijmegen, the Netherlands
| | | | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9010, 6500 GL Nijmegen, the Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9010, 6500 GL Nijmegen, the Netherlands,Department of Social Development, Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, the Netherlands
| |
Collapse
|
19
|
Caparros-Gonzalez RA, Lynn F, Alderdice F, Peralta-Ramirez MI. Cortisol levels versus self-report stress measures during pregnancy as predictors of adverse infant outcomes: a systematic review. Stress 2022; 25:189-212. [PMID: 35435113 DOI: 10.1080/10253890.2022.2059348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Systematically review existing evidence to (1) identify the association between self-report stress and cortisol levels measured during pregnancy; and, (2) assess their association with adverse infant outcomes to determine which is the better predictor. A systematic review was conducted in accordance with PRISMA guidelines. Search terms focused on pregnancy, psychological stress and cortisol. Nine electronic databases were searched, in addition to reference lists of relevant papers. Eligibility criteria consisted of studies that included measurement of self-reported psychological stress, cortisol and assessed their associations with any infant-related outcome. Further limits included studies published in English or Spanish with human female participants. A meta-regression was not feasible due to differences in study samples, measurement tools employed, types of cortisol assessed and outcomes reported. A narrative synthesis was provided. 28 studies were eligible for inclusion. Convergent validity between self-report measures and cortisol was reported by three studies (range r = 0.12-0.41). Higher levels of self-report stress were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low anthropometric measures (birth length, head circumference, length of the neonate), poor infant neurodevelopment (cognitive development) and potentially pathogenic gut microbiota (Clostridiaceae Clostridium, Haemophilus) in six studies. Higher cortisol levels were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low infant birth weight, poor infant neurodevelopment (attention scores on the Network Neurobehavioral Scale) and low levels of potentially protective gut microbiota (Lactobacillus, Slackia and Actinobaculum) in 13 studies. Of the studies that assessed which type of measure was a better predictor of infant outcomes (n = 6), there was agreement that cortisol levels were statistically better at predicting adverse outcomes than self-reported stress. Self-report stress measures appear to be modest predictors of adverse infant outcomes in comparison to cortisol. A number of methodological limitations need to be addressed in future studies to help understand the relationship between cortisol and self-reported stress and how they are related to adverse infant outcomes.
Collapse
Affiliation(s)
- Rafael A Caparros-Gonzalez
- Faculty of Health Sciences, Department of Nursing, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Fiona Lynn
- Medical Biology Center, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | |
Collapse
|
20
|
Prenatal maternal transdiagnostic, RDoC-informed predictors of newborn neurobehavior: Differences by sex. Dev Psychopathol 2021; 33:1554-1565. [PMID: 33779535 PMCID: PMC8478962 DOI: 10.1017/s0954579420002266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We examined whether Research Domain Criteria (RDoC)-informed measures of prenatal stress predicted newborn neurobehavior and whether these effects differed by newborn sex. Multilevel, prenatal markers of prenatal stress were obtained from 162 pregnant women. Markers of the Negative Valence System included physiological functioning (respiratory sinus arrhythmia [RSA] and electrodermal [EDA] reactivity to a speech task, hair cortisol), self-reported stress (state anxiety, pregnancy-specific anxiety, daily stress, childhood trauma, economic hardship, and family resources), and interviewer-rated stress (episodic stress, chronic stress). Markers of the Arousal/Regulatory System included physiological functioning (baseline RSA, RSA, and EDA responses to infant cries) and self-reported affect intensity, urgency, emotion regulation strategies, and dispositional mindfulness. Newborns' arousal and attention were assessed via the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. Path analyses showed that high maternal episodic and daily stress, low economic hardship, few emotion regulation strategies, and high baseline RSA predicted female newborns' low attention; maternal mindfulness predicted female newborns' high arousal. As for male newborns, high episodic stress predicted low arousal, and high pregnancy-specific anxiety predicted high attention. Findings suggest that RDoC-informed markers of prenatal stress could aid detection of variance in newborn neurobehavioral outcomes within hours after birth. Implications for intergenerational transmission of risk for psychopathology are discussed.
