A randomized trial of prenatal cognitive behavioral stress management effects on obstetric health outcomes and infant cortisol levels

Abstract

Background: Altered cortisol patterns during pregnancy have been linked to heightened risk for obstetric health complications (e.g., low infant birthweight) and dysregulated infant cortisol levels after birth, particularly in chronically stressed, low-income and ethnic minority families. Considering the detrimental effects that dysregulated cortisol may have on maternal and infant health, prenatal interventions aimed at cortisol regulation in at-risk families are needed. In a previous study, we reported that low-income, ethnic minority pregnant women randomized to a prenatal cognitive behavioral stress management (CBSM) intervention showed improved pre- and postnatal stress and salivary cortisol patterns relative to a control group. The current study extends this work by investigating whether families who received this prenatal CBSM intervention, relative to a control group, experienced fewer obstetric health complications and more regulated infant post partum cortisol patterns, and if maternal cortisol patterns and psychosocial factors (stressful life events, resilience) influenced CBSM intervention effects.

Methods: One hundred pregnant women (76 % annual income < $20 K, <17 weeks of gestation) were randomized to an eight-week CBSM group intervention (n = 55) or a control group (n = 45). Salivary cortisol was collected at baseline (1st trimester), after the intervention (3rd trimester), and at three months post partum (mothers and infants). Obstetric health complications were assessed via a medical record review.

Results: Prenatal CBSM (compared to the control group) showed fewer obstetric health complications for mothers with elevated prenatal cortisol levels. Further, CBSM (compared to the control group) showed more regulated cortisol patterns (i.e., reducing total cortisol, steeper decline in diurnal cortisol) for infants of mothers who had high cortisol and stress levels, and for infants of African American mothers.

Conclusions: These results lend support to the effectiveness of prenatal CBSM in enhancing the health of low-income, ethnic minority mothers and their infants, and emphasize the need to investigate the prolonged impact of CBSM in community-based settings.

Keywords: Birth outcomes; Cortisol; Infants; Pregnancy; Prenatal health; Stress management.