Pearl La Marca-Ghaemmaghami

The association between perceived emotional support, maternal mood, salivary cortisol, salivary cortisone, and the ratio between the two compounds in response to acute stress in second trimester pregnant women

OBJECTIVE Little is known about the effect of social support on the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy. Moreover, when investigating the HPA axis most studies do not consider the activity of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), an enzyme within the salivary glands that inactivates cortisol to cortisone. This study explores the association between perceived emotional support and the maternal psychobiological stress response to a standardized naturalistic stressor by assessing maternal mood and the reactivity of salivary cortisol (SalF), salivary cortisone (SalE), and the SalE/(E+F) ratio as a marker of 11β-HSD2 activity. METHODS Repeated saliva samples and measures of maternal mood were obtained from 34 healthy second trimester pregnant women undergoing amniocentesis which served as a psychological stressor. The pregnant women additionally responded to a questionnaire of perceived emotional support and provided sociodemographic (e.g., maternal educational degree) and pregnancy-specific data (e.g., planned versus unplanned pregnancy). RESULTS Perceived emotional support neither showed a significant effect on mood nor on the SalF or SalE response to stress. However, a moderately strong positive association was found between perceived emotional support and SalE/(E+F) (r=.49). Additionally, the final regression analysis revealed a significant negative relationship between educational degree, planned/unplanned pregnancy and SalE/(E+F). CONCLUSION Findings suggest a higher metabolization of cortisol to cortisone in pregnant women with higher emotional support. In contrast, higher maternal education and unplanned pregnancy appear to be associated with decreased salivary 11β-HSD2 activity. The current study emphasizes the importance of taking the activity of 11β-HSD2 into account when examining SalF.

The acute autonomic stress response and amniotic fluid glucocorticoids in second-trimester pregnant women

Objective The maternal autonomic nervous system (ANS) has received little attention in the investigation of biological mechanisms linking prenatal stress to fetal cortisol (F) excess. In vitro, norepinephrine and epinephrine inhibit placental 11&bgr;-hydroxysteroid dehydrogenase type 2 (11&bgr;-HSD2), which protects the fetus from F overexposure by inactivating it to cortisone (E). Here, we investigated the acute ANS stress response to an amniocentesis and its association with amniotic fluid F, E, and E/(E + F) as a marker of fetoplacental 11&bgr;-HSD2 activity. Methods An aliquot of amniotic fluid was obtained from 34 healthy, second-trimester pregnant women undergoing amniocentesis. Repeated assessment of mood states served to examine the psychological stress response to amniocentesis. Saliva samples were collected to measure stress-induced changes in salivary &agr;-amylase concentrations in response to amniocentesis. Cardiac parameters were measured continuously. Results Undergoing amniocentesis induced significant psychological and autonomic alterations. Low-frequency (LF)/high-frequency (HF) baseline, suggested to reflect sympathovagal balance, was negatively correlated with amniotic E/(E + F) (r=−0.53, p = .002) and positively with F (r = 0.62, p < .001). In contrast, a stronger acute LF/HF response was positively associated with E/(E + F) (r = 0.44, p = .012) and negatively with F (r=−0.40, p = .025). Conclusions These findings suggest that the maternal ANS is involved in the regulation of the fetoplacental barrier to stress. Allostatic processes may have been initiated to counterbalance acute stress effects. In contrast, higher LF/HF baseline values, possibly indicative of chronic stress exposure, may have inhibited 11&bgr;-HSD2 activity in the fetoplacental unit. These results parallel animal findings of up-regulated placental 11&bgr;-HSD2 in response to acute stress but impairment under chronic stress.

Mixed Expectations: Effects of Goal Ambivalence during Pregnancy on Maternal Well-Being, Stress, and Coping

BACKGROUND We hypothesised that experiencing ambivalence toward the childbearing goal would be related to indicators of well-being, stress, and coping among women with planned pregnancies. METHODS Study 1 (N = 208) tested cross-sectional associations between goal ambivalence and measures of well-being, stress, and coping. It also included a postpartum measurement point (N = 71) to examine prospective effects of goal ambivalence. Study 2 (N = 109) extended the investigation to within-person effects in a three-week daily diary assessment. RESULTS In Study 1, goal ambivalence in pregnant women was positively associated with depressive symptoms, perceived stress, and pregnancy-specific avoidance-oriented coping, and negatively associated with coping self-efficacy. Goal ambivalence also predicted changes in life satisfaction, depressive symptoms, perceived stress, and coping self-efficacy postpartum. Study 2 revealed within-person effects of daily fluctuations in goal ambivalence on day-to-day changes in positive emotions, negative activation, and avoidance-oriented coping. CONCLUSIONS Ambivalence towards the childbearing goal is a source of significant distress to pregnant women with planned pregnancies and its effects seem to extend into the postpartum period. These findings may have important clinical implications for maternal and child well-being. Future studies should examine whether goal ambivalence during pregnancy affects the maternal-child relationship in the long term.

