Associations of Hormonal Biomarkers With Mental Health and Healthy Behaviors Among Mothers of Very-Low-Birthweight Infants

Abstract

Objectives:

To examine the concurrent use of self-report questionnaires and hormonal biomarkers, specifically levels of testosterone and cortisol, along with demographic variables and corrected age (CA) in the assessment of mental health and healthy behaviors among mothers of very-low-birthweight (VLBW, BW < 1,500 g) infants at five time points over 2 years post birth.

Method:

Data on 40 mothers from a neonatal intensive care unit of a tertiary medical center in the southeast United States were collected from the medical record, standard questionnaires for the mother (depressive symptoms, perceived stress, anxiety, mental health status, parenting stress, and healthy lifestyle behaviors), and biochemical measurement of maternal testosterone and cortisol using enzyme immunoassay at birth, 40 weeks’ postmenstrual age, and 6, 12, and 24 months CA.

Results:

Maternal self-report of mental health improved from birth to 6 or 12 months then worsened at 24 months. Mixed linear models showed that mothers with higher testosterone levels had more depressive symptoms and smoked more, whereas mothers with higher cortisol levels had healthier behaviors and exercised more. Testosterone levels were negatively correlated with cortisol levels. Marital status, education, and health insurance were the most predictive demographic variables for the levels of hormonal biomarkers, mental health, and healthy behaviors.

Conclusions:

The use of self-report and biochemical measurement was effective in assessing maternal mental health and healthy behaviors over 2 years post birth, when mothers of VLBW infants tend to experience more mental health problems and parenting difficulties than mothers of normal-BW full-term infants.

Keywords

hormonal biomarkers maternal mental health maternal healthy behaviors

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References

Abidin

R. R.

(2012). Parenting stress index, 4th edition short form (PSI-4-SF). Lutz, FL: PAR.

Andreou

Alexopoulos

E. C.

Lionis

Varvogli

Gnardellis

Chrousos

G. P.

Darviri

(2011). Perceived stress scale: Reliability and validity study in Greece. International Journal of Environmental Research and Public Health, 8, 3287–3298. doi:10.3390/ijerph8083287ijerph-08-03287

Baud

Sola

(2007). Corticosteroids in perinatal medicine: How to improve outcomes without affecting the developing brain? Seminars in Fetal & Neonatal Medicine, 12, 273–279. doi:10.1016/j.siny.2007.01.025

Blehar

M. C.

(2006). Women’s mental health research: The emergence of a biomedical field. Annual Review of Clinical Psychology, 2, 135–160. doi:10.1146/annurev.clinpsy.2.022305.095344

Bogaerts

A. F.

Devlieger

Nuyts

Witters

Gyselaers

Van den Bergh

B. R.

(2013). Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: A randomized controlled trial. International Journal of Obesity (2005), 37, 814–821. doi:10.1038/ijo.2012.162

Bolten

M. I.

Wurmser

Buske-Kirschbaum

Papousek

Pirke

K. M.

Hellhammer

(2011). Cortisol levels in pregnancy as a psychobiological predictor for birth weight. Archives of Women’s Mental Health, 14, 33–41. doi:10.1007/s00737-010-0183-1

Brockington

Butterworth

Glangeaud-Freudenthal

(2017). An international position paper on mother-infant (perinatal) mental health, with guidelines for clinical practice. Archives of Women’s Mental Health, 20, 113–120. doi:10.1007/s00737-016-0684-7

Buckwalter

J. G.

Stanczyk

F. Z.

McCleary

C. A.

Bluestein

B. W.

Buckwalter

D. K.

Rankin

K. P.

… Goodwin

T. M.

(1999). Pregnancy, the postpartum, and steroid hormones: Effects on cognition and mood. Psychoneuroendocrinology, 24, 69–84.

Cho

Holditch-Davis

Miles

M. S.

(2008). Effects of maternal depressive symptoms and infant gender on the interactions between mothers and their medically at-risk infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37, 58–70. doi:10.1111/j.1552-6909.2007.00206.x

10.

Cho

Phillips

Holditch-Davis

(2016). Associations between maternal hormonal biomarkers and maternal mental and physical health of very low birthweight infants. Asian/Pacific Island Nursing Journal, 1, 149–161. doi:10.9741/23736658.1047

11.

Cho

J. I.

Carlo

W. A.

McCormick

K. L.

(2012). Associations between salivary testosterone and cortisol levels and neonatal health and growth outcomes. Early Human Development, 88, 789–795. doi:10.1016/j.earlhumdev.2012.05.002

12.

