Determinants of maternal hair cortisol concentrations at delivery reflecting the last trimester of pregnancy

doi:10.1016/j.psyneuen.2014.12.006

Psychoneuroendocrinology

Volume 52, February 2015, Pages 289-296

https://doi.org/10.1016/j.psyneuen.2014.12.006 Get rights and content

Highlights

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There is little evidence on determinants of hair cortisol (HCC) in pregnancy.
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This large study investigated multiple factors potentially contributing to HCC.
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Major determinants were BMI, smoking, single motherhood, season and mode of delivery.

Summary

Hair cortisol concentrations (HCC) are emerging as a promising marker of chronic psychosocial stress. However, limited information on relevant correlates of this biomarker in late pregnancy is available. In the Ulm SPATZ Health Study mothers were recruited between 04/2012 and 05/2013 shortly after delivery in the University Medical Center Ulm, Germany. Cortisol concentrations of N = 768 participants were determined by HPLC–MS/MS in the scalp-near 3 cm of maternal hair reflecting stress exposure over the preceding three months. Sociodemographic characteristics, pregnancy-related variables and comorbidities were assessed. We conducted bivariate and multiple linear regression analyses using log transformed HCC. In bivariate analyses, significantly higher cortisol concentrations were found in obese compared to normal weight (b = 0.32, p < 0.001) and smoking as opposed to non-smoking mothers (b = 0.34, p = 0.002). Conversely, primary C-section was associated with lower HCC compared to spontaneous delivery. Besides, a strong impact of season of delivery with significantly higher HCC in summer and autumn as opposed to winter (both bs = 0.58, p < 0.001) was found. Further determinants of HCC were maternal education, number of persons in the household, premature delivery and hair characteristics. In a mutually adjusted model, all but education, multiple jobholding, hair characteristics and premature delivery remained statistically significant.

Maternal hair cortisol in the last trimester of pregnancy is determined by many factors. Delivery mode, body mass index and season of delivery should be considered when investigating the association between HCC and further outcomes in mothers shortly after delivery.

Introduction

Maternal psychosocial distress during pregnancy is associated with poor pregnancy outcomes like low gestational age, birth weight or body length, as well as a high risk of miscarriage and may affect offspring's morbidity in later life (Beydoun and Saftlas, 2008, Graignic-Philippe et al., 2014).

Among others, one potential mechanism linking maternal psychosocial distress (in the following referred to as stress) to infant health is the hypothalamus–pituitary–adrenal (HPA) axis with its final effector, cortisol. However, cortisol secretion is characterized by a considerable degree of intra- and interindividual variability due to specific circadian patterns. Beyond that, high susceptibility to situational characteristics (Hellhammer et al., 2007, Kudielka et al., 2009, Stalder and Kirschbaum, 2012) makes measuring basal cortisol secretion challenging.

In this context, the analysis of steroids in hair is an important methodological development. Long periods of stress were associated with increased hair cortisol concentrations (HCC) in animals (Davenport et al., 2006) and humans (review: Staufenbiel et al., 2013; original articles: O’Brien et al., 2012, Henley et al., 2013, Stalder et al., 2014). Furthermore, a range of studies have now provided direct and indirect support for the validity of HCC as measures of long-term cortisol secretion (Thomson et al., 2010, Stalder and Kirschbaum, 2012).

Only recently, potentially influencing factors on HCC have been studied (Dettenborn et al., 2012, Feller et al., 2014) and reviewed (Wosu et al., 2013). Socioeconomic aspects, age, race, psychiatric symptoms, and hair characteristics have been identified as important factors associated with HCC. However, results are still controversial. Furthermore, late pregnancy, identified as a state of elevated cortisol level (Kirschbaum et al., 2009, D’Anna-Hernandez et al., 2011), may constitute a highly specific period of cortisol secretion, possibly differing from other stages of life. Research on HCC in pregnant women is limited to few previous studies having rather small sample sizes (Kalra et al., 2007, Kirschbaum et al., 2009, Kramer et al., 2009, D’Anna-Hernandez et al., 2011) and lacking details on potential predictors of HCC. Therefore, the purpose of the present study was to examine potential determinants of HCC as a measure of HPA axis activity in a large number of women consecutively recruited shortly after delivery.

