Maternal prenatal and early postnatal distress and child stress responses at age 6.

Individuals differ in their physiological and behavioral stress responses. Alterations in these responses have been associated with mental and physical health. Therefore, it is important to understand how stress responses develop. This study investigated whether in a healthy, non-risk population, 6-year-old's physiological (cortisol) and behavioral (gazing) stress responses were associated with stress early in the child's life, in the form of maternal prenatal and early postnatal distress. Additionally, associations between the two stress responses were studied. At age 6, children (n = 149; Mage = 6.09; 70 girls) in a longitudinal project that started prenatally (n = 193), participated in a social evaluative stress test (Children's Reactions to Evaluation Stress Test, CREST) in front of a judge. To operationalize physiological stress responses six cortisol saliva samples were collected and cortisol stress reactivity and total stress cortisol scores were calculated. To operationalize behavioral stress responses, gazing at the judge during the stress test was observed. Maternal prenatal distress (week 37) was measured using questionnaires and physiological measures, that is, cortisol saliva samples. Early postnatal maternal distress (first 6 months) was measured using questionnaires. Results of hierarchical regression analyses indicated that less maternal prenatal fear of giving birth, higher maternal prenatal evening cortisol concentrations, and more maternal feelings of anxiety in the first 6 postnatal months were all uniquely associated with higher total stress cortisol concentrations in children at age 6. Additionally, correlations indicated that children with higher cortisol stress reactivity gazed less in the direction of the judge. Results indicate that maternal prenatal and early postnatal distress are associated with children's later hypothalamic-pituitary-adrenal-axis functioning and that in children gazing and physiological stress reactivity are related. Lay summary We examined whether maternal stress and anxiety during pregnancy, as measured by means of maternal self-reports and saliva cortisol samples, as well as maternal stress and anxiety in the first 6 months of the child's life, measured using maternal self-reports, were associated with children's physiological (cortisol) and behavioral (gazing) responses during a stressful laboratory situation at the age of 6. Results showed that mothers with higher levels of distress in late pregnancy and/or the early postnatal period had children with higher cortisol concentrations during the stressful situation. This suggests that maternal prenatal and early postnatal distress are associated with children's later hypothalamic-pituitary-adrenal-axis functioning.

Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study.

AIM: Maternal prenatal anxiety and stress (PNS) have been positively associated to physical health prob lems in offspring in the first year of life. Whether these associations are transient, persistent, or even progressive over time, is as yet unknown. The goal of this study is to investigate associations between late pregnancy PNS and child health from 18 months to age 6. METHODS: Mothers were recruited in late pregnancy, and had uncomplicated, singleton pregnancies without physical health problems. Around week 37 of pregnancy, mothers reported on their PNS by means of questionnaires, and provided saliva for determination of circadian cortisol concentrations. Children's illnesses in the preceding year were assessed using maternal reports at 30, 48, 60, and 72 months. Antibiotic use was obtained from medical records between one and six years. Multilevel models (N»174) showed a positive relation between maternal prenatal general and pregnancy-specific anxiety during late pregnancy and offspring respiratory illnesses and symptoms. Interaction effects with time indicated that more PNS was related to more respiratory illnesses until toddlerhood, but not later in life. Furthermore, maternal prenatal cortisol concentrations were related to child digestive illnesses. A steeper maternal cortisol decline over the day was related to more child digestive illnesses, until around three years of age. Finally, children of mothers who suffered more from daily hassles during pregnancy received more antibiotics between one and six years of age. PNS was not related to general and skin illnesses. CONCLUSION: Summarizing, this study showed that late pregnancy anxiety and cortisol was associated with children's respiratory and digestive illnesses till the age of 3.0-3.5 years. Additionally, more daily hassles were related to more prescribed antibiotics between one and six years. These findings point in the direction of possible effects of PNS persisting beyond the first year of life and into toddlerhood, but disappearing at older ages.

Cortisol responses to social evaluation in 10- to 15-year-old boys and girls.

This study investigated Cortisol responses and perceived stress of 10-15-year-olds to a computerized paradigm including elements of social evaluation, unpredictability, and uncontrollability. Both age and sex differences were examined. Participants were 52 children and adolescents (23 boys, mean age = 12.5 years). Over the course of an approximately 2-h testing session participants were exposed to a computerized testing paradigm, the social evaluative stress test (SEST), that lasted for 50 min and includes elements of social evaluation, unpredictability and uncontrollability. Seven saliva samples were obtained to measure cortisol concentrations before, during and after the SEST, to provide pre-stress values, cortisol reactivity to the stressor and recovery after stress. In addition, subjective emotional stress experiences were recorded. The results showed no effect of age on cortisol responses. Furthermore, although both sexes reported experiencing the paradigm as (equally) stressful, only boys reacted with significant cortisol increases (M = 163%). To our knowledge, this is the first computerized stressor that induces cortisol responses in 10- to 15-year-old boys. Whether the girls' perceived stress results in the activation of other biological systems, such as the sympathetic nervous system as well as in differential activation of brain regions, remains to be determined. Future studies investigating sex differences in stress reactivity during adolescence should include neuroimaging, as well as psychophysiological measures, to unveil some of the mechanisms behind the current findings.

Is prenatal maternal distress context-dependent? Comparing United States and the Netherlands.

