Hair cortisol levels, psychological stress and psychopathological symptoms prior to instrumental deliveries

Abstract

Objective

To determine whether psychological variables (perceived stress, pregnancy-specific stress and psychopathology symptoms) and physiological variables (hair cortisol levels) are related to type of delivery (eutocic or instrumental delivery; spontaneous or induced labor).

Design

This was a longitudinal study.

Setting

Spain.

Participants

A total sample of 88 pregnant women.

Measurement and Findings

Perceived stress, pregnancy-specific stress, psychopathology symptoms and hair cortisol level were assessed in pregnant women throughout the third trimester of pregnancy until they gave birth. Participants were grouped by type of delivery (eutocic or instrumental delivery; spontaneous or induced labor). ANOVA tests were performed in order to determine differences between groups. We found differences between the eutocic and instrumental delivery groups in the SCL-90-R subscales somatisation (t = 6.98; p = 0.01), anxiety (t = 3.42; p < 0.05), depression (t = 5.20; p < 0.02) and psychoticism (t = 5.28; p < 0.01), and in the general indices global severity index (t = 5.57; p < 0.05) and positive symptoms (t = 5.21; p < 0.01). No differences were found between groups for the other variables.

Key Conclusions

Maternal psychological status could have an impact on delivery, since women who had an instrumental delivery presented more psychopathology symptoms in the third trimester.

Implications for Research

The psychological assessment and treatment of pregnant women could play a key role in enhancing maternal mental health and preventing the processes and outcomes associated with poor psychological status.

Introduction

Pregnancy is a highly stressful period due to the many challenges it presents. These include physical changes, concerns about motherhood, tension in personal relationships, fear of childbirth and worries about the infant's health (Lobel and Dunkel Schetter, 2016). These all correspond to a particular kind of stress, termed pregnancy-specific stress, which can lead to negative health outcomes for the mother and her newborn infant. Pregnancy-specific stress has been associated with a higher risk of spontaneous abortion, preterm delivery and low birth weight, as well as postpartum depression and even poor cognitive neurodevelopment in the infant (Alderdice et al., 2012, Caparros-Gonzalez et al., 2017, Romero-Gonzalez et al., 2018). It has been reported to be a better predictor of negative outcomes than general stress, and together with depression and anxiety, it poses a major problem for mothers (Alderdice et al., 2012, Lobel and Dunkel Schetter, 2016).

From the biological point of view, cortisol is released as a result of experiencing psychological stress (El-Farhan et al., 2017). Cortisol levels can be measured in hair, saliva or blood, but hair offers the unique advantage of providing retrospective information. In addition, collection is non-invasive and hair is easy to handle and transport (Wright et al., 2015). However, the most important advantage of hair is that it provides information on chronic stress levels in the months prior to collection, because cortisol is deposited and stored in the capillary root (Wright et al., 2015). High cortisol levels during pregnancy have been associated with preterm delivery, delivery complications, maternal illness, postpartum depression and permanent changes in infant physiology (Caparros-Gonzalez et al., 2017, Hoffman et al., 2016, Littleton et al., 2010, Romero-Gonzalez et al., 2018). High saliva cortisol has also been reported to be a predictor of low birth weight (van den Heuvel et al., 2018).

Psychological stress and cortisol levels both increase towards the end of gestation, and a marked rise in these variables may be related to delivery complications, which in turn are associated with a higher risk for mothers and babies (Mylonas and Friese, 2015, Rallis et al., 2014, Sandman et al., 2006). Labor is a decisive process in a pregnant woman's life, since it has been demonstrated that instrumental deliveries reduce the probability of wanting to have another baby (Elvander et al., 2015). Furthermore, instrumental deliveries and caesarean sections both have repercussions for maternal and child health and are associated with worse obstetric outcomes in subsequent pregnancies and children (Black et al., 2015, Hu et al., 2018, Youssef et al., 2005).

Maternal age, a higher body mass index, previous instrumental deliveries and first pregnancies are among the risk factors that have been related to instrumental deliveries and caesarean sections (Dietz et al., 2006, Roos et al., 2010). In terms of psychological variables in pregnant woman, some studies have reported that depression and anxiety are related to delivery complications (Alder et al., 2007), but this relationship remains inconclusive since other studies have failed to find the same association (Larsson et al., 2004). However, these studies were conducted on women with a depressive or anxiety disorder, and no comparisons were performed with the psychological profile of healthy pregnant women. Besides the lack of agreement regarding the relationship between psychopathology and delivery, it should be noted that to the best of our knowledge, there is no evidence of the role of chronic and pregnancy-specific stress in delivery complications.

Consequently, given the possible impact of stress in the final stages of gestation on delivery, the aim of the present study was to determine which psychological (perceived stress, pregnancy-specific stress and psychopathology symptoms), physiological (hair cortisol), sociodemographic and obstetric variables, collected during the third trimester of pregnancy, are associated with important delivery variables (eutocic or instrumental delivery, spontaneous or induced labor).