Physiological and psychological stress responses to labor and delivery as expressed by salivary cortisol: a prospective study

Miller, Netanella; Asali, Aula; Agassi-Zaitler, Moran; Neumark, Eran; Eisenberg, Michal Matzkin; Hadi, Efrat; Elbaz, Meyer; Pasternak, Yael; Fishman, Ami; Biron‐Shental, Tal

doi:10.1016/j.ajog.2019.06.045

Cited by 26 publications

(30 citation statements)

References 17 publications

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“…Indeed, labor is widely assumed to be a stressful process. Miller et al found the salivary cortisol concentration to gradually increase from the latent to the active phase in low-risk VAG deliveries, with the maximum concentration being observed within two minutes of the onset of labor [70]. In line with our results, some authors have described how VAG deliveries are associated with higher serum cortisol concentrations and more intense inflammation than elective CS deliveries, although the inflammatory response period is shorter than in the case of CS [71][72][73].…”

Section: Discussionsupporting

confidence: 90%

Maternal Microbiota, Cortisol Concentration, and Post-Partum Weight Recovery Are Dependent on Mode of Delivery

et al. 2020

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The importance of the maternal microbiota in terms of the initial bacterial seeding has previously been highlighted; however, little is currently known about the perinatal factors that could affect it. The aim of this study was to evaluate the effects of various delivery-related factors on the intestinal microbiome at delivery time and on post-partum weight retention. Data were collected from mothers (n = 167) during the first four months post-partum. A subset of 100 mothers were selected for the determination of the salivary cortisol concentration and microbiome composition at birth by 16S rRNA gene sequencing. The maternal microbiota was classified into two distinct clusters with significant differences in microbial composition and diversity. Maternal microbiota was also significantly influenced by the mode of delivery. Moreover, the salivary cortisol concentration was associated with some maternal microbiota genera and it was significantly higher in the vaginal delivery group (p = 0.003). The vaginal delivery group exhibited lower post-partum weight retention than the C-section (CS) mothers at four months post-partum (p < 0.001). These results support the hypothesis that the mode of delivery as well as the codominant hormonal changes could influence the maternal microbiota and possibly impact maternal weight recovery during the post-partum period.

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Section: Discussionsupporting

confidence: 90%

Maternal Microbiota, Cortisol Concentration, and Post-Partum Weight Recovery Are Dependent on Mode of Delivery

et al. 2020

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“…This discrepancy could be the result of the fact that assessment took place only a few days after childbirth when the lactation was only initiated, which is a different stage of the postpartum period and therefore difficult to compare. Further, cortisol levels could have been affected by hormonal conditions related to the previous pregnancy state, but there is evidence showing that maternal salivary cortisol should return to prepregnancy levels at 12-24 h postpartum [31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Cortisol is released to mobilize physiological and psychological resources of the organism and to support recovery by counteracting the physiological effects of the SNS activation [29]. Cortisol release gradually increases during pregnancy, with a peak at the end of the pregnancy, and then returns to nongravid levels 12-24 h after childbirth [30][31][32][33]. There is evidence that early postpartum conditions can have an additional impact on cortisol release, such as breastfeeding within the last hour that causes blunted cortisol stress reactivity [34].…”

Section: Psychophysiological Stress Reactivity and Posttraumatic Strementioning

confidence: 99%

The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder

Sandoz

Stuijfzand

Lacroix

et al. 2021

JPM

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Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic–pituitary–adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.

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“…A recent study by our group showed the patterns of physiological and psychological stress at 6 points during and after labor, without addressing the effects of induction [11].…”

Section: Introductionmentioning

confidence: 99%

Induction of labor, and physiological and psychological stress responses as expressed by salivary cortisol: a prospective study

Haj-Yahia

Asali

Cohen

et al. 2020

Arch Gynecol Obstet

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Purpose To describe patterns of physiological and psychological stress during induced labor and their correlation to obstetrical and neonatal outcomes. Methods This prospective, observational study included 167 women, with low-risk, singleton pregnancies, who delivered at term, at a tertiary academic center from 2015 through 2018. Among them, 72 (43%) underwent induction and 95 (57%) had spontaneous labor onset. Physiological stress was evaluated by salivary cortisol measurements and emotional stress by questionnaires (visual analogue stress scale 0-10) during latent phase, active phase and full dilation stages of labor, as well as 2 min and 2 h postpartum. Cord blood cortisol and pH were obtained. Stress patterns were compared between parturients who did or did not undergo induction. Modes of delivery, labor and delivery complications, and early neonatal outcomes were compared. Mothers completed the Hospital Anxiety and Depression Scale. Results Induced women had lower cortisol concentrations during the latent phase compared to spontaneous onset of labor (p = 0.003), with no differences during active (p = 0.237), full dilation (0.668), 2 min and 2 h after delivery (p = 0.666). Stress scale and Hospital Anxiety and Depression Scale scores were similar between groups. Cord cortisol (p = 0.294), 1-min Apgar score ≤ 7 (p = 0.502) and 5-min Apgar score ≤ 7 (p = 0.37) were similar. All had cord pH > 7. Conclusions Induction does not increase stress during labor. Moreover, it might have a positive effect on reducing cortisol during the latent phase. These findings might reassure women who are concerned about induction of labor.

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Physiological and psychological stress responses to labor and delivery as expressed by salivary cortisol: a prospective study

Cited by 26 publications

References 17 publications

Maternal Microbiota, Cortisol Concentration, and Post-Partum Weight Recovery Are Dependent on Mode of Delivery

Maternal Microbiota, Cortisol Concentration, and Post-Partum Weight Recovery Are Dependent on Mode of Delivery

The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder

Induction of labor, and physiological and psychological stress responses as expressed by salivary cortisol: a prospective study

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