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Stoye DQ, Boardman JP, Osmond C, Sullivan G, Lamb G, Black GS, Homer NZM, Nelson N, Theodorsson E, Mörelius E, Reynolds RM. Saliva cortisol diurnal variation and stress responses in term and preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:558-564. [PMID: 35256524 PMCID: PMC9411886 DOI: 10.1136/archdischild-2021-321593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/11/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine if preterm birth is associated with adaptation of the hypothalamic-pituitary-adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at <28 weeks or very preterm birth at 28-32 weeks gestation). DESIGN This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age. SETTING Infants born at a single Scottish hospital. PARTICIPANTS 45 term-born, 42 very preterm and 16 extremely preterm infants. OUTCOMES Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) and mean log-transformed daily cortisol. RESULTS Compared with infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8 nmol/L vs 13.1 nmol/L, difference in means: -7.3 nmol/L, 95% CI -14.0 to -0.6) and a flattened diurnal slope (difference in geometric means: -72.9%, 95% CI -87.1 to -42.8). In contrast, the cortisol response to vaccination (difference in means -2.7 nmol/L, 95% CI -7.4 to 2.0) and diurnal slope at 4 months (difference in geometric means: -33.6%, 95% CI -62.0 to 16.0) did not differ significantly in infants born very preterm compared with infants born at term. CONCLUSIONS Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity and could contribute to later metabolic and neurodevelopmental phenotypes observed in this population.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gillian Lamb
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Natalie Z M Homer
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Nina Nelson
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linkoping, Sweden
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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Stoye DQ, Boardman JP, Osmond C, Sullivan G, Lamb G, Black GS, Homer NZ, Nelson N, Theodorsson E, Reynolds RM, Mörelius E. Preterm birth and infant diurnal cortisol regulation. Arch Dis Child Fetal Neonatal Ed 2022; 107:565-567. [PMID: 35288450 DOI: 10.1136/archdischild-2021-323296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal (HPA) axis adaptation is a potential mechanism linking early life exposures with later adverse health. This study tested the hypothesis that preterm birth is associated with adaptation of diurnal cortisol regulation across infancy. METHODS A secondary analysis was conducted of saliva cortisol measured morning, midday and evening, monthly, across infancy, as part of a birth cohort conducted in Linköping, Sweden. Diurnal cortisol regulation of infants born extremely preterm (n=24), very preterm (n=27) and at term (n=130) were compared across infancy through random coefficients regression models. RESULTS Compared with infants born at term, infants born extremely preterm (-17.2%, 95% CI: -30.7 to -1.2), but not very preterm (1.7%, 95% CI: -14.1 to 20.4), had a flattened diurnal slope across infancy. CONCLUSIONS Extremely preterm birth is associated with a flattened diurnal slope in infancy. This pattern of cortisol regulation could contribute to adverse metabolic and neurodevelopmental phenotypes observed in this population.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, Southampton, Southampton, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gillian Lamb
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Natalie Zm Homer
- Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nina Nelson
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linkopings universitet, Linkoping, Sweden
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Stoye DQ, Sullivan G, Galdi P, Kirschbaum C, Lamb GJ, Black GS, Evans MJ, Boardman JP, Reynolds RM. Perinatal determinants of neonatal hair glucocorticoid concentrations. Psychoneuroendocrinology 2021; 128:105223. [PMID: 33878601 PMCID: PMC8155393 DOI: 10.1016/j.psyneuen.2021.105223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
Adult hair glucocorticoid concentrations reflect months of hypothalamic-pituitary-adrenal axis activity. However, little is known about the determinants of neonatal hair glucocorticoids. We tested associations between perinatal exposures and neonatal hair glucocorticoids. Cortisol and cortisone were measured by LC-MS/MS in paired maternal and infant hair samples collected within 10 days of birth (n = 49 term, n = 47 preterm), with neonatal samples collected at 6-weeks in n = 54 preterm infants. We demonstrate cortisol accumulation in hair increases with fetal maturity, with hair cortisol being higher in term than preterm born infants after delivery (median 401 vs 106 pg/mg; p < 0.001). In term born infants, neonatal hair cortisol is positively associated with maternal hair cortisol concentration (β = 0.240, p = 0.045) and negatively associated with birthweight z-score (β = -0.340, p = 0.006). Additionally, being born without maternal labour is associated with lower hair cortisol concentrations (β = -0.489, p < 0.001) and a lower ratio of cortisol to cortisone (β = -0.484, p = 0.001). In preterm infants, histological chorioamnionitis is associated with a higher cortisol to cortisone ratio in hair (β = 0.459, p = 0.001). In samples collected 6 weeks after preterm birth, hair cortisol concentration is associated with cortisol hair concentrations measured after birth (β = 0.523, p < 0.001), chorioamnionitis (β = 0.250, p = 0.049) and postnatal exposures including intravenous hydrocortisone therapy (β = 0.343, p < 0.007) and neonatal sepsis (β = 0.290, p = 0.017). In summary, neonatal hair cortisol is associated with birth gestation, maternal hair cortisol concentration and fetal growth. Additionally, exposures at delivery are important determinants of hair cortisol, and should be considered in the design of future research investigating how neonatal hair cortisol relates to prenatal exposures or fetal development.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Paola Galdi
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Gillian J Lamb
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Margaret J Evans
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Cardiovascular Science, University of Edinburgh, UK.
