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Psychophysiology and posttraumatic stress disorder symptom profile in pregnant African-American women with trauma exposure

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Abstract

While female sex is a robust risk factor for posttraumatic stress disorder (PTSD), pregnant women are an understudied population in regards to PTSD symptom expression profiles. Because circulating hormones during pregnancy affect emotionality, we assessed whether pregnant women would have increased expression of the intermediate phenotypes of hyperarousal and fear-potentiated startle (FPS) compared to non-pregnant women. We examined PTSD symptom profiles in pregnant (n = 207) and non-pregnant women (n = 370). In a second study, FPS responses were assessed in 15 pregnant and 24 non-pregnant women. All participants were recruited from the obstetrics and gynecology clinic at a public hospital serving a primarily African-American, low socioeconomic status, inner-city population. Our results indicate that overall PTSD symptoms were not different between the groups of women. However, pregnant women reported being more hypervigilant (p = 0.036) than non-pregnant women. In addition, pregnant women showed increased FPS to a safety signal compared to non-pregnant women (p = 0.024). FPS to a safety signal in pregnant women was significantly correlated with PTSD hyperarousal symptoms (r = 0.731, p < 0.001). Furthermore, discrimination between danger and safety signals was present in non-pregnant women (p = 0.008), but not in pregnant women (p = 0.895). Together, these data suggest that pregnant women show clinical and psychophysiological hyperarousal compared to non-pregnant women, and support screening for PTSD and assessment of PTSD risk in pregnant women.

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References

  • APA APA (2000) Diagnostic and statistical manual of mental disorders

  • Ayers S, Pickering AD (2001) Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 28:111–118

    Article  CAS  PubMed  Google Scholar 

  • Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  CAS  PubMed  Google Scholar 

  • Bernstein DP, Ahluvalia T, Pogge D, Handelsman L (1997) Validity of the childhood trauma questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry 36:340–348. doi:10.1097/00004583-199703000-00012

    Article  CAS  PubMed  Google Scholar 

  • Brand SR, Engel SM, Canfield RL, Yehuda R (2006) The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant. Ann N Y Acad Sci 1071:454–458

    Article  PubMed  Google Scholar 

  • Brennan PA, Pargas R, Walker EF, Green P, Newport DJ, Stowe Z (2008) Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. J Child Psychol Psychiatry 49:1099–1107

    Article  PubMed Central  PubMed  Google Scholar 

  • Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the national comorbidity survey. Am J Epidemiol 147:353–361

    Article  CAS  PubMed  Google Scholar 

  • Burleson MH, Malarkey WB, Cacioppo JT, Poehlmann KM, Kiecolt-Glaser JK, Berntson GG, Glaser R (1998) Postmenopausal hormone replacement: effects on autonomic, neuroendocrine, and immune reactivity to brief psychological stressors. Psychosom Med 60:17–25

    Article  CAS  PubMed  Google Scholar 

  • Buss C, Davis EP, Shahbaba B, Pruessner JC, Head K, Sandman CA (2012) Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci U S A 109:E1312–E1319. doi:10.1073/pnas.1201295109

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Dailey DE, Humphreys JC, Rankin SH, Lee KA (2011) An exploration of lifetime trauma exposure in pregnant low-income African American women. Matern Child Health J 15:410–418. doi:10.1007/s10995-008-0315-7

    Article  PubMed Central  PubMed  Google Scholar 

  • Dell’Osso L et al (2013) Age, gender and epicenter proximity effects on post-traumatic stress symptoms in L’Aquila 2009 earthquake survivors. J Affect Disord 146:174–180

    Article  PubMed  Google Scholar 

  • Dias BG, Ressler KJ (2014) Parental olfactory experience influences behavior and neural structure in subsequent generations. Nat Neurosci 1:89–96

  • Foa EB, Tolin DF (2000) Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. J Trauma Stress 13:181–191. doi:10.1023/A:1007781909213

    Article  CAS  PubMed  Google Scholar 

  • Foa EB, Riggs DS, Dancu CV, Rothbaum BO (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 6:459–473

    Article  Google Scholar 

  • Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, Marks JS (2000) Violence and reproductive health: current knowledge and future research directions. Matern Child Health J 4:79–84

