Pregnancy-specific Anxiety and Gestational Length: The Mediating Role of Diurnal Cortisol Indices

Overview

Journal Psychoneuroendocrinology

Specialties Endocrinology
Neurology
Psychiatry

Date 2023 Apr 21

PMID 37084672

Authors

Kharah M Ross

Harmeen Mander

Gabrielle Rinne

Michele Okun

Calvin Hobel

Mary Coussons-Read

Christine Dunkel Schetter

Affiliations

Soon will be listed here.

Abstract

Background: Preterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length.

Methods: A sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS.

Results: There was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= -0.102(0.057), .95CI [- 0.227,- 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= -0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length.

Conclusion: Lower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.

Citing Articles

Anxiety trajectories from pregnancy to one-year postpartum and their contributors during the COVID-19 pandemic.

Preis H, Wang W, St Denis I, Zhu W, Mahaffey B, Lobel M J Reprod Infant Psychol. 2023; :1-13.

PMID: 38111259 PMC: 11182884. DOI: 10.1080/02646838.2023.2293914.

References

Entringer S, Buss C, Andersen J, Chicz-DeMet A, Wadhwa P . Ecological momentary assessment of maternal cortisol profiles over a multiple-day period predicts the length of human gestation. Psychosom Med. 2011; 73(6):469-74. PMC: 3137948. DOI: 10.1097/PSY.0b013e31821fbf9a. View

Ross K, Murphy M, Adam E, Chen E, Miller G . How stable are diurnal cortisol activity indices in healthy individuals? Evidence from three multi-wave studies. Psychoneuroendocrinology. 2013; 39:184-193. PMC: 3869640. DOI: 10.1016/j.psyneuen.2013.09.016. View

Doane L, Mineka S, Zinbarg R, Craske M, Griffith J, Adam E . Are flatter diurnal cortisol rhythms associated with major depression and anxiety disorders in late adolescence? The role of life stress and daily negative emotion. Dev Psychopathol. 2013; 25(3):629-42. DOI: 10.1017/S0954579413000060. View

Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L . The cortisol awakening response: more than a measure of HPA axis function. Neurosci Biobehav Rev. 2009; 35(1):97-103. DOI: 10.1016/j.neubiorev.2009.12.011. View

Sandman C . Prenatal CRH: An integrating signal of fetal distress. Dev Psychopathol. 2018; 30(3):941-952. DOI: 10.1017/S0954579418000664. View

Buss C, Entringer S, Reyes J, Chicz-DeMet A, Sandman C, Waffarn F . The maternal cortisol awakening response in human pregnancy is associated with the length of gestation. Am J Obstet Gynecol. 2009; 201(4):398.e1-8. DOI: 10.1016/j.ajog.2009.06.063. View

Kramer M, Lydon J, Seguin L, Goulet L, Kahn S, McNamara H . Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol. 2009; 169(11):1319-26. DOI: 10.1093/aje/kwp061. View

Stalder T, Kirschbaum C, Kudielka B, Adam E, Pruessner J, Wust S . Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology. 2015; 63:414-32. DOI: 10.1016/j.psyneuen.2015.10.010. View

Mazor M, Chaim W, Hershkowitz R, Levy J, Leiberman J, Glezerman M . Association between preterm birth and increased maternal plasma cortisol concentrations. Obstet Gynecol. 1994; 84(4):521-4. View

10.

Fritz M, MacKinnon D . Required sample size to detect the mediated effect. Psychol Sci. 2007; 18(3):233-9. PMC: 2843527. DOI: 10.1111/j.1467-9280.2007.01882.x. View

11.

Dunkel Schetter C . Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol. 2010; 62:531-58. DOI: 10.1146/annurev.psych.031809.130727. View

12.

Peterson G, Espel E, Davis E, Sandman C, Glynn L . Characterizing prenatal maternal distress with unique prenatal cortisol trajectories. Health Psychol. 2020; 39(11):1013-1019. PMC: 10650951. DOI: 10.1037/hea0001018. View

13.

Entringer S, Buss C, Shirtcliff E, Cammack A, Yim I, Chicz-DeMet A . Attenuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human pregnancy. Stress. 2010; 13(3):258-68. PMC: 2862645. DOI: 10.3109/10253890903349501. View

14.

Rotenberg S, McGrath J . Sampling compliance for cortisol upon awakening in children and adolescents. Psychoneuroendocrinology. 2014; 40:69-75. PMC: 5730429. DOI: 10.1016/j.psyneuen.2013.10.002. View

15.

Obel C, Hedegaard M, Henriksen T, Secher N, Olsen J, Levine S . Stress and salivary cortisol during pregnancy. Psychoneuroendocrinology. 2005; 30(7):647-56. DOI: 10.1016/j.psyneuen.2004.11.006. View

16.

Howland M, Sandman C, Glynn L . Developmental origins of the human hypothalamic-pituitary-adrenal axis. Expert Rev Endocrinol Metab. 2018; 12(5):321-339. PMC: 6334849. DOI: 10.1080/17446651.2017.1356222. View

17.

McEwen B . The neurobiology of stress: from serendipity to clinical relevance. Brain Res. 2000; 886(1-2):172-189. DOI: 10.1016/s0006-8993(00)02950-4. View

18.

Havermans R, Nicolson N, Berkhof J, deVries M . Mood reactivity to daily events in patients with remitted bipolar disorder. Psychiatry Res. 2010; 179(1):47-52. DOI: 10.1016/j.psychres.2009.10.020. View

19.

Adam E, Kumari M . Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009; 34(10):1423-36. DOI: 10.1016/j.psyneuen.2009.06.011. View

20.

Barker D . The origins of the developmental origins theory. J Intern Med. 2007; 261(5):412-7. DOI: 10.1111/j.1365-2796.2007.01809.x. View