Hair Cortisol Concentrations as a Biological Marker of Maternal Prenatal Stress: A Systematic Review

Recently, biological markers of maternal prenatal stress, hair cortisol, along with saliva, blood, and urine cortisol, have received attention. However, it is necessary to validate measuring hair cortisol concentrations (HCC) as a biomarker of perceived stress among healthy and high-risk pregnant women. This study aimed to confirm the correlation between HCC and the perceived stress of pregnant women over 18 years of age. In this systematic review, we used various search engines to extract relevant articles using specific keywords related to pregnancy, hair cortisol, and psychological stress. Four out of 3639 studies met the inclusion criteria. We conducted a quality assessment with the help of three independent reviewers using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The correlation between HCC and perceived stress was confirmed in one study. There was only one study on hair washing, shampoo, conditioner, and hair structure that could affect hair samples. In four studies, hair samples differed in length, methods of storage, and laboratory analysis. The review was limited to confirming the relationship between HCC and perceived stress in pregnant women based on the current evidence. Studies on hair cortisol need regulated and standardized methods for collection, storage, and analysis of hair samples.

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The relationship between stress and hair cortisol in healthy pregnant women

Clinical & Investigative Medicine ◽

10.25011/cim.v30i2.986 ◽

2007 ◽

Vol 30 (2) ◽

pp. 103 ◽

Cited By ~ 152

Author(s):

Sanjog Kalra ◽

Adrienne Einarson ◽

Tatyana Karaskov ◽

Stan Van Uum ◽

Gideon Koren

Keyword(s):

Pregnant Women ◽

Perceived Stress ◽

Biological Marker ◽

Hair Cortisol ◽

Stress Scale ◽

Potential Biomarker ◽

Cortisol Levels ◽

Gestational Stress ◽

The Relationship

Purpose: Stress has been shown to cause a large range of adverse fetal effects. This pilot study is the first attempt to examine cortisol level in the hair of pregnant women and assess its potential as a biomarker of gestational stress. Patients and Methods: Twenty-five healthy pregnant women, in whom hair cortisol levels and the Perceived Stress Scale (PSS) were measured and correlated. Results: Maternal hair cortisol levels, ranging between 0.06 and 0.23 nmol/g of hair correlated positively and significantly with measures of perceived stress (ranging between 2-22); (Rs=0.47) (P < 0.05). Conclusions: Our findings corroborate recent primate studies with induced stress, and suggest that hair cortisol is a potential biomarker of chronic stress in pregnancy. This new long term biological marker may have important implications in research and clinical practice.

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Effects of Moringa Oleifera Leaves and Honey Supplementation during Pregnancy on Mothers and Newborns: A Review of the Current Evidence

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4670 ◽

2020 ◽

Vol 8 (F) ◽

pp. 208-214

Author(s):

Veni Hadju ◽

Muhammad Dassir ◽

Andi Sadapotto ◽

Aliyah Putranto ◽

Geoffrey Marks ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Moringa Oleifera ◽

Current Evidence ◽

Maternal Weight ◽

Health Food ◽

Negative Effects ◽

Nutrient Supplementation ◽

Moringa Oleifera Leaves

BACKGROUND: Malnutrition in pregnant women has been known to bring effects on the mothers’ and infants’ health. Food or nutrient supplementation is now being used to correct the problems. Moringa Oleifera leaves and honey are the two types of natural supplements used by pregnant women. AIM: This systematic review aimed to evaluate the potential effects of Moringa, honey, and both compared to ironfolic acid supplements given to pregnant women on the pregnancy outcomes. METHODS: A systematic review was conducted to evaluate the extent of the benefits of the supplementation of M. Oleifera, honey, or both against pregnant women. There were seven studies which are conducted in Indonesia on this topic. RESULTS: This review shows that M. Oleifera leaves in the form of extract and powder as well as honey could improve maternal weight and hemoglobin, and baby’s birth weight. Moreover, both interventions could reduce stress and protect mothers and their babies from negative effects of oxidative stress. CONCLUSION: Nevertheless, efforts are needed to formulate a recommended dose as adequate supplements for pregnant women.