Collapse
|
21
|
Andhavarapu M, Orwa J, Temmerman M, Musana JW. Maternal Sociodemographic Factors and Antenatal Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136812. [PMID: 34201920 PMCID: PMC8297233 DOI: 10.3390/ijerph18136812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/24/2022]
Abstract
Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone, and PSS score) was examined using univariate, bivariate and multivariate models. We found a negative association between PSS scores and household income (β = −2.40, p = 0.016, 95% CI = −4.36, −0.45). There was a positive association of the ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06, 1.22), and a negative association with Cohabitation (β = −1.21, p = 0.009, 95% CI = −2.11, −0.31). We conclude that household income influenced psychological stress in pregnancy. Adolescence and cohabitation may have an influence on biological stress, but the nature of this effect is unclear.
Collapse
Affiliation(s)
- Maheshwari Andhavarapu
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
- Correspondence: ; Tel.: +254-720-885527
| | - James Orwa
- Department of Population Health, The Aga Khan University, Nairobi 00100, Kenya;
| | - Marleen Temmerman
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
| | - Joseph Wangira Musana
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
| |
Collapse
|
22
|
Hair Cortisol Concentrations Are Associated with Dental Anxiety during Pregnancy. Dent J (Basel) 2021; 9:dj9040042. [PMID: 33920415 PMCID: PMC8069593 DOI: 10.3390/dj9040042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
Dental anxiety (DA) and hair cortisol concentrations (HCC) are associated with psychological symptoms and vary during pregnancy. We aimed to examine the association between HCC and DA at two points of pregnancy. Participants were pregnant mothers (n = 533) drawn from the FinnBrain Birth Cohort Study donating a hair sample at gestational week (gwk) 24 (n = 442) and/or at delivery (n = 176) and completed questionnaires on DA. Two groups, HCC1 and HCC2, treated as separate in the analyses, were formed according to the hair sample donation time i.e., gwk24 and delivery. 85 subjects were included in both groups. MDAS, EPDS, and SCL-90 were used to measure DA, depressive and anxiety symptoms, respectively, at gwk14 for the HCC1 group and gwk34 for the HCC2 group. The association between DA and HCC was studied with a binary logistic regression model, adjusted for anxiety and depressive symptoms, age, BMI, and smoking status. Individuals with high DA had lower HCC levels at gwk24 (OR = 0.548; 95% CI = 0.35–0.86; p = 0.009), but the association was not statistically significant at the delivery (OR = 0.611; 95% CI = 0.28–1.33; p = 0.216). The independent association between HCC and DA in pregnant women suggests that long-term cortisol levels could play a role in the endogenous etiology of DA. Further studies are however, needed.
Collapse
|
23
|
Marceau K, Rolan E, Robertson O, Wang W, Shirtcliff EA. Within-person changes of cortisol, dehydroepiandrosterone, testosterone, estradiol, and progesterone in hair across pregnancy, with comparison to a non-pregnant reference group. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 5. [PMID: 33778789 PMCID: PMC7990345 DOI: 10.1016/j.cpnec.2020.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The literature on hormone changes in pregnancy has focused largely on cortisol, and changes in sample average concentrations. Within-person changes and variability in hormone concentrations are less commonly reported, particularly for sex hormones, and especially measured in hair. Using a prospective sample of pregnant women and a non-pregnant comparison group, we examined changes in five steroid hormones in hair. Non-pregnant women were recruited from the same area with parallel procedures and assessment timeline. Participants include 68 women (34 pregnant, average age = 29.14, and 34 non-pregnant; average age = 27.18) who were predominately non-Hispanic White (83%), and above the 2020 poverty line (75%). Pregnant women provided 3 cm hair samples and completed questionnaires three times during pregnancy: 1) at 12 weeks, 2) at 26 weeks, and 3) at 38 weeks. Non-pregnant women provided 3 cm hair samples and completed questionnaires three times, at baseline, 14 weeks later, and 12 weeks after that to mirror the assessment schedule of the pregnant group. There was clear evidence that progesterone was higher initially and increased dramatically across pregnancy whereas non-pregnant patterns showed no systematic change. There was suggestive evidence that cortisol and estradiol increased over pregnancy and in non-pregnant women similarly across the same time course. There was suggestive evidence that DHEA decreased across pregnancy, particularly early in pregnancy, differently from patterns in non-pregnant women over the same time course. Most importantly, there was substantial variability of hormone concentrations and many different within-person patterns of changes in these hormones over time, with little evidence of systematic change or stability within-individuals. Moving beyond discussing sample averages to including within-person and non-linear changes in studies of hormones-behavior associations during pregnancy is an important future direction for further investigation. We describe within-person hormone changes in pregnant and non-pregnant women. There were many observed patterns of change over time within individuals. Average hair progesterone increased and DHEA decreased across early pregnancy. Average hair cortisol and estradiol weakly increased in both groups of women. There was far more variability over time than systematic change or stability.