    Article  CAS  PubMed  Google Scholar 

  • Gillespie CF et al (2009) Trauma exposure and stress-related disorders in inner city primary care patients. Gen Hosp Psychiatry 31:505–514. doi:10.1016/j.genhosppsych.2009.05.003

    Article  PubMed Central  PubMed  Google Scholar 

  • Glover EM et al (2011) Tools for translational neuroscience: PTSD is associated with heightened fear responses using acoustic startle but not skin conductance measures. Depress Anxiety 28:1058–1066. doi:10.1002/da.20880

    Article  PubMed Central  PubMed  Google Scholar 

  • Glover EM, Jovanovic T, Mercer KB, Kerley K, Bradley B, Ressler KJ, Norrholm SD (2012) Estrogen levels are associated with extinction deficits in women with posttraumatic stress disorder. Biol Psychiatry 72:19–24. doi:10.1016/j.biopsych.2012.02.031

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Glover EM et al (2013) Inhibition of fear is differentially associated with cycling estrogen levels in women. J Psychiatry Neurosci 38:341–348. doi:10.1503/jpn.120129

    Article  PubMed Central  PubMed  Google Scholar 

  • Grillon C, Pine DS, Baas JM, Lawley M, Ellis V, Charney DS (2006) Cortisol and DHEA-S are associated with startle potentiation during aversive conditioning in humans. Psychopharmacology 186:434–441. doi:10.1007/s00213-005-0124-2

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Gudmundsson A et al (1999) Effects of estrogen replacement therapy on the circadian rhythms of serum cortisol and body temperature in postmenopausal women. Exp Gerontol 34:809–818

    Article  CAS  PubMed  Google Scholar 

  • Hellgren C, Bannbers E, Akerud H, Risbrough V, Poromaa IS (2012) Decreased startle modulation during anticipation in the postpartum period in comparison to late pregnancy. Archives Women’s Mental Health 15:87–94. doi:10.1007/s00737-012-0261-7

    Article  Google Scholar 

  • Huot RL, Brennan PA, Stowe ZN, Plotsky PM, Walker EF (2004) Negative affect in offspring of depressed mothers is predicted by infant cortisol levels at 6 months and maternal depression during pregnancy, but not postpartum. Ann N Y Acad Sci 1032:234–236

    Article  CAS  PubMed  Google Scholar 

  • Jovanovic T, Ressler KJ (2010) How the neurocircuitry and genetics of fear inhibition may inform our understanding of PTSD. Am J Psychiatry 167:648–662. doi:10.1176/appi.ajp.2009.09071074

    Article  PubMed Central  PubMed  Google Scholar 

  • Jovanovic T et al (2009) Posttraumatic stress disorder may be associated with impaired fear inhibition: relation to symptom severity. Psychiatry Res 167:151–160. doi:10.1016/j.psychres.2007.12.014

    Article  PubMed Central  PubMed  Google Scholar 

  • Jovanovic T, Norrholm SD, Blanding NQ, Davis M, Duncan E, Bradley B, Ressler KJ (2010a) Impaired fear inhibition is a biomarker of PTSD but not depression. Depress Anxiety 27:244–251. doi:10.1002/da.20663

    Article  PubMed Central  PubMed  Google Scholar 

  • Jovanovic T et al (2010b) Fear potentiation is associated with hypothalamic-pituitary-adrenal axis function in PTSD. Psychoneuroendocrinology 35:846–857

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Jovanovic T, Kazama A, Bachevalier J, Davis M (2012) Impaired safety signal learning may be a biomarker of PTSD. Neuropharmacology 62:695–704. doi:10.1016/j.neuropharm.2011.02.023

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Keen-Rhinehart E et al (2009) Continuous expression of corticotropin-releasing factor in the central nucleus of the amygdala emulates the dysregulation of the stress and reproductive axes. Mol Psychiatry 14:37–50

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL (2003) Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol 71:692–700

    Article  PubMed  Google Scholar 

  • Kline A et al (2013) Gender differences in the risk and protective factors associated with PTSD: a prospective study of National Guard troops deployed to Iraq. Psychiatry 76:256–272. doi:10.1521/psyc.2013.76.3.256

    Article  PubMed  Google Scholar 

  • Kuo CD, Chen GY, Yang MJ, Lo HM, Tsai YS (2000) Biphasic changes in autonomic nervous activity during pregnancy. Br J Anaesth 84:323–329

