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Biomedical subjects

C Dunkel-Schetter

Publications and source records attributed to C Dunkel-Schetter.

At least 19 recordsLinked to original sources
PubMed2001

Stress, infection and preterm birth: a biobehavioural perspective.

Preterm birth is currently the most important problem in maternal-child health in the United States. Epidemiological studies have suggested that two factors, maternal stress and maternal urogenital tract infection, are significantly and independently associated with an increased risk of spontaneous preterm birth. These factors are also more prevalent in the population of sociodemographically disadvantaged women who are at increased risk for preterm birth. Studies of the physiology of parturition suggest that neuroendocrine and immune processes play important roles in the physiology and pathophysiology of normal and preterm parturition. However, not all women with high levels of stress and/or infection deliver preterm, and little is understood about factors that modulate susceptibility to pathophysiological events of the endocrine and immune systems in pregnancy. We present here a comprehensive, biobehavioural model of maternal stress and spontaneous preterm delivery. According to this model, chronic maternal stress is a significant and independent risk factor for preterm birth. The effects of maternal stress on preterm birth may be mediated through biological and/or behavioural mechanisms. We propose that maternal stress may act via one or both of two physiological pathways: (a) a neuroendocrine pathway, wherein maternal stress may ultimately result in premature and/or greater degree of activation of the maternal-placental-fetal endocrine systems that promote parturition; and (b) an immune/inflammatory pathway, wherein maternal stress may modulate characteristics of systemic and local (placental-decidual) immunity to increase susceptibility to intrauterine and fetal infectious-inflammatory processes and thereby promote parturition through pro-inflammatory mechanisms. We suggest that placental corticotropin-releasing hormone may play a key role in orchestrating the effects of endocrine and inflammatory/immune processes on preterm birth. Moreover, because neuroendocrine and immune processes extensively cross-regulate one another, we further posit that exposure to both high levels of chronic stress and infectious pathogens in pregnancy may produce an interaction and multiplicative effect in terms of their combined risk for preterm birth. Finally, we hypothesise that the effects of maternal stress are modulated by the nature, duration and timing of occurrence of stress during gestation. A discussion of the components of this model, including a theoretical rationale and review of the available empirical evidence, is presented. A major strength of this biobehavioural perspective is the ability to explore new questions and to do so in a manner that is more comprehensive than has been previously attempted. We expect findings from this line of proposed research to improve our present state of knowledge about obstetric risk assessment for preterm birth by determining the characteristics of pregnant women who are especially susceptible to stress and/or infection, and to broaden our understanding of biological (endocrine, immune, and endocrine-immune interactions) mechanisms that may translate social adversity during pregnancy into pathophysiology, thereby suggesting intervention strategies.

Female↗
PubMed2001

When stress happens matters: effects of earthquake timing on stress responsivity in pregnancy.

OBJECTIVE: The purpose of the study was to assess the effects of the timing of stress during pregnancy on emotional responses and birth outcome. We hypothesized that as pregnancy advanced women would become increasingly resistant to the adverse effects of stress, and so early stress would have more profound effects than later stress. STUDY DESIGN: Forty pregnant women who had experienced an earthquake during pregnancy or shortly afterward were identified. Using regression analyses we determined whether the timing of the earthquake was related to an affective response to this event and to length of gestation. RESULTS: The earthquake was rated as more stressful when it occurred early in pregnancy compared with late in pregnancy, and postpartum ratings were similar to first-trimester ratings (r (quad) =.39; P <.05). Stress experienced early in pregnancy was associated with shorter gestational length (r =.35; P <.05). CONCLUSIONS: As pregnancy advances, women become decreasingly sensitive to the effects of stress. This decrease in vulnerability may reflect increasing protection of the mother and fetus from adverse influences during pregnancy.

Corticotropin-Releasing Hormone↗
PubMed2001

Prolonged periods without food intake during pregnancy increase risk for elevated maternal corticotropin-releasing hormone concentrations.