BACKGROUND: Maternal anxiety and depression symptoms during pregnancy can compromise a woman's well-being and affect offspring development. The present study represents a comparison of maternal late-pregnancy internalizing symptoms (i.e., depression and anxiety) between the United States of America (US) and the Netherlands. We hypothesized that women in the US would report higher levels of anxiety and depression during pregnancy compared to their Dutch counterparts, both on individual symptom indicators and overall latent distress, due to more favorable policies/accessible services relevant to perinatal health in the Netherlands. METHODS: Pregnant women were recruited at two comparable sites in the Netherlands (n = 327) and the US (n = 228). Measures included self-reports of internalizing distress and key covariates (i.e., parity, gestational, and maternal age). RESULTS: Expectant mothers in the US reported higher depressive and anxiety symptoms compared to their Dutch counterparts. Results were consistent across individual internalizing symptom indicators and the overall latent prenatal distress means computed for US and Dutch samples, with an estimated large effect size for the latter after controlling for covariates. LIMITATIONS: Despite their relatively large sizes, our samples were limited in their representativeness of the two cultures and mechanisms contributing to observed differences were not examined. CONCLUSIONS: Pregnant women in the US reported higher levels of depression and anxiety symptoms than women in the Netherlands. Implications concern perinatal policy and clinical services (e.g., emotional health support provided to mothers).

An experimental study on mother-infant skin-to-skin contact in full-terms.

In premature infants, daily skin-to-skin contact (SSC) has various beneficial effects on the health of the infant and the mother. These beneficial effects might extend to full-term infants. This experimental within-subject study examines the immediate effects of SSC on full-terms' cortisol physiology during SSC and subsequent physiological and behavioral reactions to a mild stressor (a bathing session). Additionally, the effects of SSC on the quality of maternal behavior are examined. Between 5 and 7 weeks postpartum, 17 full-term infant-mother dyads were visited at home twice. During one home visit, a bathing session was proceeded by 50min of mother-infant SSC, while during the other visit the bathing session was proceeded by 50min of the infant resting alone. The order of the home visits was counterbalanced. Infant salivary cortisol measures were taken to measure the cortisol response to the experimental condition (SSC versus solitary resting) and the bathing session. Furthermore, infant behavioral distress and the quality of maternal behavior during the bathing session were scored from videotapes. Two-way within-subject repeated measures ANOVA's showed that, when compared to solitary resting, full-terms' cortisol concentrations significantly decreased during SSC, followed by higher cortisol reactivity in response to the subsequent bathing session. No effects of SSC on infant behavioral distress and maternal caregiving behavior were found. Apparently, a single session of mother-infant SSC can affect infant cortisol physiology in full-term infants. Future SSC research is needed to investigate the neurobiological mechanisms and dose-response relations in full-term infants.

Associations between maternal prenatal cortisol concentrations and child outcomes: A systematic review.

A frequently proposed mechanism underlying the link between maternal prenatal stress/anxiety and child outcomes is heightened concentrations of maternal cortisol. In this systematic review, empirical findings on associations between maternal prenatal cortisol concentrations and child outcomes (physical/health, cognitive/motor, psychological/behavioral, and cortisol) are summarized. The number of empirical studies that find significant associations between maternal prenatal cortisol and child outcomes is small, but the majority of the studies that do find associations show that maternal cortisol is related to altered child outcomes (e.g. more physical/health problems, lower cognitive/motor development, more psychological/behavioral problems, and higher child cortisol concentrations). Inspection of the studies reveals possible critical gestational periods for maternal cortisol to affect different child outcomes. The heterogeneity in study designs and cortisol assessment methods makes drawing strong conclusions premature. However, the fact that most studies did not find significant associations suggests that maternal cortisol may not to be the sole or even main underlying mechanism in the relation between maternal prenatal stress/anxiety and child outcomes. Limitations of the reviewed studies are discussed, and directions for future research and reporting strategies are provided.

Maternal prenatal stress is associated with the infant intestinal microbiota.

Maternal prenatal stress has been often associated with infant physical development and health, as well as psychological functioning and behavior. However, the mechanisms underlying these relations remain elusive. The goal of the present study was to prospectively investigate the development of the intestinal microbiota as a potential pathway linking maternal prenatal stress and infant health. The development of the infant intestinal microbiota was followed over the first 110 days after birth in a healthy cohort of 56 vaginally born Dutch infants. Additionally, the relation between infant intestinal microbiota and gastrointestinal and allergic symptoms was examined. Results showed that maternal prenatal stress, i.e., either reported stress or elevated basal maternal salivary cortisol concentrations or both, was strongly and persistently associated with the infants' microbiota composition as determined by a phylogenetic microarray. Infants of mothers with high cumulative stress (i.e., high reported stress and high cortisol concentrations) during pregnancy had significantly higher relative abundances of Proteobacterial groups known to contain pathogens (related to Escherichia, Serratia, and Enterobacter), and lower relative abundances of lactic acid bacteria (i.e., Lactobacillus, Lactoccus, Aerococcus) and Bifidobacteria, altogether characteristics of a potentially increased level of inflammation. Furthermore, this aberrant colonization pattern was related to more maternally reported infant gastrointestinal symptoms and allergic reactions. In conclusion, clear links were found between maternal prenatal stress and the infant intestinal microbiota and health. Although causality cannot be concluded, the results suggest a possible mechanism by which maternal prenatal stress influences the offspring development. These results suggest a potential for bacterial interventions to enhance offspring health and development in pregnant women with stress.