    Article  CAS  PubMed  Google Scholar 

  • Landolt MA, Schnyder U, Maier T, Schoenbucher V, Mohler-Kuo M (2013) Trauma exposure and posttraumatic stress disorder in adolescents: a national survey in Switzerland. J Trauma Stress 26:209–216. doi:10.1002/jts.21794

    Article  PubMed  Google Scholar 

  • Lissek S, Powers AS, McClure EB, Phelps EA, Woldehawariat G, Grillon C, Pine DS (2005) Classical fear conditioning in the anxiety disorders: a meta-analysis. Behav Res Ther 43:1391–1424. doi:10.1016/j.brat.2004.10.007

    Article  PubMed  Google Scholar 

  • Lissek S, Rabin S, Heller RE, Lukenbaugh D, Geraci M, Pine DS, Grillon C (2010) Overgeneralization of conditioned fear as a pathogenic marker of panic disorder. Am J Psychiatry 167:47–55. doi:10.1176/appi.ajp.2009.09030410

    Article  PubMed Central  PubMed  Google Scholar 

  • Lissek S, Kaczkurkin AN, Rabin S, Geraci M, Pine DS, Grillon C (2013) Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biol Psychiatry. doi:10.1016/j.biopsych.2013.07.025

    PubMed Central  PubMed  Google Scholar 

  • Loveland Cook CA (2004) Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment. Obstet Gynecol 103

  • Mastorakos G, Ilias I (2003) Maternal and fetal hypothalamic-pituitary-adrenal axes during pregnancy and postpartum. Ann N Y Acad Sci 997:136–149

    Article  CAS  PubMed  Google Scholar 

  • Matthews TJ, MacDorman MF (2007) Births: final data for 2005. Natl Vital Stat Rep 56:1–103

    Google Scholar 

  • McEwen BS (2002) Sex, stress and the hippocampus: allostasis, allostatic load and the aging process. Neurobiol Aging 23:921–939

    Article  CAS  PubMed  Google Scholar 

  • McEwen BS (2008) Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol 583:174–185. doi:10.1016/j.ejphar.2007.11.071

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Michopoulos V, Wilson ME (2011) Body weight decreases induced by estradiol in female rhesus monkeys are dependent upon social status. Physiol Behav 102:382–388. doi:10.1016/j.physbeh.2010.11.031

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Morland L et al (2007) Posttraumatic stress disorder and pregnancy health: preliminary update and implications. Psychosomatics 48:304–308. doi:10.1176/appi.psy.48.4.304

    Article  PubMed  Google Scholar 

  • Norrholm SD, Jovanovic T, Olin IW, Sands LA, Karapanou I, Bradley B, Ressler KJ (2011) Fear extinction in traumatized civilians with posttraumatic stress disorder: relation to symptom severity. Biol Psychiatry 69:556–563. doi:10.1016/j.biopsych.2010.09.013

    Article  PubMed Central  PubMed  Google Scholar 

  • Pearson RM, Lightman SL, Evans J (2009) Emotional sensitivity for motherhood: late pregnancy is associated with enhanced accuracy to encode emotional faces. Horm Behav 56:557–563. doi:10.1016/j.yhbeh.2009.09.013

    Article  CAS  PubMed  Google Scholar 

  • Roy BN, Reid RL, Van Vugt DA (1999) The effects of estrogen and progesterone on corticotropin-releasing hormone and arginine vasopressin messenger ribonucleic acid levels in the paraventricular nucleus and supraoptic nucleus of the rhesus monkey. Endocrinology 140:2191–2198

    Article  CAS  PubMed  Google Scholar 

  • Sanchez MM, Noble PM, Lyon CK, Plotsky PM, Davis M, Nemeroff CB, Winslow JT (2005) Alterations in diurnal cortisol rhythm and acoustic startle response in nonhuman primates with adverse rearing. Biol Psychiatry 57:373–381. doi:10.1016/j.biopsych.2004.11.032

    Article  CAS  PubMed  Google Scholar 

  • Schwartz AC, Bradley RL, Sexton M, Sherry A, Ressler KJ (2005) Posttraumatic stress disorder among African Americans in an inner city mental health clinic. Psychiatr Serv 56:212–215. doi:10.1176/appi.ps.56.2.212

    Article  PubMed  Google Scholar 

  • Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I (2009) Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstet Gynecol 114:839–847

