Department of Psychology, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840-0901, USA.
Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA.
Psychoneuroendocrinology. 2019 Jun;104:174-184. doi: 10.1016/j.psyneuen.2019.02.022. Epub 2019 Feb 22.
Dysregulations in maternal hypothalamus-pituitary-adrenal function and the end product, cortisol, have been associated with a heightened risk for stress-related health complications during pregnancy and post partum. Given the adverse health impact that maternal cortisol may have on expectant mothers and their infants, empirically-based prenatal interventions are needed to target optimal management of stress and its biological effects in at-risk pregnant women, a primary example of which is cognitive behavioral stress management (CBSM). This randomized-controlled trial examined the effects of a prenatal CBSM intervention on reduction in perceived stress and regulation of salivary cortisol patterns [i.e., overall cortisol output (area under the curve), cortisol awakening response (CAR), diurnal slope] during pregnancy and the early postpartum period, as compared to a control group.
One hundred low-income pregnant women (71% Latina; 76% annual income < $20 K) with low or high anxiety during pregnancy were randomized (stratified by anxiety) to either an eight-week CBSM group intervention (n = 55) or a control group (n = 45). They provided seven salivary cortisol samples (four am samples, 12 pm, 4 pm, and 8 pm samples on one collection day) at baseline (1 trimester; < 17 weeks of gestation), after their prenatal program (2 trimester), and also in the third trimester and at three months post partum.
Women receiving CBSM had lower perceived stress levels throughout pregnancy and early post partum compared to women in the control group (p = .020). Among women with high prenatal anxiety, those in CBSM showed a steeper decline in their diurnal cortisol at three months post partum compared to those in the control group (p = .015). Further, non-Latina women in CBSM had a lower CAR at three months post partum compared to non-Latina women in the control group (p = .025); these randomization group differences on the CAR were not observed among Latina women.
These findings provide preliminary support for the efficacy of prenatal CBSM interventions in improving stress outcomes among low-income pregnant women and suggest the need to test the effects of these interventions on a larger scale for improving maternal and infant health outcomes long-term.
母体下丘脑-垂体-肾上腺功能失调及其产物皮质醇与妊娠和产后应激相关健康并发症的风险增加有关。鉴于母体皮质醇可能对孕妇及其婴儿造成的不良健康影响，需要基于经验的产前干预措施来针对高危孕妇进行压力及其生物学效应的最佳管理，其中一个主要示例是认知行为应激管理 (CBSM)。本随机对照试验研究了产前 CBSM 干预对降低妊娠和产后早期感知压力和唾液皮质醇模式调节（即总体皮质醇输出量（曲线下面积）、皮质醇唤醒反应 (CAR)、日间斜率）的影响，与对照组相比。
100 名低收入孕妇（71%拉丁裔；76%年收入<20000 美元）在妊娠期间焦虑程度低或高，按焦虑程度分层（分为焦虑低组和焦虑高组），随机分为 8 周 CBSM 组干预组（n = 55）或对照组（n = 45）。她们在基线（妊娠早期；<17 周妊娠）、产前计划后（妊娠中期）以及妊娠晚期和产后三个月时提供了 7 个唾液皮质醇样本（4 个 am 样本，12 pm、4 pm 和 8 pm 样本在一个采集日）。
与对照组相比，接受 CBSM 的女性在整个妊娠和产后早期的压力水平较低（p =.020）。在产前焦虑较高的女性中，CBSM 组在产后三个月时的日间皮质醇下降幅度较对照组更大（p =.015）。此外，与对照组的非拉丁裔女性相比，CBSM 组的非拉丁裔女性在产后三个月时的 CAR 较低（p =.025）；在拉丁裔女性中未观察到这些随机分组组间在 CAR 上的差异。
这些发现初步支持了产前 CBSM 干预在改善低收入孕妇应激结果方面的有效性，并表明需要在更大范围内测试这些干预措施对改善母婴健康结果的长期影响。
