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The rate of preterm birth in the United States remains high. In up to 40% of cases of preterm birth, the mothers are healthy women who have no clear risk factors. Accordingly, research has begun to explore the effect of prenatal stress on the risk of preterm birth and shortened gestational age at birth. There is increasing evidence that psychosocial stress throughout gestation increases the risk of preterm birth through changes in maternal endocrine, immune, and inflammatory activity during pregnancy. In this article, I describe foundational and current research examining the effects and biological mechanisms of prenatal stress in preterm birth and shortened gestational age at birth. I emphasize psychoneuroimmunology-focused studies showing that prenatal stress alters inflammatory and endocrine markers during gestation and that these changes are associated with preterm birth and shortened gestational age at birth.
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... A majority of studies administered the full 17-item version of the NuPDQ. A small number of studies used the earlier version, which, as explained above, had three forms for administration in early, mid-, and late pregnancy (e.g., Coussons-Read et al., 2012;Woods-Giscombé et al., 2010). ...
... This question is best answered with evidence from studies using the NuPDQ, as the PDQ was designed for use during mid-pregnancy only and does not include items that are more relevant in early or late pregnancy, although a few studies have administered the PDQ repeatedly, finding either stability in PSS or a decline over the course of pregnancy (e.g., Gennaro et al., 2008;Levine et al., 2017). Seven studies administering the NuPDQ repeatedly found declines in total scores over pregnancy [Cole-Lewis et al., 2014;Coussons-Read et al., 2012;Gillespie et al., 2018 (only for multiparas); Hamilton Lobel, Cannella, et al., 2008;Lobel, Hamilton, et al., 2008;Staneva et al., 2017;Woods-Giscombé et al., 2010 (only for women without previous miscarriage)]. However, total scores are not as informative as item or subscale scores for investigating changes in PSS, because some sources of stress are likely to recede as pregnancy advances (e.g., nausea and vomiting, which usually subside by mid-pregnancy), while stress from other sources (e.g., concerns about labor and delivery) may increase. ...
... Although a number of scholars posit that women's behaviors are an important causal pathway, we currently have little evidence to substantiate this. Neuroendocrine, immunological, cardiovascular, and metabolic mechanisms linking PSS to birth outcomes have been relatively betterdocumented (e.g., Christian, 2012;Coussons-Read, 2012), but these are likely to operate in conjunction with important behaviors such as eating, substance use, sleep, and physical exercise. ...
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Pregnancy-specific stress (PSS) arises from the numerous changes that women experience during pregnancy and from their concerns about childbirth and the health of their offspring. Prolonged or elevated maternal stress heightens risk for poor fetal, infant, and child outcomes. The Prenatal Distress Questionnaire (PDQ) and its expanded successor, the revised Prenatal Distress Questionnaire (NuPDQ), were developed to assess PSS, but their psychometric properties and findings are not well-documented. We reviewed research using the PDQ (n = 45) or NuPDQ (n = 37). Results establish that PSS as measured by these instruments is common in pregnancy; PSS is associated with sociodemographic and obstetric characteristics, perceptions of pregnancy, health behaviors, maternal health, and birth outcomes. The NuPDQ is an especially appropriate tool to assess PSS, with demonstrated reliability and convergent, concurrent, and predictive validity. The ability to assess PSS in a reliable and valid manner is critical to advance research and improve maternal and child health.
... The significance of adversely affected perinatal maternal mental health as a potential risk factor for infant development has been emphasized (17). Prenatal stress affects the development of fetal systems (14,15,(18)(19)(20)(21). These fetal systems are also potentially related factors and causes of neuropsychiatric disorders (depression, anxiety, behavioral dysfunction, attention-deficit hyperactivity disorder, autism spectrum disorder) in children (21). ...
