Prenatal stress and hair cortisol in a sample of Latina women

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.

Pregnancy anxiety, placental corticotropin-releasing hormone and length of gestation

OBJECTIVE

High pregnancy anxiety is a consistent predictor of earlier labor and delivery. Placental corticotropin-releasing hormone (pCRH) predicts earlier delivery consistently and it has been identified as a biological mediator of the association between pregnancy anxiety and gestational length. However, studies have not examined whether changes in pregnancy anxiety are associated with earlier birth as mediated by changes in pCRH during pregnancy. Accordingly, this study tests whether linear changes in pregnancy anxiety are associated with length of gestation indirectly through nonlinear increases in pCRH over pregnancy.

METHODS

A sample of pregnant women (n=233) completed prenatal assessments in early pregnancy, second trimester, and third trimester that included a 4-item assessment of pregnancy anxiety and collection of blood samples assayed for pCRH using radioimmunoassay. Length of gestation was abstracted from medical records after birth.

RESULTS

Increases in pregnancy anxiety from early pregnancy to third trimester predicted shorted length of gestation, as did nonlinear increases in pCRH over pregnancy. However, there was no evidence of an indirect effect of changes in pregnancy anxiety on length of gestation via changes in pCRH.

CONCLUSIONS

These results indicate that linear changes in pregnancy anxiety and nonlinear changes in pCRH during pregnancy are independent risk factors for shortened gestational length. This study adds to a small but growing body of work on biopsychological processes in pregnancy and length of gestation. Modeling changes in psychological and biological processes during pregnancy could provide more insight into understanding risk for adverse pregnancy outcomes.

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

ISSUE

Fear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.

AIM

To conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.

METHODS

A meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.

FINDINGS

One overarching theme "Ownership of Childbirth" and three analytical themes "Facing the fear", "Feeling empowered", "Managing the fear with a sense of security" were generated through the synthesis. There were no studies outside of Scandinavia located.

DISCUSSION

This meta-synthesis provides a new way to describe the process of moving from fear to "Ownership of childbirth". The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.

CONCLUSION

These findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.

Pregnancy anxiety in expectant mothers predicts offspring negative affect: The moderating role of acculturation

BACKGROUND

Pregnancy anxiety predicts adverse developmental outcomes in offspring from infancy through late childhood, but studies have not examined associations with outcomes in early childhood, nor clarified ethnic or cultural variations in these processes.

AIMS

(1) To examine differences in pregnancy anxiety and related concerns between non-Hispanic White women, Latina women who prefer to speak in English, and Latinas who prefer Spanish; (2) To test prospective associations between pregnancy anxiety and child negative affect and moderation by ethnicity and language preference, used as a proxy for acculturation.

STUDY DESIGN AND METHODS

This longitudinal study included 95 women (40 Non-Hispanic Whites, 31 Spanish-preference Latinas, and 24 English-preference Latinas). Language preference was provided at study entry. Pregnancy anxiety was assessed in the second and third trimesters of pregnancy with two standardized measures. Mothers reported child negative affect at age 4.

RESULTS

Spanish-preference Latinas had significantly more pregnancy-related anxiety about their health and safety in childbirth and concerning the medical system compared to English-preference Latinas and non-Hispanic White women. Adjusting for covariates, pregnancy anxiety in the second trimester, though not the third trimester, predicted significantly higher child negative affect in the full sample. A significant moderation effect indicated that the association was strongest among the lower acculturated Latinas, i.e., those who preferred Spanish.

CONCLUSION

These results document higher risk for offspring associated with pregnancy anxiety in the second trimester especially among less acculturated Latina women, and suggest the need for culturally-sensitive screening tools and interventions to improve outcomes for Latina mothers and their children.

Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study

Background

Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound.

Methods

We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA.

Results

Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one.

Conclusions

Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Newborn genome-wide DNA methylation in association with pregnancy anxiety reveals a potential role for GABBR1

BACKGROUND

There is increasing evidence for the role of prenatal stress in shaping offspring DNA methylation and disease susceptibility. In the current study, we aimed to identify genes and pathways associated with pregnancy anxiety using a genome-wide DNA methylation approach.

METHODS

We selected 22 versus 23 newborns from our Prenatal Early Life Stress (PELS) cohort, exposed to the lowest or highest degree of maternal pregnancy anxiety, respectively. Cord blood genome-wide DNA methylation was assayed using the HumanMethylation450 BeadChip (HM450, n = 45) and candidate gene methylation using EpiTYPER (n = 80). Cortisol levels were measured at 2, 4, and 12 months of age to test infant stress system (re)activity.

RESULTS

Data showed ten differentially methylated regions (DMR) when comparing newborns exposed to low versus high pregnancy anxiety scores. We validated a top DMR in the GABA-B receptor subunit 1 gene (GABBR1) revealing the association with pregnancy anxiety particularly in male newborns (most significant CpG Pearson R = 0.517, p = 0.002; average methylation Pearson R = 0.332, p = 0.039). Cord blood GABBR1 methylation was associated with infant cortisol levels in response to a routine vaccination at 4 months old.