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Within person associations of hair cortisol concentration and maternal prenatal stress in the context of the hormonal milieu

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2020.104983 ◽

2020 ◽

Vol 119 ◽

pp. 104983

Author(s):

Olivia C. Robertson ◽

Emily Rolan ◽

Wen Wang ◽

Elizabeth A. Shirtcliff ◽

Kristine Marceau

Keyword(s):

Prenatal Stress ◽

Cortisol Concentration ◽

Hair Cortisol ◽

Hormonal Milieu ◽

Maternal Prenatal Stress

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Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.796009 ◽

2021 ◽

Vol 8 ◽

Author(s):

Carlos Pascual-Morena ◽

Iván Cavero-Redondo ◽

Celia Álvarez-Bueno ◽

José Alberto Martínez-Hortelano ◽

Sara Reina-Gutiérrez ◽

...

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Physical Exercise ◽

Cesarean Section ◽

Pregnant Women ◽

Current Evidence ◽

Cochrane Library ◽

Exercise Interventions ◽

Combined Exercise ◽

Meta Analyses

Background: Overweight/obesity is associated with the risk of delivery- and newborn-related complications in pregnancy. Interventions such as exercise or metformin could reduce the risk of these complications.Objective: To estimate and compare the effects of different types of exercise interventions (i.e., aerobic, resistance, combined exercise) and metformin on delivery- and newborn-related outcomes among pregnant women with overweight/obesity.Methods: MEDLINE, Scopus, Web of Science, Cochrane Library databases and the gray literature were searched from inception to September 2021. This systematic review was registered in PROSPERO (CDR: 42019121715). Randomized controlled trials (RCTs) of metformin or an exercise intervention aimed at preventing cesarean section, preterm birth, macrosomia, or birth weight among pregnant women with overweight/obesity were included. Random effects meta-analyses and frequentist network meta-analyses (NMA) were conducted for each outcome.Results: Fifteen RCTs were included. In the NMA, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.46, 0.95), combined exercise reduced the risk of macrosomia (RR = 0.37, 95% CI: 0.14, 0.95), and aerobic exercise reduced birth weight (mean difference = −96.66 g, 95% CI: −192.45, −0.88). In the subgroup among pregnant women with obesity, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.45, 0.97).Conclusions: Combined exercise could reduce the risk of macrosomia in pregnant women with overweight, whereas metformin could reduce the risk of cesarean section in pregnant women with obesity. However, previous evidence suggests a larger effect of physical exercise in other outcomes for this population group. Therefore, the medicalization of healthy pregnant women with obesity is not justified by the current evidence.Systematic Review Registration: PROSPERO: CRD42019121715; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019121715

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Hair Cortisol and Its Association With Psychological Risk Factors for Psychiatric Disorders: A Pilot Study in Adolescent Twins

Twin Research and Human Genetics ◽

10.1017/thg.2016.50 ◽

2016 ◽

Vol 19 (5) ◽

pp. 438-446 ◽

Cited By ~ 14

Author(s):

Liz Rietschel ◽

Fabian Streit ◽

Gu Zhu ◽

Kerrie McAloney ◽

Clemens Kirschbaum ◽

...

