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Physiological Stress Reactivity in Late Pregnancy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During pregnancy, the basal activity is increased in both of our major stress response systems: the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. At the same time, the reactivity towards stressors is reduced. These alterations sustain maternal and fetal homeostasis, and are involved in the regulation of gestational length. Although the feto-placental hormone synthesis produces the main endocrinological changes, also the central nervous system undergoes adaptation. Together, these profound adjustments have been suggested to make women’s mental health more vulnerable during pregnancy and postpartum period. The aim of this thesis was to examine factors connected to physiological stress responses during the late pregnancy in relation to pain, labour onset, emotional reactivity, and mental health.

The first study examined the pain and sympathetic response during cold stress, in relation to time to delivery. Women with fewer days to spontaneous delivery had lower sympathetic reactivity, while no pain measure was associated with time to delivery.

In the second study, acoustic startle response modulation was employed to study emotional reactivity during late gestation, and at four to six weeks postpartum. The startle response was measured by eye-blink electromyography, while the participants watched pleasant and unpleasant pictures, and positive and negative anticipation stimuli. A significant reduction in startle modulation by anticipation was found during the postpartum assessment. However, no startle modulation by pleasant, or unpleasant, pictures was detected at either time-point.

The serum level of allopregnanolone, a neurosteroid implied in pregnancy-induced hyporeactivity, was analysed in relation to self-reported symptoms of anxiety and depression. Although the participants reported low levels of depression, the women with the highest depression scores had significantly lower levels of serum allopregnanolone. There was no correlation between allopregnanolone and anxiety scores.

In the fourth study, the cortisol awakening response was compared between women with depression during pregnancy, women with depression prior to pregnancy, and women who had never suffered from depression. No group differences in cortisol awakening response during late pregnancy were found.

The results are in line with the previously described pregnancy-induced hyporesponsiveness, and add to the knowledge on maternal stress hyporeactivity, gestational length, and maternal mental health.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 887
Keyword [en]
acoustic startle response, allopregnanolone, antenatal, anxiety, cold pressor test, cortisol, cortisol awakening response, depression, electrodermal, estradiol, hypothalamic-pituitary-adrenal axis, postpartum, pregnancy, progesterone, skin conductance, stress, sympathetic nervous system
National Category
Physiology Neurosciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-197441ISBN: 978-91-554-8636-5 (print)OAI: oai:DiVA.org:uu-197441DiVA: diva2:613938
Public defence
2013-05-17, Sal X, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2013-04-26 Created: 2013-03-25 Last updated: 2013-08-30Bibliographically approved
List of papers
1. Sympathetic reactivity in late pregnancy is related to labour onset in women
Open this publication in new window or tab >>Sympathetic reactivity in late pregnancy is related to labour onset in women
2011 (English)In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 14, no 6, 627-633 p.Article in journal (Refereed) Published
Abstract [en]

Stress regulation during pregnancy is considered to be connected to the timing of labour initiation. Although increasing knowledge is emerging on the regulation of parturition, there is currently no way to predict the start of spontaneous labour in women. The main aim of this study was to assess pain threshold and the sympathetic nervous system response to cold pain in relation to the onset of labour in healthy pregnant women. Ninety-three pregnant women were recruited and assessed for skin conductance (SC) activity during a cold pressor test in gestational week 38. Pain threshold and cold endurance were also measured and the results were compared with data obtained from hospital records. Seventy-four women had a spontaneous labour onset and a valid SC measurement. SC activity during the cold pressor test decreased significantly with the number of days left to spontaneous parturition. This may indicate a gradual decrease in sympathetic autonomic nervous system reactivity even during the last weeks of pregnancy. Measuring SC activity during mild stress provocation is a rapid and non-invasive means to study variation in sympathetic reactivity during pregnancy, and may be useful in research on stress regulation in pregnancy and its relation to labour initiation.

Keyword
Cold pressor test, initiation of labour, pain threshold, pregnancy, skin conductance, sympathetic activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-161450 (URN)10.3109/10253890.2011.614662 (DOI)000295891600006 ()
Available from: 2011-11-15 Created: 2011-11-14 Last updated: 2017-12-08Bibliographically approved
2. Decreased startle modulation during anticipation in the postpartum period in comparison to late pregnancy
Open this publication in new window or tab >>Decreased startle modulation during anticipation in the postpartum period in comparison to late pregnancy
Show others...
2012 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 15, no 2, 87-94 p.Article in journal (Refereed) Published
Abstract [en]

Knowledge about healthy women's psychophysiological adaptations during the large neuroendocrine changes of pregnancy and childbirth is essential in order to understand why these events have the potential to disrupt mental health in vulnerable individuals. This study aimed to compare startle response modulation, an objective psychophysiological measure demonstrated to be influenced by anxiety and depression, longitudinally across late pregnancy and the postpartum period. The acoustic startle response modulation was assessed during anticipation of affective images and during image viewing in 31 healthy women during gestational weeks 36-39 and again at 4 to 6 weeks postpartum. No startle modulation by affective images was observed at either time point. Significant modulation during anticipation stimuli was found at pregnancy assessment but was reduced in the postpartum period. The women rated the unpleasant images more negative and more arousing and the pleasant images more positive at the postpartum assessment. Self-reported anxiety and depressive symptoms did not change between assessments. The observed postpartum decrease in modulation of startle by anticipation suggests a relatively deactivated defense system in the postpartum period.

