Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants

doi:10.1016/j.psyneuen.2011.04.002

Psychoneuroendocrinology

Volume 36, Issue 10, November 2011, Pages 1480-1494

https://doi.org/10.1016/j.psyneuen.2011.04.002 Get rights and content

Summary

Recent findings suggest that elevated stress levels during the pre- and postpartum period are related to poor maternal and infant health outcomes; yet, few studies have prospectively examined the efficacy of stress management interventions on regulating stress levels among mothers and their infants. The current study examined whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol (a biological marker of stress) and self-reported stress levels among mothers and their infants at six and 18 months postpartum, relative to two control groups. Our sample was comprised of predominantly Spanish-speaking, low-income women (80%; mean age = 25 ± 5 years) who were screened for depression during their second trimester of pregnancy (M = 16 ± 5 weeks of gestation). Women at high risk for depression [i.e., having either a past history of major depression or current elevated symptoms of depression (≥16 on CES-D)] were randomized to either a CBSM group (n = 24) or a usual care (UC) group (n = 33), while a low risk comparison (LRC) group (n = 29) was comprised of women not meeting either depression criteria. ANCOVA analyses demonstrated that: (1) infants of women in the CBSM and LRC groups had significantly lower cortisol levels than infants of women in the UC group at six months postpartum (p < .001); and (2) women in the CBSM group had lower cortisol levels than women in the UC group at 18 months postpartum (p < .01). These results suggest that prenatal CBSM interventions may be efficacious in regulating biological markers of stress among mothers and their infants, thereby decreasing their risk for developing health complications over time.

Section snippets

Participants and procedure

The objective of the Mothers and Babies: Mood and Health Project was to reduce the incidence of major depression in low-income, pregnant women receiving prenatal health services in a public sector hospital in California (Muñoz et al., 2007a, Urizar et al., 2004). Of the 110 pregnant women who participated in the original study, the current results focus on the 86 women and their infants (78%) for whom cortisol samples were collected from 2000 to 2003.

Women were eligible to join the study if

Participants

Of the 86 women who participated in cortisol collection for the Mothers and Babies: Mood and Health Project, 57 women (66%) were identified as being at high risk for depression during pregnancy and randomized to the CBSM intervention (n = 24) or the UC group (n = 33). In addition, 29 women were identified as being at low risk for depression during pregnancy and took part in the LRC group. A description of the study sample is shown in Table 1.

Overall, women in all three groups were similar on most

CBSM intervention effects on maternal cortisol

Despite the adverse effects of stress on maternal and infant health, few studies have examined the efficacy of stress management interventions on regulating cortisol and stress levels among mothers and their infants. Results from the current pilot study are one of the first, to our knowledge, to prospectively examine whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol and self-reported stress levels among low-income

Implications

In summary, our results suggest that teaching low-income women CBSM strategies during pregnancy is effective in regulating maternal and infant cortisol levels up to 18 months postpartum, particularly among women with a past history of depression or among younger mothers. These results potentially have long-term implications for the health of mothers and their infants in helping to prevent the onset of stress-related health complications that have been associated with elevated cortisol levels

Role of the funding source

Funding for this study was provided by a grant from the Division of Research Resources at the National Institute of Health (5-MO1-RR00083) and a grant by the University of California Office of the President's Committee on Latino Research for the UCSF/San Francisco General Hospital Latino Mental Health Research Program (Ricardo F. Muñoz, PI). Additional support was provided by grants from the National Institute of Mental Health (MH 596056, Ricardo F. Muñoz, PI), the Research and Evaluation

Conflict of interest

The authors have read and consented to the authorship on this final version of the manuscript. There are no conflicts of interest in this study with any of the authors in any way.

Acknowledgements

Guido G. Urizar Jr. is in the Department of Psychology, California State University, Long Beach. Ricardo F. Muñoz is in the Department of Psychiatry, University of California, San Francisco.

This study was conducted in part in the GCRC at San Francisco General Hospital and supported by Grant 5-MO1-RR00083, Division of Research Resources, National Institutes of Health. The authors would like to acknowledge Bobbye Chang for conducting the cortisol assays. The preparation of this paper was

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Stress experienced during pregnancy can lead to significant long-term health problems for mothers and their infants. At greatest risk are low-income women. One biological mechanism that has been identified in heightening a woman’s risk for health complications during pregnancy and the postpartum period is the stress hormone cortisol. However, the best methods for regulating cortisol, in order to optimize maternal and infant health outcomes, have received little attention. This chapter reviews our work in examining the impact of cognitive behavioral stress management (CBSM) interventions on regulating pre- and postnatal cortisol and identifying mechanisms that may lead to intervention effects. The results of our work suggest that CBSM interventions are highly needed among low-income pregnant women and have strong potential to effectively regulate elevated cortisol and stress levels, as well as help prevent the onset of future stress-related health complications in this population.
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The intervention group had 38 percent (p=0.01) lower maternal cortisol levels and 45 percent (p < 0.01) lower maternal cortisone compared to the EUC group. Maternal DHEA levels were higher among women in the intervention group compared to the EUC group by 29 percent (p = 0.02). Intergenerational intervention effects show higher DHEA levels in infants by 43% (p = 0.03). Infant cortisol and cortisone did not differ across groups.
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Therefore, more tailored interventions are needed to help reduce socioeconomically disadvantaged parents’ high levels of anxiety. Only three studies measured salivary cortisol; surprisingly, the overall pooled effects were positive (g = 0.25), meaning that the interventions increased parents’ salivary cortisol (Urizar and Munoz, 2011; Urizar et al., 2019). One plausible explanation is that socioeconomically disadvantaged parents potentially grew up in a disadvantaged socioeconomic environment, thereby experiencing a persistent and high level of stress since childhood, which may lead to hypothalamic-pituitary-adrenal axis dysfunction or adrenal fatigue (de Kock et al., 2015).
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This meta-analysis aimed to (1) quantitatively examine the intervention effects of prior stress management interventions among socioeconomically disadvantaged parents on reducing stress, depression, and anxiety; and (2) explore the potential moderators of intervention effects.
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Published by Elsevier Ltd.

Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants

Summary

Section snippets

Participants and procedure

Participants

CBSM intervention effects on maternal cortisol

Implications

Role of the funding source

Conflict of interest

Acknowledgements

Journal of Obstetric Gynecologic, and Neonatal Nursing

Psychology Review

Journal of Affective Disorders

Journal of Steroid Biochemistry and Molecular Biology

Biological Psychiatry

Infant Behavior & Development

Psychoneuroendocrinology

The Lancet

Journal of Obstetrical, Gynecological, and Neonatal Nursing

Steroids

Social Science & Medicine

Preventive Medicine

Psychosomatics

Psychoneuroendocrinology

Baillière's Clinical Obstetrics and Gynaecology

Cognitive & Behavioral Practice

Psychoneuroendocrinology

Biological Psychology

Biological Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: empirical support for a psychoneuroimmunological model

Stress

Stress hormone levels of children of depressed mothers

Development and Psychopathology

Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms

The Australian & New Zealand Journal of Obstetrics & Gynaecology

Social Learning Theory

Psychological Treatment of Panic

Cognitive therapy: a 30-year retrospective

American Psychologist

Maternal depression and infant cortisol: influences of timing, comorbidity and treatment

Journal of Child Psychology and Psychiatry

Prevention and treatment of post-partum depression: a controlled randomized study on women at risk

Psychological Medicine

Standardization of the visual analogue scale

Nursing Research

The Positive and Negative Affect Schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample

British Journal of Clinical Psychology