Collapse
|
24
|
Maternal Prenatal Hair Cortisol Is Associated with Child Wheeze among Mothers and Infants with Tobacco Smoke Exposure and Who Face High Socioeconomic Adversity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052764. [PMID: 33803272 PMCID: PMC7967280 DOI: 10.3390/ijerph18052764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
The association of co-occurring prenatal stress and tobacco exposures on childhood wheezing and asthma are not well established. In this study, we compared maternal prenatal hair cortisol concentration (HCC) to the maternal report of infant wheezing (y/n) in the first year of life among mother-infant dyads exposed to tobacco smoke and socioeconomic adversity. Data were obtained from the Vitamin C to Decrease Effects of Smoking in Pregnancy on Infant Lung Function study. Maternal adversity was defined by the level of education, household income, and health insurance provider. Hair was collected at delivery, representing average circulating third-trimester cortisol levels. HCC was log transformed and dichotomized into high/low cortisol groups that were placed into a multivariate model predicting wheeze. Subjects (n = 132) were primarily White with ≤high school education and receiving government-provided health insurance. Forty-five percent of infants wheezed. Average HCC was 3.39 pg/mg hair. Women with HCC > 3.55 pg/mg were more than twice as likely to report having a child who wheezed (odds ratio 2.56, 95% confidence interval 1.22-5.40; p = 0.01), adjusting for insurance provider and maternal asthma. Among this sample of dyads with prenatal smoke exposure, elevated maternal HCC was associated with child wheeze that was not diminished after consideration of covariates.
Collapse
|
25
|
Epstein CM, Houfek JF, Rice MJ, Weiss SJ. Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy. J Obstet Gynecol Neonatal Nurs 2021; 50:242-255. [PMID: 33524324 DOI: 10.1016/j.jogn.2020.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesize published findings on the relationship between early life adversity and hypothalamic-pituitary-adrenal axis cortisol parameters in pregnant women. DATA SOURCES We searched PubMed, CINAHL, and PsycINFO databases using variants and combinations of the keywords early life adversity, pregnancy, hypothalamic-pituitary-adrenal axis, and cortisol. STUDY SELECTION We selected articles that included pregnant participants, included measures of cortisol and early life adversity, were published in English in a peer-reviewed journal, and were of sufficient methodologic quality. Date of publication was unrestricted through May 2020. DATA EXTRACTION Twenty-five articles met the inclusion criteria and were evaluated for quality and risk of bias. Sources of cortisol included saliva, hair, plasma, and amniotic fluid. DATA SYNTHESIS We categorized findings according to four physiologically distinct cortisol output parameters: diurnal (daily pattern), phasic (in response to an acute stressor), tonic (baseline level), and pregnancy-related change. Preliminary evidence suggests that early adversity may be associated with elevated cortisol awakening response (diurnal) and blunted response to acute stressors (phasic), irrespective of other psychosocial symptoms or current stress. For women with high levels of current stress or psychological symptoms, early adversity was associated with higher baseline (tonic) cortisol levels. CONCLUSION Early life adversity in women is linked with alterations in cortisol regulation that are apparent during pregnancy. Researchers should examine how variations in each cortisol parameter differentially predict pregnancy health risk behaviors, maternal mental health, and neonatal health outcomes.