    Article  PubMed Central  PubMed  Google Scholar 

  • Seng JS et al (2010) Exploring posttraumatic stress disorder symptom profile among pregnant women. J Psychosom Obstet Gynaecol 31:176–187. doi:10.3109/0167482X.2010.486453

    Article  PubMed Central  PubMed  Google Scholar 

  • Smith MV, Poschman K, Cavaleri MA, Howell HB, Yonkers KA (2006) Symptoms of posttraumatic stress disorder in a community sample of low-income pregnant women. Am J Psychiatry 163:881–884. doi:10.1176/appi.ajp.163.5.881

    Article  PubMed  Google Scholar 

  • Soldin OP, Guo T, Weiderpass E, Tractenberg RE, Hilakivi-Clarke L, Soldin SJ (2005) Steroid hormone levels in pregnancy and 1 year postpartum using isotope dilution tandem mass spectrometry. Fertil Steril 84:701–710

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Steven Betts K, Williams GM, Najman JM, Alati R (2013) Exploring the female specific risk to partial and full PTSD following physical assault. J Trauma Stress 26:86–93. doi:10.1002/jts.21776

    Article  PubMed  Google Scholar 

  • Toufexis DJ, Davis C, Hammond A, Davis M (2004) Progesterone attenuates corticotropin-releasing factor-enhanced but not fear-potentiated startle via the activity of its neuroactive metabolite, allopregnanolone. J Neurosci 24:10280–10287

    Article  CAS  PubMed  Google Scholar 

  • Weissman MM, Olfson M (1995) Depression in women: implications for health care research. Sci (New York NY) 269:799–801

    Article  CAS  Google Scholar 

  • Yehuda R, Engel SM, Brand SR, Seckl J, Marcus SM, Berkowitz GS (2005) Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. J Clin Endocrinol Metab 90:4115–4118

    Article  CAS  PubMed  Google Scholar 

  • Yonkers KA, Smith MV, Forray A, Epperson CN, Costello D, Lin H, Belanger K (2014) Pregnant women with posttraumatic stress disorder and risk of preterm birth. JAMA Psychiatry 71:897–904. doi:10.1001/jamapsychiatry.2014.558

    Article  PubMed Central  PubMed  Google Scholar 

  • Zhang Z, Shi Z, Wang L, Liu M (2012) Post-traumatic stress disorder, anxiety and depression among the elderly: a survey of the hard-hit areas a year after the Wenchuan earthquake. Stress Health 28:61–68

    Article  PubMed  Google Scholar 

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Acknowledgments

The current study was supported by MH096764, MH071537 (KJR), MH100122, MH092576 (TJ), the Emory and Grady Memorial Hospital General Clinical Research Center, NIH National Centers for Research Resources (M01RR00039), NARSAD (TJ), The Burroughs Welcome Fund (KJR), Emory Medical Care Foundation (TJ), and the Howard Hughes Medical Institute (KJR). The study was supported in part by PHS Grant (UL1 RR025008, KL2 RR025009 or TL1 RR025010) from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources. The contents of this manuscript do not reflect the views of the Department of Veterans Affairs or the United States Government. This study would not have been possible without the research expertise and technical assistance of Allen Graham, Angelo Brown, and all the staff, volunteers, and participants of the Grady Trauma Project.

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All authors have no conflicts of interests.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr. NE, Atlanta, GA, 30303, USA

    Vasiliki Michopoulos, Alex O. Rothbaum, Kerry J. Ressler & Tanja Jovanovic

  2. Yerkes National Primate Research Center, Atlanta, GA, USA

    Vasiliki Michopoulos & Kerry J. Ressler

  3. Emory University School of Nursing, Atlanta, GA, USA

    Elizabeth Corwin

  4. Mental Health Service Line, Department of Veterans Affairs Medical Center, Atlanta, GA, USA

    Bekh Bradley

  5. Howard Hughes Medical Institute, Bethesda, MD, USA

    Kerry J. Ressler

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  1. Vasiliki Michopoulos
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Correspondence to Vasiliki Michopoulos.

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Michopoulos, V., Rothbaum, A.O., Corwin, E. et al. Psychophysiology and posttraumatic stress disorder symptom profile in pregnant African-American women with trauma exposure. Arch Womens Ment Health 18, 639–648 (2015). https://doi.org/10.1007/s00737-014-0467-y

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