... There is evidence that maternal stress impacts fetal central and autonomic nervous system function (ANS) (15) and both maternal hypothalamic-pituitary-adrenocortical axis (HPA) activity and fetal HPA development (19,20). The early structures of the developing limbic system (e.g., amygdala and hippocampus) may also be influenced by the maternal stress (21). ...
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This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.
... tersebut tidak ditemukan pada susu formula [7]. Kortisol plasma ibu memiliki korelasi dengan gangguan psikologis dan kesulitan proses menyusui selama periode postpartum, dan sangat berpengaruh dengan produksi ASI [8]. ...
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Breastfeeding is an obligation that must be given to babies during their growth period. Consistent breast milk production and confidence to breastfeed are very necessary for the success of exclusive breastfeeding. Hypnopressure is one method that can increaseand maintain breastmilk production and breastfeeding confidence. The purpose of this project is to analyze the effect of hypnopressure on breast milk production and breastfeeding confidence. This study uses Quasy Eksperimental with Pretest dan Posttest Controlled Group Design. There were 28 postpartum mothers who were divided into two groups and taken with simple random sampling. Production of breast milk was measured by electric breast pump and breastfeeding sel efficacy was measured Breastfeeding Self Efficacy Scale (BSES). Data were analyzed using paired and unpaired t-test. Primary outcomes of this study will be effect of the intervention on breastmilk production and breastfeeding confidence. We conclude that hypnopressure could improve breastmilk production (p=0.00) and breasfeeding confidence (p=0.00) and breastfeeding confidence (p=0.00). Result of this greater understanding about increase breast milk production and confidence which influence the success of breastfeeding by hypnopressure then be useful targets for midwife intervention in post partum.
... Durante el periodo de gestación se llevan a cabo múltiples cambios fisiológicos, posiblemente uno de los cambios más significativos es la variación que se produce a nivel del sistema inmune, el cual permite lograr un adecuado embarazo, puesto que la mujer se encuentra vulnerable frente a enfermedades, incluyendo trastornos mentales (10). ...
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Neurological disorders represent a large number of conditions that can affect the proper development of pregnancy, which have a high rate of morbidity and mortality in these patients representing a high obstetric risk. Among these disorders are epilepsy, preeclampsia, eclampsia, stress, HELLP syndrome and migraine, to name a few. To prevent the onset or any of these symptoms, it is important to plan and have an adequate control of pregnancy, allowing to be aware of the alterations in the health of the mother as well as the fetus. RESUMEN Los trastornos neurológicos representan un gran número de condiciones que pueden afectar el desarrollo apropiado del embarazo, los cuales tienen un alto índice de morbimortalidad en estas pacientes representando un alto riesgo obstétrico. Entre estos trastornos se encuentran la epilepsia, preeclampsia, eclampsia, estrés, síndrome de HELLP y migraña, por mencionar algunos. Para prevenir la aparición o de cualquiera de estos síntomas, es importante planificar y tener un control adecuado del embarazo, permitiendo estar al tanto de las alteraciones de la salud de la madre como del feto.
... 2 Also, it has been shown that psychological stress causes rise in inflammatory proteins such as CRP, which can result in poor prognosis and pregnancy complications. 3 This protein is a senstive marker in inflamatory process also there is an association between the rise of this protein and occurrence of atherothrombosis, preterm delivery, low weight of the fetous and pre-eclampsia. [4][5][6] This protein enforces the innate immunity and protection against tissue damage from damaged, dead or dying organisms. ...
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... Based on the results of this study, the improvement on the production of cortisol hormone will be followed by a high improvement of glucose rate. The high rate of cortisol hormone and glucose is associated to the delay of breast milk production and, thus, might cause the decrease of breast milk production in each breast within the first post-partum week (Coussons, 2012;Adedinsewo et al., 2013). ...