Collapse
|
26
|
Broeks CW, Choenni V, Kok R, van der Voorn B, de Kruijff I, van den Akker ELT, van Rossum EFC, Hoogendijk WJG, Hillegers MHJ, Kamperman AM, Lambregtse-Van den Berg MP. An exploratory study of perinatal hair cortisol concentrations in mother-infant dyads with severe psychiatric disorders versus healthy controls. BJPsych Open 2021; 7:e28. [PMID: 33407971 PMCID: PMC8058941 DOI: 10.1192/bjo.2020.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal psychopathology during pregnancy is associated with negative outcomes in offspring. Increased placental transfer of maternal cortisol may contribute to mediate this association. Hair cortisol concentrations (HCCs) appear to be a good biomarker of long-term prenatal stress exposure. Little is known about the associations between severe maternal psychopathology and perinatal infant HCCs. AIMS We assessed HCCs in the perinatal period in mother-infant dyads with and without severe psychiatric disorders. METHOD We examined group differences in HCCs of mother-infant dyads (n = 18) subjected to severe maternal psychiatric disorders versus healthy control dyads (n = 27). We assessed the correlation of HCCs between mother and infant within both groups, and the association between current maternal symptoms and HCCs in patient dyads. RESULTS Median (interquartile range) and distribution of HCC differed in patients compared with control mothers (U = 468.5, P = 0.03). HCCs in infants of patients did not differ from control infants (U = 250.0, P = 0.67). Subsequently, we found that HCCs within healthy control dyads were correlated (n = 27, r 0.55 (0.14), P = 0.003), but were not within patient dyads (n = 18, r 0.082 (0.13), P = 0.746). HCCs in infants of patients showed a positive correlation with maternal symptoms (n = 16, r = 0.63 (0.06), P = 0.008). CONCLUSIONS These preliminary findings suggest that infant HCC reflect perinatal stress exposure. In infants, these early differences could influence lifetime hypothalamic-pituitary-adrenal axis functioning, which might be associated with increased susceptibility to later disease.
Collapse
Affiliation(s)
- Carlinde W Broeks
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Department of Psychiatry, Arkin Institute for Mental Health, the Netherlands
| | - Vandhana Choenni
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
| | - Rianne Kok
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Bibian van der Voorn
- Department of Pediatric Endocrinology, Obesity Center CGG, Erasmus MC-Sophia Children's Hospital, the Netherlands; and Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | - Ineke de Kruijff
- Department of Pediatrics, St Antonius Hospital Nieuwegein, the Netherlands
| | | | - Elisabeth F C van Rossum
- Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | | | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, the Netherlands
| | - Mijke P Lambregtse-Van den Berg
- Department of Psychiatry, Erasmus University Medical Center, the Netherlands; and Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, the Netherlands
| |
Collapse
|
27
|
Marceau K, Wang W, Robertson O, Shirtcliff EA. A systematic review of hair cortisol during pregnancy: Reference ranges and methodological considerations. Psychoneuroendocrinology 2020; 122:104904. [PMID: 33080521 PMCID: PMC8634732 DOI: 10.1016/j.psyneuen.2020.104904] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/24/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
The present study systematically reviewed 56 articles that assessed hair cortisol concentrations during pregnancy collected from PubMed, Scopus, and Web of Science on 8/9/19 and updated on 6/29/20. Our goals were to establish reference ranges by trimester based on published studies. The majority of any given sample (e.g., 70 %, the range of -1SD to +1SD) is expected to fall between 0 and 34.15 pg/mg in trimester 1 and 2, and between 8.59 and 44 pg/mg in trimester 3, with very wide ranges (e.g., values of >250 pg/mg) and substantially higher values (e.g., averages of 200's-300's reaching as high as 768 pg/mg) coming out of one specific lab. Delineating a reference range for hair cortisol concentrations across pregnancy is challenging because of known factors like differences in values returned by different laboratories and assay types. We observed inconsistency in descriptions of the data and data preparation steps post-assay. Key findings include that only half of the studies examining all three trimesters showed a constant increase in mean levels (most retrospectively assessed via segmenting), with considerable variability in patterns of change. None of the studies reported individual patterns of change. Examining within-person changes are an important next step for the field. We conclude that researchers should more clearly report decisions around outliers, units, and specifics of data transformations in the future in order to improve our ability to compare findings across studies, to understand differences in HCC values reported, and potentially to understand differences in reported associations of HCC with other phenotypes in the literature.
