Date of Award

Spring 2021

Degree Name

Master of Science in Health Education

Department

Physician Assistant; College of Health Sciences

First Advisor

Kimberly Erikson

Abstract

Elevated levels of stress, anxiety, and depression during pregnancy are thought to influence cortisol levels. Dysregulations in cortisol, as a byproduct of the hypothalamic-pituitary axis, have been associated with preterm birth and adverse birth outcomes. Studies have demonstrated poorer long-term effects of antenatal stress on child neurodevelopment, temperament, and cognition. Psychological interventions of cognitive behavioral therapy (CBT), mindfulness, and gratitude have shown to have a positive effect on psychological wellbeing across various populations. The purpose of this literature review was to analyze a collection of randomized-controlled trials to conclude if psychological interventions during pregnancy for women with elevated levels of stress, may lead to fewer adverse birth events. A literature search was conducted in October and November of 2019 using PubMed and Google Scholar to retrieve 10 research articles meeting inclusion criteria. This study evaluated 3 variables including cortisol, stress, and adverse birth outcomes. The various psychological interventions included cognitive behavioral therapy, mindfulness, and gratitude. Several studies had evidence of at least one cortisol measurement declining with a psychological intervention. A few of the studies showed promising results that psychological interventions reduced perceived stress and/or cortisol levels. Though many of the articles are limited in their ability to draw generalizable conclusions due to limited sample size, significant participant dropout rates, differing intervention strategies, and varying protocols for measuring stress and cortisol levels. The overall evidence is lacking to support psychological interventions reducing stress levels or adverse birth events during pregnancy in women with elevated cortisol.

Comments

References

1. Bittner A, Peukert J, Zimmermann C, et al. Early Intervention in Pregnant Women with Elevated Anxiety and Depressive Symptoms. The Journal of Perinatal & Neonatal Nursing. 2014;28(3):185-195. doi:10.1097/jpn.0000000000000027

2. Entringer S, Buss C, Andersen J, Chicz-Demet A, Wadhwa PD. Ecological Momentary Assessment of Maternal Cortisol Profiles Over a Multiple-Day Period Predicts the Length of Human Gestation. Psychosomatic Medicine. 2011;73(6):469-474. doi:10.1097/psy.0b013e31821fbf9a

3. Field T, Diego M, Delgado J, Medina L. Peer support and interpersonal psychotherapy groups experienced decreased prenatal depression, anxiety and cortisol. Early Human Development. 2013;89(9):621-624. doi:10.1016/j.earlhumdev.2013.04.006

4. Matvienko-Sikar K, Dockray S. Effects of a novel positive psychological intervention on prenatal stress and well-being: A pilot randomised controlled trial. Women and Birth. 2017;30(2):111-118. doi:10.1016/j.wombi.2016.10.003

5. Osborne, S., Biaggi, A., Chua, T.E., Du Preez, A., Hazelgrove, K., Nikkheslat, N., Previti, G., Zunszain, P.A., Conroy, S., Pariante, C.M. (2018). Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood – Depression (PRAM-D) Study. Psychoneuroendocrinology. 98: 211-221. doi.org/10.1016/j.psyneuen.2018.06.017

6. Polanska K, Krol A, Merecz-Kot D, et al. Maternal stress during pregnancy and neurodevelopmental outcomes of children during the first 2 years of life. Journal of Paediatrics and Child Health. 2017;53(3):263-270. doi:10.1111/jpc.13422

7. Richoux, S. E. (2019). The Relationship of Maternal Perinatal Stress and Stress Hormones to Birth Outcomes. UCSF. ProQuest ID: Richoux_ucsf_0034D_11873. Merritt ID: ark:/13030/m5c58q6x.

8. Richter, J., Bittner, A., Petrowski, K., Junge-Hoffmeister, J., Bergmann, S., Joraschky, P., Weidner, K. (2012). Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology. Journal of Psychosomatic Obstetrics & Gynecology, 33(4): 162-170. Doi: 10.3109/0167482X.2012.729111

9. Sandman, C., Davis, E., Buss, C., & Glynn, L. (2012). Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus. Neuroendocrinology, 95(1), 7-21. doi.org/10.1159/000327017

10. Urech C, Scherer S, Emmenegger M, et al. Efficacy of an internet-based cognitive behavioral stress management training in women with idiopathic preterm labor: A randomized controlled intervention study. Journal of Psychosomatic Research. 2017;103:140-146. doi.org/10.1016/j.jpsychores.2017.10.014

11. Urizar GG, Muñoz RF. Impact of a Prenatal Cognitive-Behavioral Stress Management Intervention on Salivary Cortisol Levels in Low-Income Mothers and their Infants. Psychoneuroendocrinology. 2011;36(10):1480-1494. doi:10.1016/j.psyneuen.2011.04.002

12. Urizar GG, Yim IS, Rodriguez A, Schetter CD. The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women. Psychoneuroendocrinology. 2019;104:174-184. doi.org/10.1016/j.psyneuen.2019.02.022

13. Wadhwa, P.D., Entringer, S., Buss, C., & Lu, M. C. (2011). The Contribution of Maternal Stress of Pretrerm Birth: Issues and Considerations. Clinics in Perinatology, 38(3), 351-384. doi;10.1016/j.clp.2011.06.007

14. Wesley Y. Reduce stress: a stress reduction project for pregnant black women. Journal of Cultural Diversity. 2006;13(4):208-216.

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The Effects of Psychological Intervention on Pregnant Women with Elevated Cortisol Levels and Adverse Birth Events

Elevated levels of stress, anxiety, and depression during pregnancy are thought to influence cortisol levels. Dysregulations in cortisol, as a byproduct of the hypothalamic-pituitary axis, have been associated with preterm birth and adverse birth outcomes. Studies have demonstrated poorer long-term effects of antenatal stress on child neurodevelopment, temperament, and cognition. Psychological interventions of cognitive behavioral therapy (CBT), mindfulness, and gratitude have shown to have a positive effect on psychological wellbeing across various populations. The purpose of this literature review was to analyze a collection of randomized-controlled trials to conclude if psychological interventions during pregnancy for women with elevated levels of stress, may lead to fewer adverse birth events. A literature search was conducted in October and November of 2019 using PubMed and Google Scholar to retrieve 10 research articles meeting inclusion criteria. This study evaluated 3 variables including cortisol, stress, and adverse birth outcomes. The various psychological interventions included cognitive behavioral therapy, mindfulness, and gratitude. Several studies had evidence of at least one cortisol measurement declining with a psychological intervention. A few of the studies showed promising results that psychological interventions reduced perceived stress and/or cortisol levels. Though many of the articles are limited in their ability to draw generalizable conclusions due to limited sample size, significant participant dropout rates, differing intervention strategies, and varying protocols for measuring stress and cortisol levels. The overall evidence is lacking to support psychological interventions reducing stress levels or adverse birth events during pregnancy in women with elevated cortisol.