Abstract
Associations between salivary cortisol and maternal psychological distress and well-being were examined prospectively on 112 women with normally progressing, singleton pregnancies between 24 and 38 weeks gestation. At each of 5 visits, conducted in 3-week intervals, women provided a saliva sample and completed questionnaires measuring trait anxiety, depressive symptoms, pregnancy-specific hassles and uplifts, and psychological well-being. Maternal salivary cortisol was unrelated to psychological measures with the exception of minor associations detected with measures of anxiety and depressive symptoms between 30 and 32 weeks only. Findings indicate that self-reported maternal psychological distress and well-being are not associated with significant variation in maternal salivary cortisol levels during the second half of gestation. This suggests that studies that measure psychological factors in pregnancy but do not measure maternal cortisol should exercise caution in assuming activation of the maternal hypothalamic–pituitary–adrenal axis is the mechanism through which maternal psychological factors are transduced to the fetus.
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Allolio B, Hoffmann J, Linton EA, Winkelmann W, Kusche M, Schulte HM (1990) Diurnal salivary cortisol patterns during pregnancy and after delivery: relationship to plasma corticotrophin-releasing-hormone. Clin Endocrinol 33:279–289
Buss C, Entringer S, Reyes J, Chicz-DeMet A, Sandman C, Waffarn F, Wadhwa P (2009) The maternal cortisol awakening response in human pregnancy is associated with length of gestation. Am J Obstet Gynecol 201:398, e1–e8
Chan E, Smith R, Lewin T, Brinsmead M, Zhang H, Cubis J, Thornton K, Hurt D (1993) Plasma corticotropin-releasing hormone B-endorphin and cortisol inter-relationships during human pregnancy. Acta Endocrinol 128:339–344
Cottrell E, Seckl J (2009) Prenatal stress, glucocorticoids and the programming of adult disease. Front Behav Neurosci 3:1–9
Davis E, Sandman C (2010) The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev 81:131–148
Davis E, Glynn L, Waffarn F, Sandman C (2011) Prenatal maternal stress programs infant stress regulation. J Child Psychol Psychiat 52:119–129
de Weerth C, Buitelaar J (2005a) Cortisol awakening response in pregnant women. Psychoneuroendocrinology 30:902–907
de Weerth C, Buitelaar J (2005b) Physiological stress reactivity in human pregnancy—a review. Neurosci Biobehav Rev 29:295–312
de Weerth C, Gispen-de Weid C, Jansen L, Buitelaar J (2007) Cardiovascular and cortisol responses to a psychological stressor during pregnancy. Acta Obstet Gynecol Scand 86:1181–1192
de Wit M, Pouwer F, Gemke RJ, Delmarre-van de Waal HA, Snoek FJ (2007) Validation of the WHO-5 Well-Being Index in adolescents with type I diabetes. Diabetes Care 30:2003–2006
DiPietro J, Ghera M, Costigan K, Hawkins M (2004) Measuring the ups and downs of pregnancy. J Psychosom Obstet Gynaecol 25:189–201
DiPietro J, Christensen A, Costigan K (2008) The pregnancy experience scale—brief version. J Psychosom Obstet Gynaecol 29:262–267
DiPietro J, Kivlighan K, Costigan K, Rubin S, Shiffler D, Henderson J, Pillion JP (2010) Prenatal antecedents of newborn neurological maturation. Child Dev 81:115–130
DiPietro J, Costigan K, Kivlighan K, Chen P, Laudenslager M (2011) Maternal salivary cortisol differs by fetal sex during the second half of gestation. Psychoneuroendocrinology 36:588–591
Dunkel-Schetter C (2011) Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol 62:531–558
Eastman N (1951) Expectant motherhood, 2nd edn. Little, Brown and Company, Boston
Ellman L, Schetter C, Hobel C, Chicz-DeMet A, Glynn L, Sandman C (2008) Timing of fetal exposure to stress hormones: effects on newborn physical and neuromuscular maturation. Dev Psychobiol 50:232–241