OBJECTIVE: Fasting during pregnancy stimulates preterm delivery in animals and increases women's risk for preterm delivery. Fasting stimulates hypothalamic corticotropin-releasing hormone production in animals. Elevated maternal corticotropin-releasing hormone concentrations are associated with preterm birth. We hypothesized that prolonged periods without food during pregnancy increase maternal corticotropin-releasing hormone concentrations, which lead to preterm delivery. STUDY DESIGN: In the Behavior in Pregnancy Study, we examined prolonged periods without eating during pregnancy and corticotropin-releasing hormone concentrations and gestational age at delivery with multivariate logistic regression analysis (n = 237). RESULTS: Prolonged periods without food lasting 13 hours or longer were associated with elevated maternal corticotropin-releasing hormone concentrations compared with prolonged periods without food lasting less than 13 hours at two time points during pregnancy, controlling for pregravid body mass index, energy intake, income, race, smoking, and maternal age (18-20 weeks: adjusted odds ratio, 2.5; 95% CI, 0.9-7.1; 28-30 weeks: adjusted odds ratio, 1.7; 95% CI, 0.7-4.2). There was an inverse, linear relationship between maternal corticotropin-releasing hormone concentrations and gestational age at delivery. CONCLUSIONS: Prolonged periods without food intake during pregnancy are associated with elevated maternal corticotropin-releasing hormone concentrations and with preterm delivery.

Adolescent↗
PubMed2000

Stress and reproduction: introduction to the special section.

This special section on stress and reproduction is devoted to an emerging frontier in interdisciplinary research that merits the attention of health psychologists. The majority of the studies concern the role of stress and emotion on birth outcomes such as low birth weight, fetal growth and preterm delivery, or mechanisms underlying these findings. The implications of this research extend from maternal and infant health to life-span development and adult health and mortality.

Female↗
PubMed1999

Mediators of ethnic-associated differences in infant birth weight.

PURPOSE: To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors. METHODS: A prospective, survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk. RESULTS: As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight. CONCLUSION: These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.

Adolescent↗
PubMed1999

Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks' gestation in pregnancies ending in preterm delivery.

OBJECTIVE: This study tested the hypothesis that maternal stress is associated with elevated maternal levels of corticotropin releasing hormone and activation of the placental-adrenal axis before preterm birth. STUDY DESIGN: In a behavior in pregnancy study, 524 ethnically and socioeconomically diverse women were followed up prospectively and evaluated at 3 gestational ages: 18 to 20 weeks, 28 to 30 weeks, and 35 to 36 weeks. Maternal variables included demographic data, medical conditions, perceived stress level, and state anxiety. Maternal plasma samples were collected at each gestational age. Eighteen case patients with spontaneous onset of preterm labor were matched against 18 control subjects who were delivered at term, and their samples were assayed for corticotropin-releasing hormone, adrenocorticotropic hormone, and cortisol by means of radioimmunoassay. Statistical tests were used to examine mean differences in these hormones. In addition, the relationship between stress level and each hormone was tested with a Pearson correlation coefficient and hierarchic multiple regressions in each group. RESULTS: Patients who had preterm delivery had significantly higher plasma corticotropin-releasing hormone levels than did control subjects at all 3 gestational ages (P <.0001). Analyses did not find any differences in reported levels of stress between 18 to 20 weeks' gestation and 28 to 30 weeks' gestation. A hierarchic multiple regression indicated that maternal stress level at 18 to 20 weeks' gestation and maternal age accounted for a significant amount of variance in corticotropin-releasing hormone at 28 to 30 weeks' gestation, after controlling for corticotropin-releasing hormone at 18 to 20 weeks' gestation (P <. 001). In addition, patients who were delivered preterm had significantly elevated plasma levels of adrenocorticotropic hormone at all 3 gestational ages (P <.001) and significantly elevated cortisol levels at 18 to 20 weeks' gestation and 28 to 30 weeks' gestation (P <.001). CONCLUSION: Maternal plasma levels of corticotropin-releasing hormone are significantly elevated at as early as 18 to 20 weeks' gestation in women who are subsequently delivered preterm. Changes in corticotropin-releasing hormone between 18 to 20 weeks' gestation and 28 to 30 weeks' gestation are associated with maternal age and stress level at 18 to 20 weeks' gestation. Maternal stress and corticotropin-releasing hormone levels may be potential markers for the patient at risk for preterm birth. Activation of the placental maternal pituitary-adrenal axis is consistent with the classic endocrine response to stress.

Adult↗
PubMed1999

Ethnicity and social support during pregnancy.

Data from two multi-ethnic prospective studies of African American, Latina, and non-Hispanic White pregnant women were used to examine the influence of contextual factors on social support processes during pregnancy. Multiple types of support (perceived support, received support, support satisfaction, network support) and sources of support (baby's father, family, friends) were assessed. The role of ethnicity in social support was examined after controlling for the contribution of related contextual factors (SES, marital status, age, parity, employment) to these processes. The impact of ethnicity and related contextual factors differed across sources of social support. Ethnic differences in support from family and friends, but not from the baby's father, emerged. However, marital status was a consistent predictor of support from the baby's father, and SES was a consistent predictor of support from friends. Overall, the findings of two studies suggest that although ethnicity is associated with support from friends and family, other contextual factors, such as marital status and SES, influence support processes during pregnancy.

