Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis
Introduction
Accumulated evidence suggests that prenatal stress and anxiety experienced by expectant mothers is associated with pregnancy outcome and with long-lasting behavioural and cognitive effects in the child. Women with high antenatal anxiety or stress are more likely to have premature and low birth weight babies (Copper et al., 1996, Wadhwa et al., 1993, Wadhwa et al., 1998, Field et al., 2003). Prenatal maternal stress is also suspect of affecting infant development and promoting a range of adverse temperamental effects (O’Connor et al., 2002, O’Connor et al., 2003, Field et al., 2003, Huizink et al., 2004, Laplante et al., 2004, Van den Bergh et al., 2005, Talge et al., 2007, Glover et al., 2010). The most widely exploited hypothesis for the underlying mechanisms states that the fetus is exposed to an excess of maternally derived glucocorticoids when the latter are raised at times of stress. Such fetal exposure underpins alterations in brain development and in the functioning of the hypothalamic–pituitary–adrenal axis (HPA) (Van den Bergh et al., 2005, Cottrell and Seckl, 2009, Harris and Seckl, 2011, Charil et al., 2010, Glover et al., 2010).
When psychological problems arise during pregnancy, an assessment of the medication risks to the mother and the fetus must be made, since antidepressants and benzodiazepines are known to pass across the placenta (Hendrick et al., 2003). Non-pharmacological therapies should be considered as possible choices for pregnant women attempting to avoid medication side-effects. These include psychotherapy, massage therapy, yoga, and listening to music (Cunningham and Zayas, 2002, Narendran et al., 2005, Chang et al., 2008, Kimber et al., 2008, Maharana et al., 2009, Field et al., 2009, Field et al., 2010), the latter being probably the most accessible non-pharmacological therapy for low socioeconomic status women. Yoga, also a potentially accessible therapy, reduces sympathetic activity improving autonomic responses to stress in normal pregnant women (Maharana et al., 2009) but its practice is not well accepted in all cultures. A number of authors have discussed and reviewed the uses of music therapy to positively affect physiological functioning (Hirsch and Meckes, 2000, Schneck and Berger, 2006, Krout, 2007) and its relevance seems to be changing, being now considered more of a neuroscience than a social science model (Thaut, 2005). Music is a powerful tool in evoking emotions and, by extension, listening to music can be explored for reducing the negative effects of stress. Supportive evidence can be found in the observation that listening to music resulted in a marked reduction in salivary cortisol levels in patients exposed to pre-surgical stress, both in a medical (Miluk-Kolasa et al., 1994) and in a nonmedical setting (Khalfa et al., 2003). These experiments suggested that relaxing music is more effective than silence in decreasing cortisol levels after stress induction. Further studies are necessary to determine if the effect of relaxing music is specific to music or can be obtained with different stimuli.
A randomized controlled trial was conducted to test the hypothesis that music decreases anxiety and plasma cortisol levels in pregnant women subjected to stressful situations. Imminent amniocentesis was taken as a non-experimental paradigm for such a situation because it has been reported that state anxiety, a transient emotional condition, is considerably elevated in pregnant women awaiting an invasive procedure like amniocentesis and this can lead to an increase in their plasma cortisol (Harris et al., 2004, Ng et al., 2004, Sarkar et al., 2006, Sarkar et al., 2008).
Section snippets
Methods
This study was conducted in Lisbon, between December 2009 and November 2010, at Dona Estefânia Hospital (HDE) maternity, and involved pregnant women attending the routine appointment on prenatal diagnosis and amniocentesis briefing. By the end of the appointment, women without exclusion criteria were informed that our study was taking place, its basic procedures, and asked if willing to participate. Only singleton spontaneous pregnancies were considered, with other exclusion criteria being
Results
Of the 157 patients recruited, 3 were excluded: one for impossibility of performing amniocentesis and two due to maternal pathology. The final sample consisted of 154 cases with complete demographic information, maternal cortisol data, and anxiety scores.
Discussion
We have compared the impact of short-term interventions upon anxiety and cortisol, in pregnant women awaiting imminent amniocentesis, by means of an experimental setting that is easily portable to a clinic or a domestic environment. The association between stress, anxiety and hormonal secretion in human pregnancy is still poorly understood. Petraglia et al. (2001) and Obel et al. (2005) were among the first to study the association between self-reported psychological stress and cortisol during
Conclusion
This study suggests that pregnant women are likely to benefit from routine practice of a 30 min relaxation period when faced with the imminence of a stressful event. The benefit would be both psychological and physiological and would be greater in the morning. Women prone to become too anxious, typically younger and at earlier gestational ages, are the ones that should benefit the most.
Role of the funding source
There was no external funding source, either private or public. This study was entirely funded by the authors themselves.
Conflict of interest
None declared.
Acknowledgements
We are grateful to Ana Bernardo and Ivone Dias for helping out with the performance of amniocentesis. Thank you also to Prof Vivette Glover, whose advises helped us to conceive the experimental design.
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