Content uploaded by Mary Coussons-Read
Author content
All content in this area was uploaded by Mary Coussons-Read
Content may be subject to copyright.
A preview of the PDF is not available
The Psychoneuroimmunology of Stress in Pregnancy
Abstract and Figures
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.
Figures - uploaded by Mary Coussons-Read
Author content
All figure content in this area was uploaded by Mary Coussons-Read
Content may be subject to copyright.
... 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. ...
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). ...
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]. ...
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). ...
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. ...
Background: This study was performed to determine the level of serum C-reactive protein (CRP) in day of ovum pickup and embryo transfer as a predictor for success in patients undergoing In-Vitro Fertilization (IVF) and Intracytoplasmic Sperm injection (ICSI).Methods: This study was a cross sectional study (prospective) that was conducted in assisted reproduction unit in Al-Azhar University Hospital on 50 infertile patients who were candidate for IVF/ICSI, using standard long protocol, blood was drawn two times during cycle, in the day of ovum pick up and the day of embryo transfer.Results: In (70.6 %) the serum of CRP level was higher in day of embryo transfer than day of ovum pick up. The ratio of CRP level in the day of embryo transfer to the day of ovum pick up was heigher (1.54) in patients who became pregnant after ICSI, patients with less than this ratio have not been pregnant.Conclusions: Controlled ovarian hyper stimulation and puncture of ovaries can potentiate systemic stimulation so increasing serum CRP level in day of embryo transfer rather than day of ovum pick up can predict success in patients undergoing IVF/ICSI.
... 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). ...
Background: The incidence of post-partum blues both in Indonesia and abroad has been quite high; the stress that post-partum mothers experience will inhibit breast milk production and, as a result, breastfeeding process should be stopped earlier. Hypnobreastfeeding relaxation and oxytocin massage have been a combination of therapy that might decrease the rate of Adenocorticotropic Hormon (ACTH) and that might assist hormone and prolactin secrection in order that breast milk production becomes fluent. This study then aimed at analyzing the optimization of the combination of oxytocin massage and hypnobreastfeeding in order to decrease anxiety and to improve breast milk production among post-partum mothers.
Subjects and Method: This was an analytic experimental study with Randomized Control Trial (RCT) design. This study was conducted at Dr. Suradji Tirtonegoro Central General Hospital, Klaten, from January 25th, 2017 until March 9th, 2017. The population in this study was 200 post-partum mothers. A sample of 60 post-partum mothers was selected for this study and allocated into the intervention group (n1= 30) and the control group (n2= 30). The intervention group would be treated by the combination of oxytocin massage and hypnobreastfeeding. The dependent variables were anxiety and breast milk production. The independent variables were oxytocin massage and hypnobreastfeeding. The anxiety was measured by STAI scale. The breast milk production process was measured by checklist questionnaire. The breast milk production amount was measured by milking cups. The breast milk production between the two groups was tested by Mann-Whitney.
Results: The anxiety scale in the intervention group was better and lower than that of the control group. The differences in terms of anxiety scale between the intervention group (median= 24.00; SD= 4.45) and the control group (median= 34.00; SD= 6.93) were statistically significant (p
Serotonin modulates vascular, immune, and neurophysiology and is dysregulated in preeclampsia. Despite biological plausibility that selective serotonin reuptake inhibitors (SSRIs) prevent preeclampsia pathophysiology, observational studies have indicated increased risk and providers may be hesitant. The objective of this meta-analysis and quality assessment was to evaluate the evidence linking SSRI use in pregnancy to preeclampsia/gestational hypertension.
PubMed was searched through June 5, 2020 manually and using combinations of terms: “preeclampsia”, “serotonin”, and “SSRI”. This review followed MOOSE guidelines. Inclusion criteria were: 1) Observational cohort or population study, 2) exposure defined as SSRI use during pregnancy, 3) cases defined as preeclampsia or gestational hypertension, and 4) human participants. Studies were selected that addressed the hypothesis that gestational SSRI use modulates preeclampsia and/or gestational hypertension risk. Review Manager Web was used to synthesize study findings. Articles were read and scored (Newcastle-Ottawa Quality Assessment Scale) for quality by two independent reviewers. Publication bias was assessed using a funnel plot and the Egger test.