Second-trimester amniotic fluid corticotropin-releasing hormone and urocortin in relation to maternal stress and fetal growth in human pregnancy

Abstract This study explored the association between the acute psychobiological stress response, chronic social overload and amniotic fluid corticotropin-releasing hormone (CRH) and urocortin (UCN) in 34 healthy, second-trimester pregnant women undergoing amniocentesis. The study further examined the predictive value of second-trimester amniotic fluid CRH and UCN for fetal growth and neonatal birth outcome. The amniocentesis served as a naturalistic stressor, during which maternal state anxiety and salivary cortisol was measured repeatedly and an aliquot of amniotic fluid was collected. The pregnant women additionally completed a questionnaire on chronic social overload. Fetal growth parameters were obtained at amniocentesis using fetal ultrasound biometry and at birth from medical records. The statistical analyzes revealed that the acute maternal psychobiological stress response was unassociated with the amniotic fluid peptides, but that maternal chronic overload and amniotic CRH were positively correlated. Moreover, amniotic CRH was negatively associated with fetal size at amniocentesis and positively with growth in size from amniocentesis to birth. Hardly any studies have previously explored whether acute maternal psychological stress influences fetoplacental CRH or UCN levels significantly. Our findings suggest that (i) chronic, but not acute maternal stress may affect fetoplacental CRH secretion and that (ii) CRH is complexly involved in fetal growth processes as previously shown in animals.

Is salivary estriol detectable in very early pregnancy

Abstract Objective: Estriol (E3) is produced by the placenta and is important for early pregnancy maintenance. In blood, E3 can be detected from the 8th week of pregnancy. Under the influence of the hypothalamic-pituitary-adrenal (HPA) axis hormone ACTH, E3 levels increase sharply after the 10th week. Although E3 can be reliably analyzed in saliva, till now information about the concentrations during the first trimester is missing. The aim of this study was to verify whether the sensitivity of a newly developed enzyme immunoassay is sufficient for the determination of salivary E3 (sE3) in very early pregnancy. Methods: Saliva samples were collected at home, once weekly in 25 healthy pregnant women from the 6th week of gestation to the end of the first trimester. Results: sE3 was detectable from the beginning of the 6th pregnancy week (M = 3.17 pg/ml, SD = 2.13). A steep significant increase between the 7th and the 8th week (p = 0.029) and again between the 10th and the 11th week (p = 0.001) was apparent. Conclusion: Low concentrations of sE3 can be measured during very early pregnancy and may serve as a promising, easily assessable marker for future research on the mechanisms of healthy pregnancy.

Gynäkologie und Geburtshilfe

Gynakologische und geburtshilfliche Themen stehen in einem engen Bezug zur Psyche und zum Verhalten von Frauen. Psychischer Stress und negative Gesundheitsverhaltensweisen konnen die Symptome bereits bestehender gynakologischer oder geburtshilflicher Storungen verstarken oder deren Entstehung begunstigen. Umgekehrt konnen gynakologische und geburtshilfliche Probleme die Entwicklung psychischer Beschwerden fordern. Die verhaltensmedizinische Tatigkeit in der Gynakologie und Geburtshilfe befasst sich aber nicht ausschlieslich mit Erkrankungen, sondern auch mit naturlichen reproduktiven Entwicklungsphasen wie Menarche, Schwangerschaft und Klimakterium. Diese Entwicklungsphasen gehen mit erheblichen hormonellen Veranderungen einher und konnen weitreichende biopsychosoziale Konsequenzen zur Folge haben. Psychische Fehlanpassungen an eine reproduktive Veranderungsphase erhohen das Risiko fur die Entwicklung psychischer Beschwerden wahrend einer nachsten reproduktiven Veranderungsphase.

Lohnt sich die Exploration von pränatalem Stress für die Therapieindikation

Die Entstehung psychischer Störungen und somatischer Erkrankungen wird durch individuelle Belastungen aufgrund von Stressoren und/oder Traumata ausgelöst oder begünstigt. Demzufolge wird in der kognitiv-verhaltenstherapeutischen Diagnostik besonderer Wert auf die Exploration dieser Belastungen gelegt. Neuere Erkenntnisse aus der psychobiologischen Pränatalforschung verweisen jedoch darauf, dass eine bereits pränatal erworbene Empfindlichkeit (Suszeptibilität) die Anfälligkeit (Vulnerabilität) für psychische und somatische Fehlanpassungen an Belastungen vergrößert. Um die Therapieindikation zu differenzieren und das subjektive Krankheitsmodell pränatal bereits belasteter Patienten zu präzisieren, wird für eine Miterfassung gegebenenfalls bestehender pränataler Belastungen plädiert.