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Chapter
We review evidence that maternal stress during pregnancy and related concepts such as pregnancy anxiety are associated with risks of adverse birth outcomes especially preterm birth and low birth weight, as well as less favorable development in offspring. In addition, we describe the forms of stress, anxiety and distress shown to be harmful, and briefly review behavioral and physiological mechanisms. Finally, we discuss some maternal interventions that may be protective, and offer recommendations to women to alleviate stress and anxiety during pregnancy.
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The last decade has seen a dramatic increase in research on the effects of environment and behavior on pregnancy and infant development. A key aspect of these efforts has been to examine how prenatal stress affects pregnancy and maternal and child health and to identify candidate mechanisms for these effects. This chapter describes research addressing how prenatal stress can alter the course of pregnancy and affect infant development and the potential role of neural-immune interactions in mediating these effects. Background research in psychoneuroimmunology, discussion of the role of the immune and endocrine systems in normal and complicated pregnancy, and foundational and ongoing research on how neural-immune interactions are involved in stress-related pregnancy outcomes are presented. The chapter concludes by identifying key future directions and ongoing challenges for research in this field with an eye toward affecting clinical practice.
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This study investigated the effects of acculturation on cortisol, a biological correlate of maternal psychological distress, and perinatal infant outcomes, specifically gestational age at birth and birth weight. Fifty-five pregnant women of Mexican descent were recruited from a community hospital, and their saliva samples were collected at home for 3 days during pregnancy at 15 to 18 weeks (early), 26 to 32 weeks (mid), and more than 32 weeks (late) of gestation and once in the postpartum period (4-12 weeks). These values were used to determine the diurnal cortisol slope at each phase of pregnancy. Mothers also completed an acculturation survey and gave permission for a medical chart review to obtain neonate information. Multiple regression analyses determined that greater acculturation levels significantly predicted earlier infant gestational age at birth (R(2) = 0.09, p = .03). Results from t tests revealed that mothers of low-birth-weight infants (<2500 g) had significantly higher acculturation scores than mothers of infants with birth weight greater than 2500 g (t = -2.95, p = .005). A blunted maternal cortisol slope during pregnancy was also correlated with low birth weight (r = -0.29, p = .05) but not gestational age (r = -0.08, p = .59). In addition, more acculturated women had a flatter diurnal cortisol slope late in pregnancy (R(2) = 0.21, p = .01). Finally, diurnal maternal cortisol rhythms were identified as a potential mediator between increased acculturation and birth weight. This study associated increased acculturation with perinatal outcomes in the US Mexican population. This relationship may be mediated by prenatal maternal diurnal cortisol, which can program the health of the fetus leading to several adverse perinatal outcomes.
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There is mounting evidence that stress during pregnancy can have detrimental effects on gestation and birth. Existing studies indicate that prenatal stress may increase levels of circulating inflammatory markers that are associated with prematurity and pregnancy complications, suggesting that stress-related changes in the cytokine milieu may increase the risk of poor pregnancy outcome. Previous studies, however, have not clearly connected stress during pregnancy to changes in inflammatory mediators and, in turn, to clinically-relevant outcomes such as premature delivery. The present study sought to directly connect prenatal stress and changes in inflammatory markers to preterm delivery and gestational age at birth (GAB). A sample of 173 women was recruited during the first trimester of pregnancy and followed through delivery. Overall stress, pregnancy-specific distress, and inflammatory markers were assessed early and later in pregnancy, and the predictive value of these measures for preterm birth and GAB was determined. There were significant differences in pregnancy-specific distress, IL-6, and TNF-α between women who delivered prematurely versus those who delivered at term, and elevated levels of pregnancy-specific distress, IL-6, and TNF-α were predictive of shortened GAB overall. Importantly, in many cases, the effects of overall stress and pregnancy-specific distress on GAB were mediated by levels of circulating inflammatory markers. Collectively, these data provide strong evidence that prenatal stress experiences can affect the timing of parturition via alterations in circulating inflammatory mediators, and underscore the need for ongoing research aimed at further understanding the mechanisms and effects of prenatal stress on maternal and infant health.