Section snippets

Study design and study population

We analyzed data from a population-based, prospective birth cohort study, the Ulm SPATZ Health Study, initiated at Ulm University, Germany. All women who came to the University Medical Center Ulm between 04/2012 and 05/2013 for the delivery of their baby were asked to participate (overall response 49%). Exclusion criteria were: inadequate German language skills, outpatient childbirth, maternal age less than 18 years, postpartal transfer of mother or child to an intensive care unit, or

Results

A total of 970 women participated in the study. Prenatally, 16 mothers with recorded corticosteroid medication or with lack of information on medication (n = 10) were excluded. Further 153 mothers provided no hair sample or a hair sample that proved to be insufficient for analyses. In addition, 23 mothers with HCC <0.09 and >90.0 pg/mg were not considered due to uncertainties in the analytical procedure (Gao et al., 2013), leaving 768 mothers for statistical analyses. HCC (non-transformed) ranged

Discussion

In this large study of mothers assessed shortly after delivery of their offspring we investigated numerous influencing factors on maternal hair cortisol concentrations in the last trimester of pregnancy. We found an independent association of HCC with obesity, season of delivery, C-section, cigarette smoking during pregnancy, and the numbers of persons living in the household. Notably, mothers who will prospectively live alone with their newborns had the highest HCC.

A strength of the study is

Conflicts of interest

None declared.

Funding

An unrestricted grant from the medical faculty of Ulm University.