Of 179 screened studies, nine were included. The pooled risk ratio (random effects model) was 1.43 (95% CI: 1.15-1.78, P<0.001; range 0.96-4.86). Two studies were rated as moderate quality (both with total score of 6); others were high quality. Heterogeneity was high (I2=88%) and funnel asymmetry was significant (p<0.00001).
Despite evidence for increased preeclampsia risk with SSRIs, shared risk factors and other variables are poorly controlled. Depression treatment should not be withheld due to perceived gestational hypertension risk. Mechanistic evidence for serotonin modulation in preeclampsia demonstrates a need for future research.
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.
Objective
To explore the association of psychological distress, including stress, depression, and anxiety, with the development of a hypertensive disorder during pregnancy.
Design
A secondary data analysis using a 1:3 case control study; cases (n = 29 with a hypertensive disorder) and controls (n = 87 without hypertension) frequency matched on age and parity.
Participants
Women in the study were older than 14 years of age, Medicaid eligible, with at least one risk factor for preterm birth, and without a current diagnosis of mental illness.
Methods
Hypertensive disorder status was verified through medical record report. Components of psychological distress were measured with valid instruments. Measures of psychological distress level, including CESD-R-10, PSS-4, and GAD-7, were compared between women with a hypertensive disorder and normotensive women were made in both early and late pregnancy. Components of psychological distress were tested as independent risk factors with the development of a hypertensive disorder as the outcome.
Results
There were no differences in psychological distress between hypertensive and normotensive women. Furthermore, no changes in psychological distress by time between groups were identified. However, this population did not present with significant symptoms of psychological distress. BMI was the only independent risk factor associated with an increased risk of developing a hypertensive disorder during pregnancy (OR=1.13; 95% CI: 1.04 - 1.23, p = .003).
Conclusions
These findings indicate psychological distress was not associated with the development of a hypertensive disorder during pregnancy in women with few symptoms of psychological distress. Women with higher BMI were at an increased risk of developing a hypertensive disorder.
Background:
Stress exposure is associated with risk for adverse pregnancy outcomes, potentially in part through dysregulated immune and inflammatory activity. Evidence suggests that stress during pregnancy is associated with inflammation during pregnancy, consistent with risk for preterm birth. However, research has not tested whether complementary changes are reflected in immune cell gene expression, or upstream regulation of inflammation. The purpose of this study was to test associations between preconception and prenatal stress exposure and third trimester immune cell gene expression, focusing specifically on sets of genes previously linked to stress in non-pregnant samples: Pro-inflammatory genes, and antiviral and antibody genes.
Methods:
A sample of 116 low-income, diverse women was recruited from 5 U.S. sites by the Community Child and Health Network at the birth of a child. This study is of the subgroup of women who became pregnant again over the two-year follow-up period, and provided information on stressful life events that occurred both preconception and during the third trimester of the subsequent pregnancy. Dried blood spots (DBS) were collected in the third trimester of pregnancy, and used for gene expression analysis.
Results:
Women with more prenatal stressful life events had higher expression of pro-inflammatory genes when compared to those with fewer life events, and the effect was driven by increased activation of pro-inflammatory transcription factors, NF-κB and AP-1. Preconception stressful life event exposure was not associated with gene expression profiles. When entered into models simultaneously, only prenatal stressful life events were associated with up-regulation of pro-inflammatory genes. No differences between high or low stress groups emerged for antiviral or antibody genes.
Conclusions:
Prenatal stress exposure was associated with up-regulated pro-inflammatory gene expression during pregnancy, and increased activity of NF-κB and AP-1. In contrast, stress occurring preconception was not associated with gene expression. These results are consistent with the hypothesis that stress-induced activation of pro-inflammatory transcriptional pathways in pregnancy, but not earlier, may increase risk for inflammation-driven adverse pregnancy outcomes.
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.