Entringer S, Buss C, Shirtcliff E, Cammack A, Yim I, Chicz-Demet A, Sandman C, Wadhwa P (2010) Attentuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human gestation. Stress 13:258–268
Evans L, Myers M, Monk C (2008) Pregnant women’s cortisol is elevated with anxiety and depression, but only when comorbid. Arch Womens Ment Health 11:239–248
Field T, Diego M (2008) Cortisol: the culprit prenatal stress variable. Int J Neurosci 118:1181–1205
Fink N, Urech C, Berger C, Hoesli I, Holzgreve W, Bitzer J, Alder J (2010) Maternal laboratory stress influences fetal neurobehavior: cortisol does not provide all answers. J Matern-Fetal Neonatal Med 23:488–500
Gennaro S, Hennessy M (2003) Psychological and physiological stress: impact on preterm birth. J Obstet Gynecol Neonatal Nurs 32:668–675
Gitau R, Cameron A, Fisk N, Glover V (1998) Fetal exposure to maternal cortisol. Lancet 352:707–708
Goedhart G, Vrijkotte T, Roseboom T, van der Wal M, Cuijpers P, Bonsel G (2010) Maternal cortisol and offspring birthweight: results from a large prospective cohort study. Psychoneuroendocrinology 35:644–652
Gutteling B, de Weerth C, Zandbelt N, Mulder E, Visser G, Buitelaar J (2006) Does maternal prenatal stress adversely affect the child’s learning and memory at age six? J Abnorm Child Psychol 34:789–798
Harville E, Savitz D, Dole N, Herring A, Thorp J, Light K (2007) Patterns of salivary cortisol secretion in pregnancy and implications for assessment protocols. Biol Psychol 74:85–91
Harville E, Savitz D, Dole N, Herring A, Thorp J (2009) Stress questionnaires and stress biomarkers during pregnancy. J Womens Health 18:1425–1433
Heun R, Burkat M, Maier W, Bech P (1999) Internal and external validity of the WHO Well-Being Scale in the elderly general population. Acta Psychiat Scand 99:171–178
King N, Chambers J, O’Donnell K, Jayaweera S, Williamson C, Glover V (2010) Anxiety, depression and saliva cortisol in women with a medical disorder during pregnancy. Arch Womens Ment Health 13:339–345
Kivlighan K, DiPietro J, Costigan K, Laudenslager M (2008) Diurnal rhythm of cortisol during late pregnancy: associations with maternal psychological well-being and fetal growth. Psychoneuroendocrinology 33:1225–1235
Kramer M, Lydon J, Seguin L, Goulet L, Kahn S, McNamara H, Genest J, Dassa C, Chen M, Sharma S, Meaney M, Thomson S, Van Uum S, Koren G, Dahhou M, Lamroureux J, Platt R (2009) Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol 169:1319–1326
Magiakou M, Mastorakos G, Rabin D, Margioris A, Dubbert B, Calogero A, Tsigos C, Munson P, Chrousos G (1996) The maternal hypothalamic–pituitary–adrenal axis in the third trimester of human pregnancy. Clin Endocrinol 44:419–428
Mastorakos G, Ilias I (2003) Maternal and fetal hypothalamic–pituitary–adrenal axes during pregnancy and postpartum. Ann N Y Acad Sci 997:136–149
Mendelson T, DiPietro J, Costigan K, Chen P, Henderson J (2011) Associations of maternal psychological factors with umbilical and uterine blood flow. J Psychosom Obstet Gynaecol 32:3–9
Mercer R, Ferketich S (1988) Stress and social support as predictors of anxiety and depression during pregnancy. Adv Nurs Sci 10:36–39
Mosack V, Shore E (2006) Screening for depression among pregnant and postpartum women. J Community Health Nurs 23:37–47
Mulder E, Robles de Medina P, Huizink A, Van den Bergh B, Buitelaar J, Visser G (2002) Prenatal maternal stress: effects on pregnancy and the (unborn) child. Ear Hum Dev 70:3–14
Neu M, Goldstein M, Gao D, Laudenslager M (2007) Salivary cortisol in preterm infants: validation of a simple method for collecting saliva for cortisol determination. Ear Hum Dev 83:47–54
