Changes in the Diurnal Rhythms of Plasma Cortisol in Women during the Third Trimester of Pregnancy

Challis, John; Patrick, John

doi:10.1159/000299209

Cited by 14 publications

(7 citation statements)

References 12 publications

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“…We used the same commercially available assay kit and found similar mean evening cortisol concentrations and standard deviations, adding support for the empirical findings that cortisol values do not begin to increase until the second half of pregnancy (Challis & Patrick, 1983; Challis, Sprague & Patrick, 1983). …”

Section: Discussionsupporting

confidence: 66%

Ecological Salivary Cortisol Analysis— Part 2

King

Leichtman

Abelson

et al. 2008

J Am Psychiatr Nurses Assoc

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Background Although bio-psycho-social health research is an ideal, samples adequate for complex modeling require biomarker specimens from hundreds of participants. Ecological sampling departs from laboratory study norms, with implications for analysis. Objective This paper compares salivary cortisol levels and effect sizes of ‘focal’ psychiatric factors, such as trauma history, posttraumatic stress diagnosis, comorbidity, and chronic stress, and ‘nuisance’ factors, including endocrine disorders, medications, physiological factors, such as gestational age, and smoking, to inform ecological study designs. Study Design This is a descriptive analysis of ecologically collected cortisol specimens, assayed in an on-going perinatal psychobiological study, addressing methodological considerations. Results Focal and nuisance factors are often interdependent with similar effect sizes. Careful specimen deletion decisions and model specification are needed to achieve the hoped-for external validity while maintaining internal validity. Conclusions Results of multivariate models support the validity and usefulness of an ecological approach to incorporating biomarkers in health research.

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Section: Discussionsupporting

confidence: 66%

Ecological Salivary Cortisol Analysis— Part 2

King

Leichtman

Abelson

et al. 2008

J Am Psychiatr Nurses Assoc

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“…First, we deleted two participants with endocrine disorders (i.e., diabetes) and nine who used medications that could be threats to internal validity (e.g., corticosteroid asthma inhalers, selective serotonin reuptake inhibitors). Next, because cortisol rises in the latter parts of pregnancy (Challis & Patrick, 1983; Challis et al, 1983), and based on a receiver operator characteristic analysis, we deleted 54 women who returned kits at greater than 25 weeks gestational age or if gestational age was unknown. We substituted the detectable limit of 0.003 μg/dL of cortisol (morning n = 0 substitutions; late afternoon n = 41 substitutions; bedtime n = 42 substitutions) for cortisol specimens below the detectable limit.…”

Section: Methodsmentioning

confidence: 99%

“…Pregnancy itself alters HPA axis functioning, with the placenta and fetus contributing to maternal circulating cortisol, especially in late gestation (Challis & Patrick, 1983; Challis, Sprague, & Patrick, 1983). For this reason, pregnancy-specific studies of the effects of PTSD and smoking on cortisol levels are needed.…”

Section: Introductionmentioning

confidence: 99%

Posttraumatic stress disorder, smoking, and cortisol in a community sample of pregnant women

Lopez

Seng

2014

Addictive Behaviors

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The prevalence of posttraumatic stress disorder (PTSD) in the United States is higher among pregnant women than women generally. PTSD is related to adverse birth outcomes via physiological and behavioral alterations, such as smoking. We utilize salivary cortisol measures to examine how traumatic stress, smoking and the hypothalamic-pituitary-adrenal axis interact. Pregnant women (n =395) gave cortisol specimens as part of a cohort study of PTSD and pregnancy at three health systems in the Midwestern United States. Women were divided into three groups: nonsmokers, quitters (who stopped smoking during pregnancy), and pregnancy smokers. Mean cortisol values at three points, sociodemographics, trauma history, and PTSD were compared across groups. We assessed the association of smoking group and PTSD with late afternoon cortisol levels. Smokers, quitters, and nonsmokers differed on demographic risk factors and PTSD symptom load. Late afternoon and bedtime cortisol measures were significantly positively correlated with smoking in pregnancy, with smokers with PTSD presenting the highest cortisol levels. Regression analysis showed that smoking in pregnancy was associated with higher late afternoon cortisol in an additive manner with PTSD symptoms. Smoking appears to have a different relationship with cortisol level for those with and without PTSD. This is the first study to show additive effects of smoking and PTSD on cortisol levels in pregnant women. Since high cortisol, smoking, and PTSD have been shown to adversely affect perinatal outcomes, and since those continuing to smoke in pregnancy had the highest PTSD symptom load, PTSD-specific smoking cessation programs in maternity settings are warranted.

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“…Basal cortisol concentrations have a diurnal pattern, peaking in the morning and declining late in the day 13 . In pregnancy, the diurnal pattern appears to be somewhat flatter, 14 and the basal concentrations of cortisol increase across the second half of gestation, peaking prior to labor 15 …”

Section: Posttraumatic Stress Disordermentioning

confidence: 99%

Cortisol Level and Perinatal Outcome in Pregnant Women With Posttraumatic Stress Disorder: A Pilot Study

Seng

Low²,

Ben-Ami³

et al. 2005

J Midwife Womens Health

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Posttraumatic stress disorder (PTSD) affects 12% of women in the United States and could affect childbearing via behavioral and neuroendocrine mechanisms. This pilot study collected preliminary data about the extent to which the low cortisol profile found in patients with PTSD also occurs in the hormonal context of pregnancy, as well as the association between PTSD and less optimal processes and outcomes of pregnancy. Standardized psychiatric diagnostic telephone interviews, salivary cortisol assays, and medical records review were evaluated in a community sample of 25 women pregnant with their first child. Higher PTSD symptom counts correlated with worse overall perinatal outcomes summarized by an Optimality Index Score (n = 22; r = -.725; P < .001). The women whose symptoms met diagnostic criteria for PTSD or partial PTSD had lower peak basal salivary cortisol concentrations (n = 14; mean = .4584 versus .8123; P = .010). Further research on the effects of PTSD on pregnancy processes and outcomes is warranted. Differences in cortisol levels were consistent with the pattern seen in nonpregnant women with PTSD. This finding suggests that salivary cortisol would be a useful biological measure to include in perinatal research on PTSD and childbearing.

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Changes in the Diurnal Rhythms of Plasma Cortisol in Women during the Third Trimester of Pregnancy

Cited by 14 publications

References 12 publications

Ecological Salivary Cortisol Analysis— Part 2

Ecological Salivary Cortisol Analysis— Part 2

Posttraumatic stress disorder, smoking, and cortisol in a community sample of pregnant women

Cortisol Level and Perinatal Outcome in Pregnant Women With Posttraumatic Stress Disorder: A Pilot Study

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