Steroid profiling in nails using liquid chromatography-tandem mass spectrometry

HIGHLIGHTSAn LC‐MS/MS method was developed for the quantification of 12 steroid hormones in nails.3 steroid hormones were detected in nails for the first time.Six steroid hormones were detected and quantified in human fingernails of mothers and their infants.No significant differences could be found between right and left hand steroid levels. ABSTRACT The retrospective analysis of endogenous steroid hormones in nails can be used to elucidate endocrine diseases and thus help with their diagnosis and treatment. A liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) based method was developed for the simultaneous identification and quantification of 12 steroid hormones (aldosterone, cortisone, cortisol, corticosterone, 11‐deoxycortisol, androstenedione, 11‐deoxycorticosterone, testosterone, dehydroepiandrosterone (DHEA), 17&agr;‐hydroxyprogesterone (17‐OHP), dihydrotestosterone (DHT) and progesterone) in human fingernails. Steroid hormones were extracted from 0.5mg to 10mg pulverized nail clippings by methanolic extraction, followed by a liquid‐liquid extraction. The analysis was conducted with LC‐MS/MS in electrospray ionization positive mode. The method was validated in terms of linearity, limit of detection (LOD), limit of quantification (LOQ), precision, accuracy, matrix effect, recovery and robustness. It was successfully applied for steroid profiling in nails of mothers and their infants where cortisol, cortisone, testosterone, progesterone, androstenedione and 11‐deoxycorticosterone could be detected. Furthermore, it could be shown that there is no significant difference in concentrations between left and right hand for cortisol, cortisone and progesterone. A positive linear correlation between cortisol and cortisone in nails was found. In conclusion, it could be shown that nails are a suitable matrix for the retrospective monitoring of cumulative steroid hormone levels.

Women’s Word Use in Pregnancy: Associations With Maternal Characteristics, Prenatal Stress, and Neonatal Birth Outcome

Background: Experiencing high levels of stress during pregnancy can impair maternal well-being and fetal development. Consequently, unbiased assessment of maternal psychological state is crucial. Self-report measures are vulnerable to social desirability effects. Thus, implicit measures, such as word choice analysis, may offer an alternative. Methods: In this longitudinal online-study, 427 pregnant women described their emotional experiences in writing and additionally responded to self-report questionnaires assessing symptoms of prenatal stress and depression. The written texts were analyzed with a computerized text analysis program. After birth, 253 women provided information on birth outcome. Results: Word use differed significantly depending on maternal socioeconomic (e.g., marital status) and pregnancy-related characteristics (e.g., parity). Prenatal stress and depressive symptoms were associated with more frequent use of negative emotion words and words of anxiety, as well as with less first-person plural, but not singular pronoun use. Negative emotion and cognitive mechanism words predicted birth outcome, while self-report measures did not. Conclusion: In addition to self-report measures, word choice may serve as a useful screening tool for symptoms of depression and stress in pregnant women. The findings on pronoun use may reflect women’s changing experience of self-identity during the transition to motherhood.

Is the acute psychobiological stress response in healthy pregnant women associated with amniotic fluid corticotropin-releasing hormone?

Introduction: The mechanisms underlying the effects of maternal prenatal stress on foetal development remain elusive. One hypothesis is that maternal stress leads to increased cortisol blood concentrations, which in turn may overstimulate the secretion of placental corticotropin releasing hormone (CRH) into the foetal circulation. However, whether acute stress-induced rises in maternal cortisol affect foeto-placental CRH levels is unknown. We therefore aimed at exploring the association between the acute maternal psychobiological stress response as well as chronic maternal stress perception and foeto-placental CRH levels. Methods: We examined thirty-four healthy pregnant women (37.4 ± 4.0 years) undergoing second-trimester amniocentesis. The amniocentesis served as a naturalistic stress situation during which we repeatedly obtained questionnaires on maternal acute stress perception and saliva samples for cortisol analysis. We furthermore monitored maternal cardiac activity continuously (i.e., heart rate, heart rate variability). The women also responded to the social overload scale of the Trier Inventory of Chronic Stress (Schultz and Schlotz, 1999). CRH levels were analysed from an amniotic fluid aliquot. Results: The amniocentesis induced significant changes in maternal stress perception, salivary cortisol, and cardiac activity. No significant association between the acute psychobiological stress response and amniotic CRH was apparent (all p > .10). However, maternal chronic social overload was positively correlated with CRH levels (Kendall’s tau = .34, p = .02). Conclusions: The current findings provide evidence that maternal chronic stress affects placental CRH secretion. However, we cannot exclude that a different or longer timeframe might be required to detect an association between acute maternal stress and foeto-placental CRH. Further studies are called for.