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Stoye DQ, Blesa M, Sullivan G, Galdi P, Lamb GJ, Black GS, Quigley AJ, Thrippleton MJ, Bastin ME, Reynolds RM, Boardman JP. Maternal cortisol is associated with neonatal amygdala microstructure and connectivity in a sexually dimorphic manner. eLife 2020; 9:60729. [PMID: 33228850 PMCID: PMC7685701 DOI: 10.7554/elife.60729] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/25/2020] [Indexed: 12/21/2022] Open
Abstract
The mechanisms linking maternal stress in pregnancy with infant neurodevelopment in a sexually dimorphic manner are poorly understood. We tested the hypothesis that maternal hypothalamic-pituitary-adrenal axis activity, measured by hair cortisol concentration (HCC), is associated with microstructure, structural connectivity, and volume of the infant amygdala. In 78 mother-infant dyads, maternal hair was sampled postnatally, and infants underwent magnetic resonance imaging at term-equivalent age. We found a relationship between maternal HCC and amygdala development that differed according to infant sex. Higher HCC was associated with higher left amygdala fractional anisotropy (β = 0.677, p=0.010), lower left amygdala orientation dispersion index (β = −0.597, p=0.034), and higher fractional anisotropy in connections between the right amygdala and putamen (β = 0.475, p=0.007) in girls compared to boys. Furthermore, altered amygdala microstructure was only observed in boys, with connectivity changes restricted to girls. Maternal cortisol during pregnancy is related to newborn amygdala architecture and connectivity in a sexually dimorphic manner. Given the fundamental role of the amygdala in the emergence of emotion regulation, these findings offer new insights into mechanisms linking maternal health with neuropsychiatric outcomes of children. Stress during pregnancy, for example because of mental or physical disorders, can have long-term effects on child development. Epidemiological studies have shown that individuals exposed to stress in the womb are at higher risk of developmental and mood conditions, such as ADHD and depression. This effect is different between the sexes, and the biological mechanisms that underpin these observations are poorly understood. One possibility is that a baby’s developing amygdala, the part of the brain that processes emotions, is affected by a signal known as cortisol. This hormone is best known for its role in coordinating the stress response, but it also directs the growth of a fetus. Tracking fetal amygdala changes as well as cortisol levels in the pregnant individual could explain how stress during pregnancy affects development. To investigate, Stoye et al. recruited nearly 80 volunteers and their newborn children. MRI scans were used to examine the structure of the amygdala, and how it is connected to other parts of the brain. In parallel, the amount of cortisol was measured in hair samples collected from the volunteers around the time of birth, which reflects stress levels during the final three months of pregnancy. Linking the brain imaging results to the volunteers’ cortisol levels showed that being exposed to higher cortisol levels in the womb affected babies in different ways based on their sex: boys showed alterations in the fine structure of their amygdala, while girls displayed changes in the way that brain region connected to other neural networks. The work by Stoye et al. potentially reveals a biological mechanism by which early exposure to stress could affect brain development differently between the sexes, potentially informing real-world interventions.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Manuel Blesa
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Paola Galdi
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian J Lamb
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Gill S Black
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan J Quigley
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Black GS. Dentists' prescribing--some questions asked. SADJ 2012; 67:466-467. [PMID: 23951813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Stratmann WC, Zastowny TR, Bayer LR, Adams EH, Black GS, Fry PA. Patient satisfaction surveys and multicollinearity. Qual Manag Health Care 1994; 2:1-12. [PMID: 10133363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The measurement of patient satisfaction is now an integral part of hospital market research. Just as consumer satisfaction is a function of the extent to which providers do things right, the value of consumer-oriented market research is directly related to whether the research itself is done right. The use of poorly designed consumer research instruments, no matter how well executed, can cause multicollinearity among the independent variables, which, in turn, can result in misleading conclusions.