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Psychiatric Disorders ◽

Chronic Stress ◽

Perceived Stress ◽

Eysenck Personality Questionnaire ◽

Hair Cortisol ◽

Symptoms Of Depression ◽

Stress Symptoms ◽

Hair Samples

Measuring cortisol in hair is a promising method to assess long-term alterations of the biological stress response system, and hair cortisol concentrations (HCC) may be altered in psychiatric disorders and in subjects suffering from chronic stress. However, the pattern of associations between HCC, chronic stress and mental health require clarification. Our exploratory study: (1) assessed the association between HCC and perceived stress, symptoms of depression and neuroticism, and the trait extraversion (as a control variable); and (2) made use of the twin design to estimate the genetic and environmental covariance between the variables of interest. Hair samples from 109 (74 female) subjects (age range 12–21 years, mean 15.1) including 8 monozygotic (MZ) and 21 dizygotic (DZ) twin pairs were analyzed. Perceived stress was measured with the Perceived Stress Scale and/or the Daily Life and Stressors Scale, neuroticism, and extraversion with the NEO-Five Factor Inventory or the Junior Eysenck Personality Questionnaire, and depressive symptoms with the Somatic and Psychological Health Report. We found a modest positive association between HCC and the three risk factors — perceived stress, symptoms of depression, and neuroticism (r = 0.22–0.33) — but no correlation with extraversion (-0.06). A median split revealed that the associations between HCC and risk factors were stronger (0.47–0.60) in those subjects with HCC >11.36 pg/mg. Furthermore, our results suggest that the genetic effects underlying HCC are largely shared with those that influence perceived stress, depressive symptoms, and neuroticism. These results of our proof of principle study warrant replication in a bigger sample but raise the interesting question of the direction of causation between these variables.

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Do Physical Activity and Personality Matter for Hair Cortisol Concentration and Self-Reported Stress in Pregnancy? A Pilot Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218050 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8050

Author(s):

Dagmara Budnik-Przybylska ◽

Radosław Laskowski ◽

Paulina Pawlicka ◽

Paulina Anikiej-Wiczenbach ◽

Ariadna Łada-Maśko ◽

...

Keyword(s):

Physical Activity ◽

Pregnant Women ◽

Perceived Stress ◽

Life Quality ◽

Significant Negative Correlation ◽

Cortisol Concentration ◽

Activity Level ◽

Hair Cortisol ◽

Cross Sectional ◽

Significant Difference

Background: Physical activity reduces psychosocial stress in pregnant women. Stress levels might be self-reported (psychosocial) or measured with biomarkers, one of which is hair cortisol concentration (HCC). Additionally, personality has been associated with stress and physical activity. Methods: The first aim of our study was to explore the differences in self-reported stress assessed by the Perceived Stress Scale (PSS) and in HCC with regard to physical activity level in pregnant (N = 29) and non-pregnant (N = 21) women. The second aim was to analyze the correlations among perceived stress, HCC, frequency of exercise and personality in the two groups separately. Results: There was a significant difference in frequency of exercise and self-reported stress between the two groups, with a lower level in pregnant women, but no differences in HCC and in personality were found. In the group of pregnant women, there was a significant negative correlation between HCC and frequency of exercise sessions, with the latter correlating positively with openness to experience. In the group of non-pregnant women, perceived stress negatively correlated with extraversion, agreeableness and emotional stability. HCC correlated negatively with conscientiousness. Conclusions: Our findings indicate the importance of physical activity programs dedicated to pregnant women for their life quality.

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Maternal Prenatal Psychosocial Stress and BMI Predict Lower Fetal Iron Status in a Mexico City Cohort (FS01-07-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.fs01-07-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Rebecca Campbell ◽

Marcela Tamayo-Ortiz ◽

Alejandra Cantoral ◽

Rosalind Wright ◽

Martha Tellez-Rojo ◽

...

Keyword(s):