Feise

R. J.

(2002). Do multiple outcome measures require p-value adjustment? BMC Medical Research Methodology, 2, 8.

13.

Gao

Wang

Ren

Kemp

D. E.

Chan

P. K.

… Calabrese

J. R.

(2015). Disagreement between self-reported and clinician-ascertained suicidal ideation and its correlation with depression and anxiety severity in patients with major depressive disorder or bipolar disorder. Journal of Psychiatric Research, 60, 117–124. doi:10.1016/j.jpsychires.2014.09.011

14.

Gettler

L. T.

Oka

R. C.

(2016). Are testosterone levels and depression risk linked based on partnering and parenting? Evidence from a large population-representative study of U.S. men and women. Social Science and Medicine, 163, 157–167. doi:10.1016/j.socscimed.2016.06.044

15.

Giltay

E. J.

Enter

Zitman

F. G.

Penninx

B. W.

van Pelt

Spinhoven

Roelofs

(2012). Salivary testosterone: Associations with depression, anxiety disorders, and antidepressant use in a large cohort study. Journal of Psychosomatic Research, 72, 205–213. doi:10.1016/j.jpsychores.2011.11.014

16.

Granger

D. A.

Shirtcliff

E. A.

Zahn-Waxler

Usher

Klimes-Dougan

Hastings

(2003). Salivary testosterone diurnal variation and psychopathology in adolescent males and females: Individual differences and developmental effects. Development and Psychopathology, 15, 431–449.

17.

Hohlagschwandtner

Husslein

Klier

Ulm

(2001). Correlation between serum testosterone levels and peripartal mood states. Acta Obstetricia et Gynecologica Scandinavica, 80, 326–330.

18.

Holditch-Davis

Schwartz

Black

Scher

(2007). Correlates of mother-premature infant interactions. Research in Nursing and Health, 30, 333–346. doi:10.1002/nur.20190

19.

Howard

L. M.

Khalifeh

(2015). Randomised controlled trial of facilitated exercise plus usual care versus usual care only as a treatment for women with a depressive disorder in the first six postnatal months. Evidence-Based Mental Health, 18, 123. doi:10.1136/eb-2015-102140

20.

Howe

T. H.

Sheu

C. F.

Wang

T. N.

Hsu

Y. W.

(2014). Parenting stress in families with very low birth weight preterm infants in early infancy. Research in Developmental Disabilities, 35, 1748–1756. doi:10.1016/j.ridd.2014.02.015

21.

Janisse

H. C.

Nedd

Escamilla

Nies

M. A.

(2004). Physical activity, social support, and family structure as determinants of mood among European-American and African-American women. Women and Health, 39, 101–116. doi:10.1300/J013v39n01_06

22.

Kim

Popkin

B. M.

Siega-Riz

A. M.

Haines

P. S.

Arab

(2004). A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: The Lifestyle Index. Preventive Medicine, 38, 160–171.

23.

King

J. T.

Jr Horowitz

M. B.

Kassam

A. B.

Yonas

Roberts

M. S.

(2005). The Short Form-12 and the measurement of health status in patients with cerebral aneurysms: Performance, validity, and reliability. Journal of Neurosurgery, 102, 489–494. doi:10.3171/jns.2005.102.3.0489

24.

Kowalska

Olszowa

Markowska

Teplik

Rymaszewska

(2014). Physical activity and childbirth classes during a pregnancy and the level of perceived stress and depressive symptoms in women after childbirth. Psychiatria Polska, 48, 889–900.

25.

Lancaster

C. A.

Gold

K. J.

Flynn

H. A.

Yoo

Marcus

S. M.

Davis

M. M.

(2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202, 5–14. doi:10.1016/j.ajog.2009.09.007

26.

Lau

Hurst

N. M.

Smith

E. O.

Schanler

R. J.

(2007). Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants. Journal of Perinatology, 27, 399–408. doi:10.1038/sj.jp.7211770

27.

Lesage

F. X.

Berjot

Deschamps

(2012). Psychometric properties of the French versions of the Perceived Stress Scale. International Journal of Occupational Medicine and Environmental Health, 25, 178–184. doi:10.2478/S13382-012-0024-8

28.

Marchi

Berg

Dencker

Olander

E. K.

Begley

(2015). Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. Obesity Reviews, 16, 621–638. doi:10.1111/obr.12288

29.

Marteau

T. M.

Bekker

(1992). The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). British Journal of Clinical Psychology, 31, 301–306.

30.

McGiveron

Foster

Pearce

Taylor

M. A.

McMullen

Langley-Evans

S. C.

(2015). Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: Finding of a pragmatic evaluation of a midwife-led intervention. Journal of Human Nutrition and Dietetics, 28, 29–37. doi:10.1111/jhn.12240

31.

