Plasma Corticotropin-Releasing Hormone and Cortisol Concentrations and Perceived Stress among Pregnant Women with Preterm and Term Birth

ABSTRACT

We sought to determine if pregnant women with poor psychosocial status or high levels of perceived stress had higher concentrations of plasma corticotropin-releasing hormone (CRH) or cortisol. This was a secondary analysis of a case-controlled study nested within a multicenter, prospective observational cohort study. Plasma CRH and cortisol concentrations and the Abbreviated Scale for the Assessment of Psychosocial Status in Pregnancy (ASAPS) were available for cases and controls. Among cases and controls, concentrations of CRH and cortisol and overall performance on the ASAPS as well as the individual components of the ASAPS were compared using Kruskal-Wallis or chi-square. There was no association between CRH or cortisol concentrations and performance on the ASAPS overall. Additionally, there was no relationship between CRH or cortisol and perceived stress. In this study, biological measures of stress assessed in the second trimester were not associated with overall psychosocial status or perceived stress. The factors contributing to the elevation in CRH that precedes some preterm birth are complex and poorly understood.

Cortisol - CRH - stress - preterm birth

REFERENCES

• 1 Lu M C, Chen B. Racial and ethnic disparities in preterm birth: the role of stressful life events.  Am J Obstet Gynecol. 2004;  191 691-699
• 2 Hoffman S, Hatch M C. Stress, social support and pregnancy outcome: a reassessment based on recent research.  Paediatr Perinat Epidemiol. 1996;  10 380-405
• 3 Messer L C, Dole N, Kaufman J S, Savitz D A. Pregnancy intendedness, maternal psychosocial factors and preterm birth.  Matern Child Health J. 2005;  9 403-412
• 4 Hobel C, Culhane J. Role of psychosocial and nutritional stress on poor pregnancy outcome.  J Nutr. 2003;  133 (5 Suppl 2) 1709S-1717S
• 5 Peacock J L, Bland J M, Anderson H R. Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine.  BMJ. 1995;  311 531-535
• 6 Glynn L M, Schetter C D, Hobel C J, Sandman C A. Pattern of perceived stress and anxiety in pregnancy predicts preterm birth.  Health Psychol. 2008;  27 43-51
• 7 Wadhwa P D, Sandman C A, Porto M, Dunkel-Schetter C, Garite T J. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation.  Am J Obstet Gynecol. 1993;  169 858-865
• 8 Lobel M, Cannella D L, Graham J E, DeVincent C, Schneider J, Meyer B A. Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.  Health Psychol. 2008;  27 604-615
• 9 Copper R L, Goldenberg R L, Das A National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network et al. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks' gestation.  Am J Obstet Gynecol. 1996;  175 1286-1292
• 10 Wadhwa P D, Garite T J, Porto M et al.. Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation.  Am J Obstet Gynecol. 2004;  191 1063-1069
• 11 Hobel C J, Dunkel-Schetter C, Roesch S C, Castro L C, Arora C P. Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks' gestation in pregnancies ending in preterm delivery.  Am J Obstet Gynecol. 1999;  180 (1 Pt 3) S257-S263
• 12 Erickson K, Thorsen P, Chrousos G et al.. Preterm birth: associated neuroendocrine, medical, and behavioral risk factors.  J Clin Endocrinol Metab. 2001;  86 2544-2552
• 13 Ruiz R J, Fullerton J, Brown C EL, Dudley D J. Predicting risk of preterm birth: the roles of stress, clinical risk factors, and corticotropin-releasing hormone.  Biol Res Nurs. 2002;  4 54-64
• 14 Korebrits C, Ramirez M M, Watson L, Brinkman E, Bocking A D, Challis J R. Maternal corticotropin-releasing hormone is increased with impending preterm birth.  J Clin Endocrinol Metab. 1998;  83 1585-1591
• 15 Holzman C, Jetton J, Siler-Khodr T, Fisher R, Rip T. Second trimester corticotropin-releasing hormone levels in relation to preterm delivery and ethnicity.  Obstet Gynecol. 2001;  97 (5 Pt 1) 657-663
• 16 Makrigiannakis A, Semmler M, Briese V et al.. Maternal serum corticotropin-releasing hormone and ACTH levels as predictive markers of premature labor.  Int J Gynaecol Obstet. 2007;  97 115-119
• 17 McLean M, Bisits A, Davies J et al.. Predicting risk of preterm delivery by second-trimester measurement of maternal plasma corticotropin-releasing hormone and alpha-fetoprotein concentrations.  Am J Obstet Gynecol. 1999;  181 207-215
• 18 Leung T N, Chung T K, Madsen G, McLean M, Chang A M, Smith R. Elevated mid-trimester maternal corticotrophin-releasing hormone levels in pregnancies that delivered before 34 weeks.  Br J Obstet Gynaecol. 1999;  106 1041-1046
• 19 Moawad A H, Goldenberg R L, Mercer B NICHD MFMU Network et al. The Preterm Prediction Study: the value of serum alkaline phosphatase, alpha-fetoprotein, plasma corticotropin-releasing hormone, and other serum markers for the prediction of spontaneous preterm birth.  Am J Obstet Gynecol. 2002;  186 990-996
• 20 Goldenberg R L, Iams J D, Mercer B M NICHD MFMU Network et al. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births.  Am J Public Health. 1998;  88 233-238
• 21 Iams J D, Goldenberg R L, Meis P J National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network et al. The length of the cervix and the risk of spontaneous premature delivery.  N Engl J Med. 1996;  334 567-572
• 22 Cliver S P, Goldenberg R L, Cutter G R et al.. The relationships among psychosocial profile, maternal size, and smoking in predicting fetal growth retardation.  Obstet Gynecol. 1992;  80 262-267
• 23 Goldenberg R L, Cilver S P, Cutter C R et al.. Maternal psychosocial characteristics and intrauterine growth retardation.  Pre Peri Nat Psychol J. 1991;  6 129-134
• 24 Goldenberg R L, Andrews W W, Mercer B M National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network et al. The preterm prediction study: granulocyte colony-stimulating factor and spontaneous preterm birth.  Am J Obstet Gynecol. 2000;  182 625-630
• 25 Goldenberg R L, Hickey C A, Cliver S P, Gotlieb S, Woolley T W, Hoffman H J. Abbreviated scale for the assessment of psychosocial status in pregnancy: development and evaluation.  Acta Obstet Gynecol Scand Suppl. 1997;  165 19-29
• 26 Mancuso R A, Schetter C D, Rini C M, Roesch S C, Hobel C J. Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery.  Psychosom Med. 2004;  66 762-769
• 27 Wadhwa P D, Dunkel-Schetter C, Chicz-DeMet A, Porto M, Sandman C A. Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy.  Psychosom Med. 1996;  58 432-446
• 28 DiPietro J A, Ghera M M, Costigan K, Hawkins M. Measuring the ups and downs of pregnancy stress.  J Psychosom Obstet Gynaecol. 2004;  25 189-201
• 29 Kramer M S, Lydon J, Séguin L et al.. Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones.  Am J Epidemiol. 2009;  169 1319-1326
• 30 Erickson K, Thorsen P, Chrousos G et al.. Preterm birth: associated neuroendocrine, medical, and behavioral risk factors.  J Clin Endocrinol Metab. 2001;  86 2544-2552
• 31 Petraglia F, Hatch M C, Lapinski R et al.. Lack of effect of psychosocial stress on maternal corticotropin-releasing factor and catecholamine levels at 28 weeks' gestation.  J Soc Gynecol Investig. 2001;  8 83-88