1. Maternal Psychological Distress and Cortisol
Jenna Schroeder 🔸 DePaul University, Chicago, IL 🔸 College of Science and Health 🔸 Masters Entry to Nursing Practice
Background and Significance
Purpose and Research Questions
Discussion
Associations exist between prenatal maternal distress and increased risk for preterm birth and having a low birth weight baby.
Low birth weight is a negative indication of health in a newborn and is a risk factor for several long-term health consequences.
If cortisol is mediator: What relationship exists between maternal psychological distress and cortisol?
Purpose: To examine the connection between perceived maternal stress during pregnancy and its relationship to maternal cortisol secretion.
Research Questions:
1) Does perceived maternal stress correlate with elevated cortisol in mothers?
2) What tools to measure maternal psychological distress accurately determine shifts in cortisol?
3) What interventions could be put in place to better recognize maternal psychological distress and potentially harmful shifts in maternal cortisol?
Future studies should focus on changes in the diurnal cortisol pattern and changes in CAR.
A pattern of a lower initial (wake-up) cortisol level and a flattened, less sharply declining diurnal pattern may be a sign of HPA axis & cortisol dysregulation.
Methods
The design of this study was an integrative literature review. Each study was assessed for its ability to demonstrate a connection between maternal psychological distress and maternal cortisol levels.
The studies were categorized in a table using the following headings: source, purpose/problem, sample, designs, instruments, results, implications, and comments
Key words included: perceived maternal stress, cortisol, pregnancy, anxiety, depression, psychological distress
Looking at CAR may provide a glimpse into overall HPA axis health rather than moment to moment changes.
A larger attenuation of the CAR from early to late gestation was associated with a longer gestational length, and a smaller attenuation of the CAR from early to late gestation was associated with a shorter gestational length.
Using the DSM may be the most accurate tool for future studies to utilize and may be the only tool that can reveal comorbidities.
Lazarus and Folkman’s (1984) Transactional Model of Stress and Coping:
Examines the human response to stress.
Individual responses to the same stressor vary by person.
Importance of coping mechanisms to modulate response.
Theoretical Framework
Results and Findings
The link between prenatal maternal stress and cortisol was present but weak.
Changes in the cortisol awakening response (CAR), or non-typical CARs, were found in depressed individuals and individuals comorbid for depression and anxiety.
Degree of change in CAR during gestation was associated with length of gestation.
When the DSM-IV was used as a diagnostic tool, elevated cortisol was seen in women comorbid for depression and anxiety, but not with depression or anxiety alone.
Positive life events predicted significantly lower cortisol while negative life events proved unrelated to cortisol.
Trait anxiety, or neuroticism, were found to be significantly correlated with self-reported distress and with elevated cortisol.
Nursing Implications
Focus on coping skills and positive life experiences which provide protective factors in the face of psychological distress.
The establishment/use of pregnancy groups where expectant mothers can share their experiences, support each other, and develop coping skills, is a cost-effective way to implement change.
More complete psychological evaluations for at-risk mothers.