Collapse
|
28
|
Meyer JS, Novak MA. Assessment of prenatal stress-related cortisol exposure: focus on cortisol accumulation in hair and nails. Dev Psychobiol 2020; 63:409-436. [PMID: 32783213 DOI: 10.1002/dev.22021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/02/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
Prenatal stress adversely affects offspring development. Although cortisol is hypothesized to be a key mediator of stress-induced developmental deficits, determining the amount of fetal cortisol exposure produced by maternal stress has proved challenging. Current approaches, such as measuring cortisol concentrations in maternal plasma, saliva, or urine, amniotic fluid, fetal plasma, or cord blood, all have significant limitations for assessing cumulative fetal cortisol exposure over time. A recently emerging approach is to measure cortisol concentrations in maternal hair and/or newborn hair or nail samples. Maternal hair cortisol potentially shows long-term production across each trimester of pregnancy, whereas neonatal hair or nail cortisol is thought to reflect mainly third trimester hormone accumulation. This review first describes fetal adrenocortical development, placental cortisol metabolism, and the various sources of fetal cortisol exposure across pregnancy. We then summarize the results obtained from "classical" methods of assessing prenatal cortisol exposure prior to the advent of hair and nail cortisol measurement. Lastly, we discuss the initial development and validation of the hair cortisol methodology, its subsequent application to studies of chronic stress, and recent findings regarding maternal and neonatal hair or nail cortisol concentrations in relation to prenatal stress and other variables of interest.
Collapse
Affiliation(s)
- Jerrold S Meyer
- Department of Psychological and Brain Sciences, Neuroscience and Behavior Program, University of Massachusetts, Amherst, MA, USA
| | - Melinda A Novak
- Department of Psychological and Brain Sciences, Neuroscience and Behavior Program, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
29
|
Hair Cortisol Concentrations as a Biological Marker of Maternal Prenatal Stress: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114002. [PMID: 32512943 PMCID: PMC7313007 DOI: 10.3390/ijerph17114002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
Recently, biological markers of maternal prenatal stress, hair cortisol, along with saliva, blood, and urine cortisol, have received attention. However, it is necessary to validate measuring hair cortisol concentrations (HCC) as a biomarker of perceived stress among healthy and high-risk pregnant women. This study aimed to confirm the correlation between HCC and the perceived stress of pregnant women over 18 years of age. In this systematic review, we used various search engines to extract relevant articles using specific keywords related to pregnancy, hair cortisol, and psychological stress. Four out of 3639 studies met the inclusion criteria. We conducted a quality assessment with the help of three independent reviewers using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The correlation between HCC and perceived stress was confirmed in one study. There was only one study on hair washing, shampoo, conditioner, and hair structure that could affect hair samples. In four studies, hair samples differed in length, methods of storage, and laboratory analysis. The review was limited to confirming the relationship between HCC and perceived stress in pregnant women based on the current evidence. Studies on hair cortisol need regulated and standardized methods for collection, storage, and analysis of hair samples.