Although there are biological pathways that conceivably might link stress with preterm birth, studies attempting to demonstrate such a relationship have given conflicting results. For the most part, social support has notbeen found to reduce preterm births. The present study is a prospective examination of how such factors as life events, social support, depression, and anxiety related to pregnancy may be associated with birth before 37 weeks' gestation. The study cohort included 1962 women who gave birth in central North Carolina in the years 1996-2000. Participants, aged 16 years and older, were entered into the study at 24-29 weeks' gestation. Many subjects were African-American women, and about half were nulliparous. More than half were not married when entering the study. Low-income households were liberally represented in the study group. The incidence of preterm birth was 12%. Life events, social support, and depression were not associated with preterm birth in this study, but women having medium and high scores for self-rated pregnancy-related anxiety were at increased risk; risk ratios were 1.5 and 2.1, respectively. High scores on a scale of perceived racial discrimination also correlated with an increased risk of preterm birth (risk ratio, 1.4). Similar findings were obtained when alcohol or tobacco use was taken into account. Women with greater self-rated anxiety were more at risk of spontaneous than of medically indicated preterm birth. A risk ratio of 1.8 was associated with life events perceived as having had a negative impact. Among women with negative life events, pregnancy-related anxiety was associated with preterm birth triggered by either labor or ruptured membranes. The association between high levels of pregnancy-related anxiety and preterm birth was less marked when limited to women lacking comorbid medical conditions, but it persisted. These findings suggest that some psychosocial measures are in fact associated with preterm birth.
Maternal stress perception has long been suspected as a possible cause of infertility, implantation failure, late pregnancy complications, and impaired fetal development, notions that exist since ancient times and across all cultures. In view of the enormous complexity of the regulatory nervous, endocrine, and immune mechanisms involved in pregnancy maintenance, it is evident that pregnancy failure is not a single entity condition, but most likely the result of complex dysregulation. This dysregulation can be initiated or aggravated by stress. Here, we review the effects of stress on the equilibrium of the nervous, endocrine, and immune systems and summarise relevant general principles of neuro-immune and endocrine-immune cross talk in the context of pregnancy and fetal tolerance. While there are still more questions than answers, the neuroendocrine-immune circuitry of the stress response during pregnancy is becoming increasingly defined, e. g. due to the development of particularly instructive rodent models and prospectively designed human cohort trials. Our goal is to prompt clinicians to become far more attentive to the effect of psychological stress on pregnancy complications. Together with basic science research elucidating hierarchical, temporal, and spatial interactions of key parameters during central and peripheral responses to psychological stress, a list of candidate molecular targets for clinically useful therapeutic intervention can then be created.
Etwa 80% aller Kinder- und Jugendlichen mit Leukämien, Lymphomen oder malignen Tumoren überleben in Europa und Nordamerika die Erkrankung langfristig. Damit einhergehend werden neuropsychologische Funktionsbeeinträchtigungen, die psychopathologische Komorbidität und gesundheitsbezogene Lebensqualität zu relevanten Parametern der Therapieevaluation und Konzeption zukünftiger Therapieprotokolle. Im letzten Jahrzehnt haben Multicenterstudien und Metaanalysen die Interaktion zwischen erkrankungs- und behandlungsassoziierten Risikofaktoren mit vorbestehenden soziodemografischen und psychosozialen Vulnerabilitätsfaktoren analysiert. Demnach bergen Hirntumoren sowie zerebral wirksame Therapiestrategien der ZNS-Chirurgie, der kranialen Radiotherapie und intrathekalen Chemotherapie besonders erhöhte Risiken für das neurologische, neuropsychologische und darüber vermittelt auch psychosoziale und beruflich-rehabilitative Langzeitoutcome. Im Bereich der psychosozialen Adaptation ergibt sich ein breites Spektrum von Entwicklungspfaden, die von erhöhter psychischer Komorbidität über subklinische Beeinträchtigungen der Lebensqualität zu unauffälligen Verläufen bis hin zu resilienten Verläufen mit einem Entwicklungsgewinn reichen. Im vorliegenden Beitrag wird ein hypothetisches Bedingungsmodell für diese extreme Varianz im Outcome vorgestellt. Demnach disponieren schon prämorbide herausgebildete, protektiv wirksame kognitiv-emotionale Schemata zu einer erfolgreichen Bewältigung auch der erkrankungs- und behandlungsbedingten Herausforderungen und damit zu einem die langfristige Adaptivität weiter stimulierenden Entwicklungsgewinn. Demgegenüber erhöhen im prämorbiden Stadium bereits manifeste, dysfunktionale Schemata das Risiko für erneute maladaptive Bewältigung und intensivieren so einen beeinträchtigten Langzeitverlauf bis hin zur Entwicklung klinisch manifester PTBS, Depression oder Angststörung.