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The association between maternal prenatal hair cortisol concentration and preterm birth: A systematic review and meta-analysis
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The risk of preterm birth (PTB) increases when experiencing stress during pregnancy. Chronic stress has been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis, for which hair cortisol concentration (HCC) is a promising biomarker. However, previous studies on the association between HCC and PTB yielded inconsistent results. This systematic review and meta-analysis synthesized previous studies on the association between maternal HCC before and during pregnancy and spontaneous PTB.
Data was extracted from N = 11 studies with k = 19 effect sizes retrieved from PubMed, Embase, Web of Science, CINAHL and citation searching by hand in June 2023 and updated in October 2023. Standardized mean differences were calculated, and a random-effects three-level meta-analysis was conducted. Effect heterogeneity was assessed using Q and I².
HCC during pregnancy was higher among PTB than term groups, but effects were not statistically significant (z = 0.11, 95% CI: − 0.28, 0.51, p = .54) and total heterogeneity was high (Q₁₆ = 60.01, p < .001, I²_Total = 92.30%). After leaving out two possible outlier studies in sensitivity analyses, HCC was lower among preterm compared to term delivering groups, although not statistically significant (z = − 0.06, 95% CI: − 0.20, 0.08, p = .39) but with a substantially reduced total heterogeneity (Q₁₂ = 16.45, p = .17, I²_Total = 42.15%). No moderators affected the estimates significantly, but an effect of trimester and gestational age at delivery is likely.
There is currently no evidence of prenatal HCC differences between PTB and term groups as effects were small, imprecise, and not significant. Low statistical power and methodological weaknesses of the small-scale studies challenge possible biological inferences from the small effects, but further research on HCC during pregnancy is highly encouraged.
Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation
2024, Brain, Behavior, and Immunity
Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation.
Hospital employees (N = 238, 182 females, M_age = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed.
The factorial structure of survey measures was confirmed. Burnout symptoms (M_T2 = 2.17, M_T3 = 2.33) and HCC (M_T2 = 4.79, M_T3 = 9.56; pg/mg) increased over time, CRP did not (M_T2 = 1.15, M_T3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (β = −0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (β = 0.28, p =.001) and of HCC on CRP (β = −0.10, p ≤.001). Associations were robust in additional analyses including further confounders.
This is the first study on prospective effects of technostress on employees’ endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.
Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids
2023, Journal of Affective Disorders
Having a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms.
Measures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAM_HAIR.
A negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events.
Analyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution.
Our results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.
Hair cortisol, cortisone and DHEA concentrations and the composition of microbiota in toddlers
2023, Psychoneuroendocrinology
Animal research suggests that the gut microbiota and the HPA axis communicate in a bidirectional manner. However, human data, especially on early childhood, remain limited. In this exploratory design, we investigated the connections between long-term HPA axis functioning, measured as cortisol, cortisone or dehydroepiandrosterone concentrations and their ratios from hair segments of three centimeters, and gut microbiota profiles, (measured as diversity and bacterial composition by 16 S rRNA sequencing) in healthy 2.5-year-old toddlers (n = 135) recruited from the FinnBrain Birth Cohort Study. The alpha diversity of the microbiota was studied by linear regression. Beta diversity analyses with weighted UniFrac or Bray-Curtis distances were performed using PERMANOVA. The bacterial core genus level analyses were conducted using DESeq2 and ALDEx2. These analyses suggested that hair sample concentrations of separate hormones, cortisol/cortisone and cortisol/dehydroepiandrosterone ratios were associated with various gut bacterial genera such as the Veillonella, the [Ruminococcus] torques group and [Eubacterium] hallii group, although multiple testing correction attenuated the p-values. Alpha or beta diversity was not linked with either steroid concentrations or ratios. These findings in toddlers suggest that long-term HPA axis activity may be related to genera abundancies but not to ecosystem-level measures in gut microbiota. The influence of these observed interrelations on later child health and development warrants further research.
Maternal hair cortisol concentrations and its association with increased insulin resistance in midpregnancy
2023, Annals of Epidemiology
Stress and elevated maternal glycemia have negative effects on pregnancy. We evaluated the association of hair cortisol concentrations (HCC), a marker of chronic stress, with insulin resistance and gestational diabetes (GDM).
In total, 527 women from Lima, Peru, provided a hair sample in the second trimester of their pregnancy to measure HCC using liquid chromatography–tandem mass spectrometry. Each 6 cm of hair captured HCC in early (T1=1–12 weeks) and midpregnancy (T2 = 13–24 weeks). GDM diagnosis was conducted in midpregnancy. Multivariable regression models adjusted for putative risk factorsincluding maternal sociodemographic factors, diabetes history, and hair characteristics, were used to estimate the association of HCC with GDM and various glycemic traits.
GDM was diagnosed in 122 (23%) women. Mean HCC across pregnancy was T1 = 3.7 (±3.4) pg/mg and T2 = 4.8 (±3.4) pg/mg. HCC was associated with increased log-transformed units of fasting insulin (T1 = 0.15 [0.03, 0.27], T2 = 0.17 [0.04, 0.30]), homeostasis model assessment for insulin resistance (T1 = 0.14 [0.01, 0.26], T2 = 0.17 [0.03, 0.30]), and homeostasis model assessment for β-cell function (T1 = 0.20 [0.05, 0.34], T2 = 0.20 [0.04, 0.36]), but not with GDM (T1 = 0.95 [0.63, 1.40], T2 = 1.11 [0.74, 1.67]).
Elevated maternal HCC was associated with abnormal insulin homeostasis in pregnancy. Dysregulation of the hypothalamic–pituitary–adrenal axis, as reflected by high HCC, may also contribute to insulin resistance syndrome in pregnancy.
Determinants of hair cortisol in preschool children and their mothers: A Brazilian birth cohort study
2023, Psychoneuroendocrinology
Few large-scale studies have provided population-based estimates of hair cortisol levels and its determinants. Hair cortisol and potential determinants were measured in children and their mothers in a population-based sample in a Brazilian city with large variations in socioeconomic conditions.
We used data from the 4-year follow-up of the 2015 Pelotas (Brazil) Birth Cohort Study. Hair samples were collected by trained fieldworkers to analyze average levels of cortisol over a 3-month period. Four groups of variables were tested as potential determinants: hair characteristics (natural color, treatment, type, and frequency of wash), use of corticosteroids and oral contraceptives, sociodemographic factors (sex, age, skin color, socioeconomic level, maternal relationship, pregnancy, daycare enrollment), maternal perceived stress, and substance exposure (smoking and illicit drug use). Linear regression with log transformation was used to test associations.
3235 children and 3102 mothers were analyzed (80.7% and 77.4% of those interviewed when children were 4 years of age, respectively), for whom sufficient hair was collected for cortisol analysis. The median of hair cortisol concentration was 7.8 pg/mg (IQR = 5.6 – 11.0) for children, and 5.6 pg/mg (IQR = 4.2 – 7.8) for mothers. In adjusted models, sex and socioeconomic level were associated with child cortisol levels. For mothers, hair cortisol levels were associated with socioeconomic level, skin color, age, hair treatment and hair natural color.
This study provides estimates of hair cortisol levels in a diverse population in a upper-middle income country. Although just a few predictors were associated with maternal/child cortisol levels, socioeconomic level was the key variable that should be incorporated in studies using hair cortisol to measure biological manifestations of stress, but other variables, such as some hair and sociodemographic characteristics are important to consider when using hair cortisol.

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Determinants of maternal hair cortisol concentrations at delivery reflecting the last trimester of pregnancy

Highlights

Summary

Introduction

Section snippets

Study design and study population

Results

Discussion

Conflicts of interest

Funding

Physiol. Behav.

Gen. Comp. Endocrinol.

Psychoneuroendocrinology

Psychoneuroendocrinology

J. Chromatogr. B. Analyt. Technol. Biomed. Life Sci.

Neurosci. Biobehav. Rev.

Psychoneuroendocrinology

Psychoneuroendocrinology

Psychoneuroendocrinology

J. Chromatogr. B. Biomed. Sci. Appl.

Brain Behav. Immun.

Psychoneuroendocrinology

Psychoneuroendocrinology

Psychoneuroendocrinology

Forensic Sci. Int.