Collapse
|
30
|
Conradt E, Shakiba N, Ostlund B, Terrell S, Kaliush P, Shakib JH, Crowell SE. Prenatal maternal hair cortisol concentrations are related to maternal prenatal emotion dysregulation but not neurodevelopmental or birth outcomes. Dev Psychobiol 2020; 62:758-767. [PMID: 32002996 DOI: 10.1002/dev.21952] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/18/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
Hair cortisol concentrations measured during pregnancy have emerged as a novel biomarker for prenatal stress exposure. However, associations between prenatal stress and distress, broadly defined, and hair cortisol concentrations during pregnancy are inconsistent. We examined relations among hair cortisol concentrations during the third trimester with (a) emotion dysregulation and (b) detailed measures of maternal prenatal stress. We also examined the predictive validity of maternal hair cortisol during pregnancy for adverse newborn health outcomes. Cortisol concentrations were derived from 6 cm of hair during the third trimester of pregnancy. Mothers reported on their emotion dysregulation and stress at this time. A standardized newborn neurobehavioral exam was conducted shortly after birth and newborn birth weight and gestational age were assessed from medical records. All hypotheses were preregistered on the Open Science Framework (osf.io/279ng). High levels of emotion dysregulation, but not stress, were predictive of high hair cortisol concentrations. Maternal prenatal BMI mediated the relation between maternal prenatal emotion dysregulation and hair cortisol concentrations. There was no association between hair cortisol and infant birth outcomes. This research supports the notion that transdiagnostic markers of psychopathology are important correlates of hair cortisol concentrations during pregnancy.
Collapse
Affiliation(s)
- Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brendan Ostlund
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Parisa Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
31
|
Salomon RE, Tan KR, Vaughan A, Adynski H, Muscatell KA. Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review. Int J Nurs Stud 2020; 103:103419. [PMID: 31945603 DOI: 10.1016/j.ijnurstu.2019.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations. OBJECTIVE To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress. DESIGN, DATA SOURCES, AND METHODS The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded. RESULTS Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors. CONCLUSIONS Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.
Collapse
Affiliation(s)
- Rebecca E Salomon
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kelly R Tan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Ashley Vaughan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Harry Adynski
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box #3270, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Campus Box #7295, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
| |
Collapse
|
32
|
Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production. Adv Neonatal Care 2019; 19:E11-E20. [PMID: 31764138 DOI: 10.1097/anc.0000000000000660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several factors can influence the production of mothers' own milk. PURPOSE To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. METHODS A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. RESULTS Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). IMPLICATIONS FOR RESEARCH Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. IMPLICATIONS FOR PRACTICE Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.
Collapse
|
33
|
Prenatal and Postnatal Hair Steroid Levels Predict Post-Partum Depression 12 Weeks after Delivery. J Clin Med 2019; 8:jcm8091290. [PMID: 31450789 PMCID: PMC6780455 DOI: 10.3390/jcm8091290] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Within three to six months after delivery, 13%–19% of women suffer from post-partum depression (PPD), understood as a dysfunctional adaptation to the postpartum condition and motherhood. In the present cross-sectional study, we compared the hair steroid levels of women 12 weeks before and after delivery and with or without PPD. Method: The present study was a cross-sectional study conducted twelve weeks after delivery. At that time, 48 women (mean age: 25.9 years) with PPD and 50 healthy controls (mean age: 25.2 years) completed questionnaires on depressive symptoms. Further, at the same time point, 6 cm lengths of hair strands were taken, providing samples of hair steroids 12 weeks before and 12 weeks after delivery in order to analyze hair steroids (cortisol, cortisone, progesterone, testosterone, and dehydroepiandrosterone (DHEA)). Results: Compared to those of women without PPD, hair steroid levels (cortisol, cortisone, progesterone) were significantly lower in women with PPD both before and after delivery. Lower prenatal cortisone and progesterone levels predicted higher depression scores 12 weeks after delivery. Lower prenatal levels of cortisol and progesterone and higher levels of DHEA, and postnatal lower levels of cortisol, cortisone, and progesterone, along with higher levels of DHEA predicted PPD-status with an accuracy of 98%. Conclusions: PPD is associated with blunted hair cortisol, cortisone, and progesterone secretions both pre- and postpartum. Such blunted steroid levels appear to reflect a stress responsivity that is less adaptive to acute and transient stressors. It follows that prenatally assessed low hair cortisol and progesterone levels, along with high DHEA levels, are reliable biomarkers of post-partum depression 12 weeks after delivery.
Collapse
|