Mezzullo

Fanelli

Fazzini

Gambineri

Vicennati

Di Dalmazi

… Pasquali

(2016). Validation of an LC-MS/MS salivary assay for glucocorticoid status assessment: Evaluation of the diurnal fluctuation of cortisol and cortisone and of their association within and between serum and saliva. Journal of Steroid Biochemistry and Molecular Biology, 163, 103–112. doi:10.1016/j.jsbmb.2016.04.012

32.

O’Hara

M. W.

McCabe

J. E.

(2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379–407. doi:10.1146/annurev-clinpsy-050212-185612

33.

Owen

D. J.

Wood

Tomenson

Creed

Neilson

J. P.

(2017). Social stress predicts preterm birth in twin pregnancies. Journal of Psychosomatic Obstetrics and Gynaecology, 38, 63–72. doi:10.1080/0167482X.2016.1235146

34.

Papacosta

Gleeson

Nassis

G. P.

(2013). Salivary hormones, IgA, and performance during intense training and tapering in judo athletes. Journal of Strength and Conditioning Research, 27, 2569–2580. doi:10.1519/JSC.0b013e31827fd85c

35.

Penedo

F. J.

Dahn

J. R.

(2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18, 189–193.

36.

Radloff

L. S.

(1977). The CES-D scale: A self-report depression scale for research in the general population. Journal of Applied Psychological Measurement, 1, 385–401.

37.

Räisänen

Lehto

S. M.

Nielsen

H. S.

Gissler

Kramer

M. R.

Heinonen

(2014). Risk factors for and perinatal outcomes of major depression during pregnancy: A population-based analysis during 2002–2010 in Finland. BMJ Open, 4, e004883. doi:10.1136/bmjopen-2014-004883

38.

Richardson

C. R.

Faulkner

McDevitt

Skrinar

G. S.

Hutchinson

D. S.

Piette

J. D.

(2005). Integrating physical activity into mental health services for persons with serious mental illness. Psychiatric Services, 56, 324–331. doi:10.1176/appi.ps.56.3.324

39.

Rohr

U. D.

(2002). The impact of testosterone imbalance on depression and women’s health. Maturitas, 41, S25–S46.

40.

Rosner

Auchus

R. J.

Azziz

Sluss

P. M.

Raff

(2007). Position statement: Utility, limitations, and pitfalls in measuring testosterone: An Endocrine Society position statement. Journal of Clinical Endocrinology and Metabolism, 92, 405–413. doi:10.1210/jc.2006-1864

41.

Sarkar

Bergman

Fisk

N. M.

O’Connor

T. G.

Glover

(2007). Amniotic fluid testosterone: Relationship with cortisol and gestational age. Clinical Endocrinology, 67, 743–747. doi:10.1111/j.1365-2265.2007.02955.x

42.

Seth

Lewis

A. J.

Galbally

(2016). Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: A systematic literature review. BMC Pregnancy and Childbirth, 16, 124. doi:10.1186/s12884-016-0915-y

43.

Staehelin

Kurth

Schindler

Schmid

Zemp Stutz

(2013). Predictors of early postpartum mental distress in mothers with midwifery home care—Results from a nested case-control study. Swiss Medical Weekly, 143, w13862. doi:10.4414/smw.2013.13862

44.

van der Bij

A. K.

de Weerd

Cikot

R. J.

Steegers

E. A.

Braspenning

J. C.

(2003). Validation of the Dutch short form of the state scale of the Spielberger State-Trait Anxiety Inventory: Considerations for usage in screening outcomes. Community Genetics, 6, 84–87. doi:10.1159/000073003

45.

Vilela

A. A.

de J. P. Pinto

Rebelo

Benaim

Lepsch

Dias-Silva

C. H.

… Kac

(2015). Association of prepregnancy dietary patterns and anxiety symptoms from midpregnancy to early postpartum in a prospective cohort of Brazilian women. Journal of the Academy of Nutrition and Dietetics, 115, 1626–1635. doi:10.1016/j.jand.2015.01.007

46.

Ware

Jr Kosinski

Keller

S. D.

(1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.

47.

Witt

W. P.

Litzelman

Spear

H. A.

Wisk

L. E.

Levin

McManus

B. M.

… Palta

(2012). Health-related quality of life of mothers of very low birth weight children at the age of five: Results from the Newborn Lung Project Statewide Cohort Study. Quality of Life Research, 21, 1565–1576. doi:10.1007/s11136-011-0069-3