Nierop A, Wirtz P, Bratsikas A, Zimmermann R, Ehlert U (2008) Stress-buffering effects of psychosocial resources on physiological and psychological stress response in pregnant women. Biol Psychol 78:261–268
Obel C, Hedegaard M, Henriksen T, Secher N, Olsen J, Levine S (2005) Stress and salivary cortisol during pregnancy. Psychoneuroendocrinology 30:647–656
Petraglia F, Florio P, Nappi C, Genazzani A (1996) Peptide signaling in human placenta and membranes: autocrine, paracrine, and endocrine mechanisms. Endocr Rev 17:156–186
Petraglia F, Hatch M, Lapinski R, Stomati M, Reis F, Cobellis L, Berkowitz G (2001) Lack of effect of psychosocial stress on maternal corticotropin-releasing factor and catecholamine levels at 28 weeks gestation. J Soc Gynecol Investig 8:83–88
Pluess M, Bolten M, Pirke K, Hellhammer D (2010) Maternal trait anxiety, emotional distress, and salivary cortisol in pregnancy. Biol Psychol 83:169–175
Pluess M, Wurmser H, Buske-Kirschbaum A, Papouse M, Pirke K, Hellhammer D, Bolten M (2012) Positive life events predict salivary cortisol in pregnant women. Psychoneuroendocrinology 37:1336–1340
Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Rothenberger S, Moehler E, Reck C, Resch R (2011) Prenatal stress: course and interrelation of emotional and physiological stress measures. Psychopathology 44:60–67
Sandman C, Wadhwa P, Chica-DeMet A, Dunkel-Schetter C, Porto M (1997) Maternal stress, HPA activity, and fetal/infant outcome. Ann N Y Acad Sci 814:266–275
Sandman C, Glynn L, Schetter C, Wadwha P, Garite T, Chicz-DeMet A, Hobel C (2006) Elevated maternal cortisol early in pregnancy predicts third trimester levels of placental corticotropin releasing hormone (CRH): priming the placental clock. Peptides 27:1457–1463
Sarkar P, Bergman K, Fisk N, Glover V (2006) Maternal anxiety at amniocentesis and plasma cortisol. Prenat Diag 26:505–509
Shea A, Streiner D, Fleming A, Kamath M, Broad K, Steiner M (2007) The effect of depression, anxiety and early life trauma on the cortisol awakening response during pregnancy: preliminary results. Psychoneuroendocrinology 32:1013–1020
Sikkema J, Robles de Medina P, Schaad R, Mulder E, Bruinse H, Buitelaar J, Visser G, Franx A (2001) Salivary cortisol levels and anxiety are not increased in women destined to develop preeclampsia. J Psychosom Res 50:45–49
Spielberger C (1983) Manual for the state-trait anxiety inventory (Form Y). Mind Garden, Palo Alto
Stalla G, Bost H, Stalk J, Kaliebe T, Dorr H, Pfeiffer D, Werder K, Muller O (1989) Human corticotropin-releasing hormone during pregnancy. Gynecol Endocrinol 3:1–10
Vining R, McGinley R (1987) The measurement of hormones in saliva: possibilities and pitfalls. J Steroid Biochem 27:81–94
Wadhwa P (2005) Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology 30:724–743
Wadhwa P, Dunkel-Schetter C, Chicz-deMet A, Porto M, Sandman C (1996) Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy. Psychosom Med 58:432–446
Wadhwa P, Entringer S, Buss C, Lu M (2011) The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol 38:351–384
World Health Organization (2008) Well-being measures in primary health care: the DepCare project. Stockholm, Sweden
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This research was supported by National Institute of Child Health and Human Development grant 5R01 HD027592, awarded to J. A. DiPietro.
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Voegtline, K.M., Costigan, K.A., Kivlighan, K.T. et al. Concurrent levels of maternal salivary cortisol are unrelated to self-reported psychological measures in low-risk pregnant women. Arch Womens Ment Health 16, 101–108 (2013). https://doi.org/10.1007/s00737-012-0321-z
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DOI: https://doi.org/10.1007/s00737-012-0321-z