Acculturation↗
PubMed1999

Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy.

Prenatal psychosocial predictors of infant birth weight and length of gestation were investigated in a prospective study of 120 Hispanic and 110 White pregnant women. Hypotheses specifying that personal resources (mastery, self-esteem, optimism), prenatal stress (state and pregnancy anxiety), and sociocultural factors (income, education, ethnicity) would have different effects on birth outcomes were tested using structural equation modeling. Results confirmed that women with stronger resources had higher birth weight babies (beta = .21), whereas those reporting more stress had shorter gestations (beta = -.20). Resources were also associated with lower stress (beta = -.67), being married, being White, having higher income and education, and giving birth for the first time. There was no evidence that resources buffered the effects of stress. The importance of personal resources in pregnancy is highlighted along with implications for understanding the etiology of adverse birth outcomes.

Adaptation, Psychological↗
PubMed1997

Maternal stress, HPA activity, and fetal/infant outcome.

Preliminary conclusions from our research include the possibility that each of the HPA products evaluated, even though correlated (e.g., ACTH and beta E), may be linked to unique and specific outcomes. Maternal stress during the 28-30 weeks of gestation is associated with birth outcome. Increased levels of psychosocial stress were significantly related to gestational age at birth and infant birth weight. Maternal stress during the third trimester was associated with increased maternal plasma levels of ACTH and cortisol. This finding is consistent with possible mechanisms whereby psychosocial stress influences birth outcome. CRH controls the timing of labor and delivery. Precocious elevation of CRH is related to the risk of preterm delivery. This system may be "stress-sensitive." Even though pregnant women may be immunized from stress, the stress signal that is transmitted (release of ACTH and cortisol) is amplified by the placental release of CRH. This possibility has at least two consequences: (1) influencing the timing of delivery and (2) desensitization of hypophyseal corticotrophs and further "protection" of the pregnant women from the results of stress (i.e., release of ACTH and beta E). Beta E appears to influence fetal learning and perhaps the developing nervous system.

Adrenocorticotropic Hormone↗
PubMed1997

Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.

OBJECTIVES: This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS: Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS: Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS: Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.

Acculturation↗
PubMed1997

Attitudes toward genetic carrier screening for cystic fibrosis among pregnant women: the role of health beliefs and avoidant coping style.

In this study we examined the relations among psychosocial factors associated with pregnant women's attitudes toward genetic carrier testing for cystic fibrosis (CF). A sample of 511 pregnant women attending various health clinics for general prenatal care were educated about CF. Women's health beliefs, coping styles, and attitudes toward CF carrier screening were assessed. Results from structural equation modeling analyses indicated that women who perceived themselves as more likely to be carriers of the CF gene and who perceived greater benefits of screening were positively inclined toward genetic screening. Perceived barriers to screening were negatively associated with women's attitudes toward CF genetic testing. In addition, the findings suggest that some types of avoidant coping styles may indirectly influence one's decision to undergo genetic screening through perceptions of risk, benefits, and barriers. Given the advent of genetic screening options for many diseases, in this study we address some issue in women's attitudes toward prenatal screening that are relevant to a variety of genetic screening programs.

Adaptation, Psychological↗
PubMed1997

PCR-based screening for cystic fibrosis carrier mutations in an ethnically diverse pregnant population.

As the most common lethal autosomal recessive disorder in North America, cystic fibrosis (CF) is an obvious candidate for general population carrier screening. Although the identification of the causative gene has made detection of asymptomatic carriers possible, the extreme heterogeneity of its mutations has limited the sensitivity of the available DNA screening tests and has called into question their utility when they are applied to patients with no family history of the disease. The purpose of this study was to determine the technical feasibility, patient acceptance and understanding, and psychosocial impact of large-scale CF carrier screening in an ethnically diverse pregnant population. A total of 4,739 pregnant women attending prenatal clinics located in both an academic medical center and a large HMO were invited in person to participate. Of this group, 3,543 received CF instruction and assessments of knowledge and mood, and 3,192 underwent DNA testing for the six most common CF mutations, by means of a noninvasive PCR-based reverse-dot-blot method. Overall participation rates (ranging from 53% at the HMO to 77% at the academic center) and consent rates for DNA testing after CF instruction (>98%) exceeded those of most other American studies. The PCR-based screening method worked efficiently on large numbers of samples, and 55 carriers and one at-risk couple were identified. Understanding of residual risk, anxiety levels, and overall satisfaction with the program were acceptable across all ethnic groups. Our strategy of approaching a motivated pregnant population in person with a rapid and noninvasive testing method may provide a practical model for developing a larger CF screening program targeting appropriate high-risk groups at the national level, and may also serve as a paradigm for population-based screening of other genetically heterogeneous disorders in the future.