Cord Blood ◽

Mexico City ◽

Perceived Stress ◽

Prenatal Stress ◽

Psychosocial Stress ◽

Overweight And Obesity ◽

Depression Symptoms ◽

Psychological Function ◽

Neurocognitive Development ◽

Maternal Prenatal Stress

Abstract Objectives Insufficient iron in utero may impair neurocognitive development. Prenatal physiological stress, as in obesity, inhibits fetal iron accumulation. Emerging evidence suggests prenatal psychosocial stress may similarly suppress fetal iron, a novel potential mechanism linking prenatal stress and child neuro-cognition. In a pregnancy cohort in Mexico City, Mexico, we investigated associations between maternal prenatal stress and psychological function, pre-pregnancy BMI and fetal iron at delivery. We hypothesized that maternal prenatal psychosocial stress and psychological dysfunction and pre-pregnancy BMI would be associated with lower cord blood Hb and ferritin. Methods Psychosocial stress and psychological function were assessed with validated questionnaires in mid-pregnancy: depression symptoms (CES-D), trait anxiety (STI), perceived stress (PSS-4), lifetime exposure to violence (ETV), and negative life events (NLEs, CRISYS). Pre-pregnancy BMI was calculated from self-reported height and weight. Cord blood was collected at delivery and ferritin (ferr.) and hemoglobin (Hb) measured. Regression models were developed for Hb and log-transformed ferr. as functions of dichotomized stress scores (CES-D ≥ 13, STI > median, PSS-4 > 4th quartile, ETV > 0.5, CRISYS > 1st quartile) and pre-pregnancy overweight and obesity in separate models, each adjusted for maternal age, SES, child sex and maternal prenatal iron supplementation (yes/no). Results In 455 dyads with complete data, median (IQR) ferr. and Hb were 186 µg/L (125, 265) and 16 g/dL (14.7, 17), respectively. In adjusted models, lower ferr. was associated with prenatal depression symptoms (11%, 95% CI: −0.26, 0.01), elevated perceived stress (23%, −0.35, −0.09), high lifetime violence (21%, −0.33, −0.06) and high NLEs count (10%, −0.22, 0.02), as well as maternal pre-pregnancy obesity (17%, −0.31, −0.00). Interaction models suggested possible stronger prenatal stressor effects among overweight and obese mothers. No associations with cord blood Hb were observed. Conclusions In Mexico City pregnant women, excess pre-pregnancy BMI and multiple prenatal psychosocial stressors were each associated with fetal iron stores at birth. Insufficient fetal iron accrual may explain links between maternal prenatal stress and child neurocognitive development, but more research is needed. Funding Sources National Institutes of Health, Office of the Director; National Institute of Environmental Health Sciences.

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Vertical transmission of SARS-CoV-2: A systematic review

Obstetric Medicine ◽

10.1177/1753495x211038157 ◽

2021 ◽

pp. 1753495X2110381

Author(s):

Kristine Jeganathan ◽

Anthea BM Paul

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Vertical Transmission ◽

Classification System ◽

Neonatal Outcomes ◽

Current Evidence ◽

Maternal And Neonatal Outcomes ◽

Intrauterine Infections

In this study, we discuss vertical transmission of SARS-CoV-2, and assess various maternal and neonatal outcomes based on the current evidence available. This systematic review using PRISMA guidelines revealed a total of 47 eligible studies describing 1188 SARS-CoV-2 positive pregnant women and 985 neonates for review. Utilizing the ‘Shah’s Classification System for Maternal-Fetal-Neonatal SARS-CoV-2 Intrauterine Infections’ by Shah et al., we found vertical transmission confirmed in 0.3% ( n = 3), probable in 0.5% ( n = 5), possible in 1.8% ( n = 17), unlikely in 80.3% (724) and not infected in 17% ( n = 153).

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The characteristics and effectiveness of pregnancy yoga interventions: A systematic review and meta-analysis

10.21203/rs.3.rs-418294/v1 ◽

2021 ◽

Author(s):

