Psychological and biological markers of stress and bacterial vaginosis in pregnant women

Abstract

Objectives To determine whether stress is associated with risk of bacterial vaginosis (BV) in pregnant women.Design Prospective cohort study.Setting The prenatal care clinics at the University of North Carolina. The residents' clinic sees mostly government-insured and uninsured women, and the physicians' clinic sees mostly those with private health insurance.Population A total of 897 women gave samples for BV analysis. Study participants were 22% African-American, 68% white; 24% unmarried and 44% nulliparous. More than half had completed college.Methods Women completed two questionnaires and two interviews reporting stress and psychological aspects of their lives. Measurement scales included the Sarason life events questionnaire, the Cohen perceived stress scale, Spielberger state-trait anxiety, the John Henryism coping style and the Medical Outcomes Study social support inventory. Two stress hormones, corticotrophinreleasing hormone and cortisol, were also measured.Main outcome measures BV at 15-19 and 24-29 weeks of gestation was diagnosed by Gram's stain.Results Women in the highest quartile of stress measures, particularly state anxiety (OR = 2.0, 95% CI 1.2-3.3), perceived stress (OR = 2.4, 95% CI 1.5-3.9) and total life events (OR = 2.0, 95% CI 1.3-3.2), had the highest risk of BV. Adjustment for confounders, especially age, race, and income, reduced these associations (state anxiety: OR = 1.3, 95% CI 0.7-2.4; perceived stress: OR = 1.4, 95% CI 0.8-2.5; total life events: OR = 1.3, 95% CI 0.7-2.4). No clear pattern of association was seen between stress hormones and BV.Conclusions Few associations between stress and BV were seen after adjustment for confounders.

Predictors of anxiety symptoms in the gynecological outpatient setting: The Thai experience

“…This association is consistent with several studies conducted in developing countries, particularly in Asia [80Á83]. Many studies demonstrate an association between stress or anxiety and an increased susceptibility to many infectious diseases including reproductive tract infections [84,88]. Stress-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis which influences the immune system has been purported to mediate the relationship between stress and infection [84,85].…”

Reproductive tract infections associated with vaginal discharge and their socio-demographic and reproductive determinants among clinic attendees in Bangladesh

“…It is possible that working women experience more psychosocial stress, which other authors have suggested increases the risk of bacterial vaginosis by lowering their immune function. 26 Using an IUD and being nulliparous were found to be associated with bacterial vaginosis in our study. A biological explanation for this could that the presence of a neutrophil elastase inhibitor known as secretory leukocyte protease inhibitor (SLPI) in human cervical mucosa.…”

Coping during pregnancy: a systematic review and recommendations

“…Three studies found that problem-focused coping styles, such as problem-solving, planning and preparation, are associated with greater pregnancy-related distress (Faisal-Cury et al, 2012; Hamilton & Lobel, 2008; Yali & Lobel, 1999), whereas a fourth found that active coping styles were associated with fewer depressive symptoms (Wells, Hobfoll, & Lavin, 1997). John Henryism, an effortful coping style, has been linked to greater likelihood of exercise during pregnancy among African-American pregnant women (Orr, James, Garry, & Newton, 2006), but it was also more strongly associated with bacterial vaginosis than any other stress-related measure in 1,587 pregnant women in North Carolina (Harville, Savitz, Dole, Thorp, & Herring, 2007). The results of the latter study suggest a link between coping processes and immune function, although this association was no longer statistically significant in analyses that controlled for age, income, and race.…”