OBJECTIVE: Our purpose was to determine whether various measures of poor psychosocial status in pregnancy are associated with spontaneous preterm birth, fetal growth restriction, or low birth weight. STUDY DESIGN: Anxiety, stress, self-esteem, mastery, and depression were assessed at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert scale. Scores for each psychosocial subscale were determined, and an overall psychosocial score was calculated. Scores were divided into quartiles, and the lowest quartile scores were used to define poor psychosocial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial scores were compared. Logistic regression analyses provided the odds ratios and 95% confidence intervals. RESULTS: Analyses revealed that stress was significantly associated with spontaneous preterm birth and with low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the combined scale or on any subscale other than stress did not predict spontaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variable significantly associated with spontaneous preterm birth, fetal growth restriction, and low birth weight; stress and low education were associated with spontaneous preterm birth and low birth weight. CONCLUSION: Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral characteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth weight even after adjustment for stress, substance use, and other demographic factors. (Am J Obstet Gynecol 1996;175:1286-92.)
In Europe and North America, about 80% of all patients with cancer in childhood and adolescence survive their leukemia, lymphomas or tumors. Therefore, neuropsychological impairments, psychopathological comorbidity and health-related quality of life become relevant parameters for treatment evaluation and conceptualization of future therapy protocols. During the last decade, a number of patient registries, multicenter studies and meta-analyses have analyzed the interaction of disease- and treatment-associated risk factors with pre-existing socio-demographic and psychosocial vulnerability factors. Brain tumors and treatment strategies including CNS surgery, cranial radiotherapy and intrathecal chemotherapy carry an increased risk for neurological and neuropsychological long-term outcomes, which in turn also threatens the patients' psychosocial and vocational participation. In the area of psychosocial adaptation, a wide range of developmental paths results, ranging from increased psychological comorbidity, to subclinical impairments in quality of life, to normal courses to resilient outcomes, even with a developmental benefit. A hypothetical model is presented to explain this enormous variance in outcomes. Protective cognitive-emotional schemata already established at the premorbid stage predispose patients to be able to cope successfully with cancer-related challenges and thus further enhance the patients' future adaptability. In contrast, dysfunctional schemata at the premorbid level increase risks of coping failure and thus intensify the long-term risk for psychopathological comorbidity in terms of post-traumatic stress disorder, anxiety disorder or depression.
Depression and inflammation are associated with poorer birth outcomes. African-American women have higher levels of inflammatory biomarkers, more depressive symptoms, and a disparate burden of poorer birth outcomes, but the association between depressive symptoms and inflammation within this higher-risk group is unknown. We examined this association among African-American women in the second trimester of pregnancy and additionally tested whether body mass index (BMI) mediates or moderates this relationship. We recruited 187 women from the obstetrics clinics of a large urban health system. Depression symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale and inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, IL-10, IL-1β, and tumor necrosis factor-α [TNF-α]) with enzyme immunoassays. Multivariate regression models were fitted to determine the association between CES-D score and each inflammatory biomarker. CES-D was not associated with hs-CRP or TNF-α. CES-D was directly associated with IL-1β (P=0.03). BMI moderated the relationship between CES-D and IL-6 (P<0.01) and IL-10 (P=0.04); in leaner women, depressive symptoms were associated with higher IL-6 and IL-10 levels, whereas in heavier women, depressive symptoms were associated with lower IL-10 levels. BMI did not mediate the relationship between CES-D and inflammation. We conclude that depressive symptoms are associated with increased inflammation among pregnant African-American women. Future studies are needed to examine if depression, mediated through inflammation, increases the risk of adverse pregnancy outcomes in African-American women.
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.
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.