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Black GS, Zastowny TR, Green PJ, Adams EH, Lawton KB. The consistency of estimates obtained through central-location sampling: analysis of the Partnership for a Drug-Free America Attitude Tracking Study. Am J Drug Alcohol Abuse 1994; 20:199-222. [PMID: 8042603 DOI: 10.3109/00952999409106782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To evaluate the reliability and validity of estimates of drug use obtained through multiple-site central-location sampling, data from the Partnership Attitude Tracking Study (PATS), collected annually beginning in 1987, are tracked longitudinally and compared with data collected through traditional household interviews. Comparisons with demographic estimates from Current Population Surveys indicate that central-location sampling can provide a broadly representative sample of the adult population. However, there is some coverage bias in central-location sampling, most notably in the underrepresentation of adults who do not have high school diplomas. Sample estimates obtained from central-location sampling are consistent over time. Basic demographic characteristics of the samples--education, income, marital status, and area of residence--vary by less than 5% across the four waves of the tracking study. Prevalence estimates of self-reported drug use demonstrate an even higher degree of consistency over time. Comparisons of PATS and National Household Survey of Drug Abuse data and the Monitoring the Future data indicate a higher level of drug use and a lower level of perceived risk of occasional use among PATS respondents. While the trends in use and perceived risk reported in all studies are similar, we suggest that perceived threats to confidentiality and anonymity often result in significant underreporting of drug use, particularly in household surveys. Sample estimate differences are attributed to sampling and measurement error. Some discrepancy in prevalence estimates is associated with the fact that the PATS sample is not a true probability sample; as a result, the sampling error of the overall study cannot be estimated precisely. It is also likely that the difference in estimates between the studies is a product of the decreased measurement error of PATS methodology. In central-location sampling, respondents are completely anonymous and may feel more comfortable in providing honest answers about illicit activities such as drug use. The potential applications of this methodology are discussed.
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Affiliation(s)
- G S Black
- Gordon S. Black Corporation, Rochester, New York 14623-1457
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Zastowny TR, Adams EH, Black GS, Lawton KB, Wilder AL. Sociodemographic and attitudinal correlates of alcohol and other drug use among children and adolescents: analysis of a large-scale attitude tracking study. J Psychoactive Drugs 1993; 25:223-37. [PMID: 8258760 DOI: 10.1080/02791072.1993.10472273] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data from the Partnership Attitude Tracking Study are analyzed to provide a greater understanding of the contributing factors to alcohol and other drug use among children and adolescents. The data were collected from children (ages 9 to 12) and teenagers (ages 13 to 17) in central locations (usually shopping malls) located in 100 primary sampling units across the United States. The analysis, which primarily employed stepwise multiple regression for model estimation, reinforced the importance of friends use, perceived risk, and tobacco and alcohol use in predicting marijuana use. An exposure model, which included antidrug advertisements, was a particularly powerful model. Implications of the findings are discussed.
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Affiliation(s)
- T R Zastowny
- University of Rochester, Department of Psychiatry, New York
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Black GS. A double blind cross-over study of a slow release aminophylline tablet (Phyllocontin Continus tablets) as a concomitant therapy in patients with chronic bronchitis on salbutamol maintenance therapy. Br J Clin Pract 1980; 34:175-7, 81. [PMID: 7002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hart WT, Black GS, Resnick H. Emotional disturbances. Use of medication. N Y State J Med 1978; 78:19-23. [PMID: 272494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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