Lisa Corrigan ◽

Patrick Moran ◽

Niamh McGrath ◽

Jessica Eustace-Cook ◽

Deirdre Daly

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Perceived Stress ◽

Meta Analysis ◽

Vaginal Birth ◽

Time Duration ◽

Positive Effects ◽

Mode Of Birth ◽

Anxiety Depression

Abstract Background: Yoga is a popular mind-body medicine frequently recommended and to pregnant women. Gaps remain in our understanding of core components of effective pregnancy yoga programmes. This review and meta-analysis examined the characteristics and effectiveness of pregnancy yoga, incorporating the FITT (frequency, intensity, time/duration and type) principle of exercise prescription in the analysis. Methods: The following electronic databases were searched: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga interventions were eligible for inclusion. Covidence was used to screen titles, abstracts, and full text articles. Outcomes of interest were stress, anxiety, depression, quality of life, labour duration, pain management in labour and mode of birth. The Cochrane Collaboration’s Risk of Bias Assessment tool was used to assess methodological quality of studies and GRADE criteria (Gradepro) evaluated quality of the evidence. Meta-analysis was performed using Revman 5.3. Results: 678 citations were retrieved, 24 studies met inclusion criteria. 22 studies with 1826 pregnant women were included for meta-analysis. Applying per-protocol analysis and a random effects model, the pooled standardised mean difference (SMD) for depression (-0.53; 95% CI: -1.04 to -0.02, P=0.04), anxiety (-0.82; 95% CI: -1.64 to -0.01; p=0.05), perceived stress (-1.03; 95% CI: -1.55 to -0.52; p<0.0001) and physiological stress (-0.24; 95% CI: -0.52 to 0.04, P=0.09) supported a statistically significant beneficial effect of pregnancy yoga interventions for anxiety, depression and perceived stress. Duration of labour was shorter (MD= -116.96; 95% CI -163.36 to -70.56, P<0.00001) and normal vaginal birth rates were higher in the yoga group (OR 2.72; 95% CI 1.26-5.90, p=0.01). The quality of evidence (GRADE) was low to very low for all factors. Twelve or more yoga sessions delivered weekly/bi-weekly had a statistically significant impact on mode of birth, while twelve or more yoga sessions of long duration (>60mins) had a statistically significant impact on perceived stress. Yoga sessions had a statistically significant impact on anxiety while yoga therapy had a statistically significant impact on depressionConclusion: The evidence supports previously cited positive effects of pregnancy yoga on anxiety, depression, perceived stress, normal vaginal birth and shorter duration of labour. Systematic review registration: PROSPERO, CRD42019119916. Registered on 11th January 2019.Protocol publication: Corrigan L, Eustace-Cook J, Moran P and Daly D. The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol [version 2; peer review: 2 approved]. HRB Open Res 2020, 2:33 (https://doi.org/10.12688/hrbopenres.12967.2)

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Effects of nonpharmacological interventions on the psychological health of high-risk pregnant women: a systematic review and meta-analysis

Korean Journal of Women Health Nursing ◽

10.4069/kjwhn.2021.09.17 ◽

2021 ◽

Vol 27 (3) ◽

pp. 180-195

Author(s):

Hyeji Yoo ◽

Sukhee Ahn

Keyword(s):

Systematic Review ◽

High Risk ◽

Gestational Diabetes ◽

Pregnant Women ◽

Psychological Health ◽

Preterm Labor ◽

Meta Analysis ◽

Current Evidence ◽

Trim And Fill ◽

Fail Safe

Purpose: This study aimed to summarize the current evidence on the effects of nonpharmacological interventions on psychological health outcomes for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, or preterm labor.Methods: The following databases were searched from January 2000 to December 2020: PubMed, Ovid Embase, CINAHL, Web of Science, DBpia, RISS, and KISS. Two investigators independently reviewed and selected articles according to the inclusion/exclusion criteria. RoB 2 and the ROBINS-I checklist were used to evaluate study quality.Results: Twenty-nine studies with a combined total of 1,806 pregnant women were included in the systematic review and meta-analysis. Psychological health improvements were found in women with preeclampsia (Hedges’ g=–0.67; 95% confidence interval [CI], –0.91 to –0.44), gestational diabetes (Hedges’ g=–0.38; 95% CI, –0.54 to –0.12), and preterm labor (Hedges’ g=–0.73; 95% CI, –1.00 to –0.46). The funnel plot was slightly asymmetrical, but the fail-safe N value and the trim-and-fill method showed no publication bias.Conclusion: Nonpharmacological interventions for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, and preterm labor can improve psychological parameters such as anxiety, stress, and depression. Nurses can play a pivotal role in the nursing management of pregnant women with high-risk conditions and apply various types of nonpharmacological interventions to meet their needs in uncertain and anxious times during pregnancy.

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