Dysregulation of Diurnal Salivary Cortisol Production Is Associated with Spontaneous Preterm Delivery: A Pilot Study

Abstract

Objectives: The purpose of this study was to evaluate whether the diurnal fluctuation of salivary cortisol and its overall diurnal secretion are associated with the length of gestation in patients who were admitted to the hospital with an assigned diagnosis of possible preterm labor (PL) at a gestational age of 28-33 weeks. Methods: In 22 patients, maternal saliva samples were collected for a cortisol assay 4 times per day (8 AM, 12 AM, 4 PM and 8 PM) on day 4 and day 6 after antenatal corticosteroid prophylaxis to prevent neonatal respiratory distress syndrome. Results: Eight patients who ultimately delivered before term (32.6 ± 1.7 gestation weeks) showed an inverted fluctuation of salivary cortisol on both days 4 and 6, morning cortisol levels being significantly lower than evening levels. In contrast, in 14 patients who delivered at term (39.5 ± 0.6 gestation weeks), the physiological diurnal fluctuation of salivary cortisol was maintained. In addition, a distinctive feature of women delivering before term was a significantly hampered salivary cortisol diurnal production measured on day 6. Conclusions: Corticoadrenal activity is dysregulated and anticipates very preterm delivery in women with an assigned diagnosis of possible PL.

Postpartal Affective and Endocrine Differences Between Parents of Preterm and Full-Term Infants

“…Unfortunately, despite extensive research until now it was not possible to establish a unique pattern of the CAR after parturition for women known to experience psychological distress or even suffering from mental disorders (27). Contrasting our results, in mothers giving preterm birth a considerable dysregulation of the hypothalamicpituitary-adrenal axis (HPA-axis) could be detected, leading to a significantly diminished AUCg for salivary cortisol on day six after delivery compared to mothers giving term birth (48). These differences might also go back to non-compliance in saliva sampling.…”

Childhood stress and birth timing among African American women: Cortisol as biological mediator

“…However, HPA output can be measured in numerous ways (e.g., CRH, ACTH, plasma cortisol, salivary cortisol, hair cortisol). Markers tend to correlate well during pregnancy (e.g., Glynn et al, 2007; O’Keane et al, 2011), with each linked to early birth in prior work (i.e., serum and plasma CRH (Guendelman et al, 2008; Hobel et al, 1999; Mancuso et al, 2004; Moog et al, 2016) plasma ACTH (Hobel et al, 1999), plasma cortisol (Hobel et al, 1999), diurnal salivary cortisol pattern (Patacchioli et al, 2013), hair cortisol (Hoffman et al, 2016)). Given our interest in the peripheral actions of cortisol, use of plasma as opposed to saliva may also be considered a strength given the notable individual variability in passive salivary diffusion and rate of conversion of active cortisol to inactive cortisone by type II 11β-hydroxysteroid dehydrogenase (Perogamvros et al, 2010).…”

Timing of birth: Parsimony favors strategic over dysregulated parturition

“…The epidemiologic literature includes reports that stressful environments increase the incidence of preterm birth (Hobel, ). This work typically offers a “dysregulated parturition” narrative to explain the association (Patacchioli et al, ). The narrative posits that the stress response, conserved by natural selection to protect humans against acute threats, includes a cascade of hormones that has the side effect of “dysregulating” and accelerating parturition (Christian, ).…”