Academic Medical Centers↗
PubMed1996

Pregnancy decision making as a significant life event: a commitment approach.

A value-laden basis for commitment to goals and the behavioral and affective sequelae of commitment were examined in the context of a stressful life event. Fifty-seven women who were interviewed during a clinic visit for a pregnancy test (Time 1 [T1]) subsequently received positive test results and were then interviewed 2 days later (Time 2 [T2]) and a month later (Time 3 [T3]). The intentionality and the meaning of the pregnancy were associated with self-reported commitment to the pregnancy at T1. In turn, commitment predicted affective states both prior to (T1) and shortly after (T2) receiving test results. Initial commitment also predicted decisions to continue versus to terminate the pregnancy. The decision to continue the pregnancy appeared to bolster self-reported commitment. Relatedly, those continuing the pregnancy reported smoking fewer cigarettes at T3 than at T1. For those aborting the pregnancy, commitment at T1 was negatively related to adjustment at T3. Initial commitment predicted subsequent depression, guilt, hostility among those who aborted, whereas commitment predicted anxiety among those who continued the pregnancy. Other correlates of commitment (pregnancy concerns, religion, abortion history, and other life goals) were explored.

Abortion Applicants↗
PubMed1995

Psychosocial predictors of postpartum depressed mood in socioeconomically disadvantaged women.

The effects of stress, social support, and labor and delivery experiences on postpartum depressed mood were examined in an ethnically diverse sample of low-income women (N = 108). Women were interviewed on multiple occasions throughout pregnancy and then once approximately 2 months postpartum. Information on labor and delivery outcomes was abstracted from medical charts. Results indicated that women who were more satisfied with the prenatal social support they received were less likely to experience postpartum depressed mood, after controlling for prenatal depressive symptomatology. In addition, women who experienced more distressing life events during pregnancy and who reported higher levels of prenatal anxiety were also more likely to feel depressed, after controlling for all other factors in the model. Finally, women who were more satisfied with their labor and delivery experience tended to be less depressed in the early months following childbirth. Together, these variables accounted for 45% of the variance in postpartum depressed mood.

Adolescent↗
PubMed1994

The multidimensional nature of received social support in gay men at risk of HIV infection and AIDS.

This article concerns received social support in gay men at risk of HIV and AIDS. Distinctions are made between three types of support (informational, tangible, emotional), four sources of support (friends, relatives, partner, organizations), and three dimensions of support (amount, satisfaction, reciprocity). A 24-item inventory reflecting these distinctions was administered to a sample of 587 gay men at two points in time. The psychometric properties of the instrument were determined, and the factor structure of the items varying sources and types of social support were tested. This was done by exploratory as well as by confirmatory factor analyses. The hypothesized structure was confirmed in both waves separately. Results corroborated the assumption that enacted or received social support is a highly differentiated construct and requires assessment tools that are designed according. Descriptive results on the support perceptions in this sample are also presented. Implications for the study of support in men at risk of HIV and AIDS are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation.

OBJECTIVE: The aim was to test a model of the influence of maternal prenatal psychosocial stress on birth outcomes after controlling for biomedical risk. STUDY DESIGN: In a prospective study a sociodemographically homogeneous sample of 90 women was assessed during the third trimester with standard, reliable questionnaires that measured episodic and chronic stress, strain (response to stress), and pregnancy-related anxiety. Birth outcomes included infant birth weight, gestational age at birth, and intrapartum complications. Parity and biomedical (antepartum) risk was also coded. Bivariate and multivariate analyses were performed after controlling for the effects of biomedical risk factors. RESULTS: Independent of biomedical risk, each unit increase of prenatal life event stress (from a possible sample range of 14.7 units) was associated with a 55.03 gm decrease in infant birth weight and with a significant increase in the likelihood of low birth weight (odds ratio 1.32), and each unit increase of prenatal pregnancy anxiety (from a possible sample range of 5 units) was associated with a 3-day decrease in gestational age at birth. CONCLUSION: Independent of biomedical risk, maternal prenatal stress factors are significantly associated with infant birth weight and with gestational age at birth.

Adult↗
PubMed1993

Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression.

This prospective study examined the effects of prenatal social support on maternal and infant health and well-being in a sample of low-income pregnant women (N = 129). Three aspects of support (amount received, quality of support received, and network resources) and four outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicated that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicated that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model.

Adolescent↗