Keyword
Acoustic startle response, Affective modulation, Anticipation, Postpartum, Pregnancy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-175634 (URN)10.1007/s00737-012-0261-7 (DOI)000304169100002 ()
Available from: 2012-06-12 Created: 2012-06-11 Last updated: 2017-12-07Bibliographically approved
3. Low Serum Allopregnanolone Is Associated with Symptoms of Depression in Late Pregnancy
Open this publication in new window or tab >>Low Serum Allopregnanolone Is Associated with Symptoms of Depression in Late Pregnancy
Show others...
2014 (English)In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 69, no 3, 147-153 p.Article in journal (Refereed) Published
Abstract [en]

Allopregnanolone (3α-hydroxy-5α-pregnan-20-one) is a neurosteroid which has inhibitory function through interaction with the GABAA receptor. This progesterone metabolite has strong sedative and anxiolytic properties, and low endogenous levels have been associated with depressed mood. This study aimed to investigate whether the very high serum allopregnanolone levels in late pregnancy co-vary with concurrent self-rated symptoms of depression and anxiety.

Ninety-six women in pregnancy weeks 37 - 40 rated symptoms of depression and anxiety with the Montgomery-Åsberg Depression Rating Scale (MADRS-S) and Spielberger State-Trait Anxiety Inventory (STAI-S and STAI–T). Their serum allopregnanolone was analyzed by celite chromatography and radioimmunoassay.

Ten women had elevated depression scores (MADRS-S ≥ 13), and this group had significantly lower allopregnanolone levels compared to women with MADRS-S scores in the lower range (39.0 ± 17.9 nmol/l vs. 54.6 ± 18.7 nmol/l, p = 0.014). A significant negative correlation was found between self-rated depression scores and allopregnanolone concentrations (Pearson’s correlation coefficient = -0.220, p = 0.031). The linear association between self-rated depression scores and allopregnanolone serum concentrations remained significant when adjusted for gestational length, progesterone levels, and parity. Self-rated anxiety, however, was not associated with allopregnanolone serum concentrations during pregnancy. In conclusion, high allopregnanolone serum concentrations may protect against depressed mood during pregnancy.

Keyword
allopregnanolone, anxiety, depression, MADRS-S, neurosteroid, pregnancy, STAI
National Category
Neurosciences Physiology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology; Medical Science; Neuroscience
Identifiers
urn:nbn:se:uu:diva-197611 (URN)10.1159/000358838 (DOI)000337267300003 ()
Available from: 2013-04-02 Created: 2013-04-01 Last updated: 2017-12-06Bibliographically approved
4. Cortisol awakening response in late pregnancy in women with previous or ongoing depression
Open this publication in new window or tab >>Cortisol awakening response in late pregnancy in women with previous or ongoing depression
2013 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 38, no 12, 3150-54 p.Article in journal (Other academic) Published
Abstract [en]

Pregnancy involves an increase in basal cortisol, and a decrease in the hypothalamic-pituitary-adrenal (HPA) axis reactivity. The cortisol awakening response is a measure of HPA axis reactivity which has been reported to be altered in patients with an ongoing depressive episode, as well as in individuals with remitted depression.

This study aimed to use the cortisol awakening response to study the HPA axis reactivity in relation to previous and ongoing depression in women during the third trimester of pregnancy. Based on structured interviews, and repeated questionnaires during pregnancy, 134 women were included in one of three groups: never depressed (n=57), depressed prior to the current pregnancy (n=39), and depressed during the current pregnancy (n=38). The hypothesis was that the women with ongoing, or previous, depression would have a higher cortisol awakening response than women who have never suffered from depression.

Linear mixed models analysis revealed no group differences in the absolute cortisol levels or in the shape of the cortisol awakening response. We conclude that the difference in cortisol awakening response between women with and without experience of a depressive episode is not evident in late pregnancy.

Keyword
cortisol awakening response, pregnancy, depression
National Category
Neurosciences Physiology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-197612 (URN)
Available from: 2013-04-02 Created: 2013-04-01 Last updated: 2017-12-06Bibliographically approved

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