Stress Questionnaires and Stress Biomarkers during Pregnancy

Abstract

Objective: Both self-reported indicators of stress and hormones such as cortisol and corticotrophin-releasing hormone (CRH) have been examined in relation to preterm birth. Although these hormones have been interpreted as biomarkers of stress, it is unclear whether psychosocial measures are empirically associated with biomarkers of stress in pregnant women. Methods: We analyzed data from 1,587 North Carolina pregnant women enrolled in the Pregnancy, Infection, and Nutrition study during 2000-2004 who provided at least one saliva sample for cortisol measurement or blood samples for CRH at 14-19 and 24-29 weeks' gestation. Cortisol measures were limited to those taken between 8 and 10 a.m. Perceived stress, state-trait anxiety, coping style, life events, social support, and pregnancy-specific anxiety were measured by questionnaires and interviews. Spearman correlations and multiple regressions were used to describe the relationship among the measures of stress. Results: No correlations larger than r ¼ 0.15 were seen between reported psychosocial measures and cortisol or CRH. Women with demographic characteristics associated with poor pregnancy outcomes (unmarried, AfricanAmerican, young, low pre-pregnancy body mass index) reported higher levels of stress but did not consistently have higher levels of stress hormones. Pre-eclampsia was associated with higher CRH, but not with higher cortisol. Conclusions:The relationship between measurements of reported stress and biomarkers is not straightforward in large epidemiological studies of pregnancy. For online Supplementary Material, see www.liebertonline.com.

Determinants of cortisol during pregnancy – The ABCD cohort

“…It must be noted that women completed the psychosocial stress questionnaires several days to weeks before or after their cortisol was measured, potentially resulting in inaccurate results in women who would have responded differently at the day of sampling. However, our findings do correspond with quite a few studies showing rather modest correlation coefficients (Wadhwa et al, 1996;Diego et al, 2006) , or no relationship at all (Harville et al 2009;Voegtline et al 2013). The lack of findings might be explained by the fact that, despite a wide range in gestational ages, most women in our study sample were in their first trimester of pregnancy, and different effects of perceived stress on cortisol have been described across the course of pregnancy (Obel et al 2005).…”

“…The proposed theory that stress-associated programming occurs through increased maternal cortisol levels and subsequently fetal exposure is therefore plausible. However, other studies have found only moderate correlations between prenatal stress, depression or anxiety and maternal cortisol levels ( Wadhwa et al, 1996;Diego et al, 2006;Harville et al, 2009), or no correlation at all (Petraglia et al, 2001;Goedhart et al, 2010;Voegtline et al, 2013).…”

Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes

“…Although many of these studies have not included measurements of maternal cortisol, it has been suggested that dysregulation of the HPA axis may underlie these associations. However, several studies show that stress and anxiety levels assessed by questionnaire do not necessarily correlate with maternal cortisol levels [64,66] . This may be related to limitations in the approaches used to assess stress and cortisol concentrations [67] as there is a higher correlation for ambulatory assessment of maternal stress and cortisol concentrations than single assessments carried out in a research laboratory [43] .…”

Understanding the relationship between disaster-related prenatal maternal stress and child motor development: The QF2011 Queensland Flood Study

“…Maternal cortisol during pregnancy can predict infant cortisol response (O'Connor et al, 2013;Perroud et al, 2014;Yehuda et al, 2005), and infant cortisol can predict later cognitive development (Bergman et al, 2010;Huizink et al, 2002b). Although there are some non-significant findings (Beijers et al, 2014) and psychosocial and biological measures of stress are not always correlated in pregnancy (Glover & Barlow, 2014;Harville, Savitz, Dole, Herring, & Thorp, 2009), physiological stress reactions are a likely mechanism of transmission for fetal programming (O'Connor et al, 2013). Coping can reduce the physiological reactions to stressors (Olff et al, 2005a;Southwick et al, 2005), but very few prenatal stress studies have tested the role of coping in prenatal maternal stress.…”

“…Coping can reduce the level of stress related hormones (Olff et al, 2005a;Southwick et al, 2005), which may reduce the level of cortisol crossing the placental barrier and thus reduce the influence of the prenatal stress on the developing fetus. Although one study found that coping and cortisol were not correlated (Harville et al, 2009), cortisol is difficult to study during pregnancy as some cortisol is necessary for optimal fetal development and cortisol levels fluctuate across pregnancy, as does cortisol reactivity (Beijers et al, 2014;Davis et al, 2011;O'Connor et al, 2014). Further, different types of coping are associated with different physiological effects (Morris & Rao, 2013;Olff et al, 2005a).…”