CONCLUSIONS

In conclusion, our results show that pregnancy anxiety is associated with differential DNA methylation patterns in newborns and that our candidate gene GABBR1 is associated with infant hypothalamic-pituitary-adrenal axis response to a stressor. Our findings reveal a potential role for GABBR1 methylation in association with stress and provide grounds for further research.

Cytokine profile and maternal depression and anxiety symptoms in mid-pregnancy-the FinnBrain Birth Cohort Study

Maternal prenatal psychological symptoms are associated with child health outcomes, e.g., atopic diseases. Altered prenatal functioning of the immune system is a potential mechanism linking maternal symptoms with child health. Research on prenatal distress and cytokines is warranted. The study population comprised consecutive N = 139 women from a general population-based FinnBrain Birth Cohort Study. Standardized questionnaires for depressive, overall anxiety, and pregnancy-related anxiety symptoms were used. Serum concentrations of selected cytokines were analyzed using Multiplex bead arrays from samples drawn at the gestational week 24. The concentrations of T helper (Th)2-related interleukins (IL)-9 and IL-13 and Th1-related IL-12 correlated positively with prenatal depressive and overall anxiety symptom scores (p values, range 0.011-0.029). Higher interferon (IFN)-γ/IL-4 ratio (p = 0.039) and Th2-related IL-5 (p = 0.007) concentration correlated positively with depressive symptoms. Pregnancy-related anxiety score correlated positively with IL-12 (p = 0.041), IL-13 (p = 0.025), and anti-inflammatory IL-10 (p = 0.048) concentrations. IL-6 and TNF-α concentrations were unrelated to prenatal symptoms. As a novel finding, we observed positive correlations between concentrations of potentially proallergenic cytokines and maternal prenatal psychological symptoms. Different symptom measures may yield distinct cytokine responses. This provides hypotheses for studies on mechanisms bridging prenatal stress and child health.

Certain Less Invasive Infertility Treatments Associated with Different Levels of Pregnancy-Related Anxiety in Pregnancies Conceived via In Vitro Fertilization

BACKGROUND

Research supports that in vitro fertilization causes anxiety and that anxiety can continue into the resulting pregnancy. Most women who have IVF will have a less invasive treatment for infertility prior to IVF; however, it is unclear if specific less invasive treatment cycles impact anxiety that is experienced in the pregnancy resulting from IVF.

METHODS

A prospective study was conducted for women who became pregnant via IVF, and data was collected about reported previous non-IVF treatment cycles as well as Pregnancy Related Anxiety Measure. Latent Class Analysis was conducted A p-value of ≤0.05 was considered significant.

RESULTS

144 subjects participated and were highly educated, affluent, married, and primarily white. The LCA process yielded two groups that on average had similar levels on most items except for use of intra uterine insemination and/or ovarian stimulation. This information was used to generate four exhaustive and mutually exclusive groups: Stimulation Only (stim-only), Stimulation and Intra uterine Insemination (stim-IUI), Intra uterine Insemination only (IUI only), or No Treatment (No Tx). ANOVA found that those in the Stim Only group had statistically significantly higher PRAM scores than the Stim IUI (p=0.0036), the IUI only group (p=0.05), and the No Tx group (p=0.0013).

CONCLUSION

Women who become pregnant via IVF and had a history of non-in vitro fertilization cycles that only involved ovarian stimulation experienced more pregnancy-specific anxiety in the pregnancy that results from in vitro fertilization.

From prenatal anxiety to parenting stress: a longitudinal study

The objective of this study was to explore how maternal mood during pregnancy, i.e., general anxiety, pregnancy-specific anxiety, and depression predicted parenting stress 3 months after giving birth, thereby shaping the child's early postnatal environmental circumstances. To this end, data were used from 1073 women participating in the Dutch longitudinal cohort Generations², which studies first-time pregnant mothers during pregnancy and across the transition to parenthood. Women filled out the State Trait Anxiety Inventory (STAI), Pregnancy-Related Anxiety Questionnaire-revised (PRAQ-R), and Beck Depression Index (BDI) three times during pregnancy: at 12, 22, and 32 weeks gestational age. Three months postpartum, a parenting stress questionnaire was filled out yielding seven different parenting constructs. Latent scores were computed for each of the repeatedly measured maternal mood variables with Mplus and parenting stress constructs were simultaneously regressed on these latent scores. Results showed that trait anxiety and pregnancy-specific anxiety were uniquely related to almost all parenting stress constructs, taking depression into account. Early prevention and intervention to reduce maternal anxiety in pregnancy could hold the key for a more advantageous trajectory of early postnatal parenting.

Pregnancy anxiety and prenatal cortisol trajectories

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 and 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy anxiety over gestation, nor pregnancy anxiety specific to only a particular time in pregnancy predicted cortisol. These findings provide support for one way in which pregnancy anxiety may influence maternal physiology and contribute to a growing literature on the complex biological pathways linking pregnancy anxiety to birth and infant outcomes.