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Cited by 58Maternal Mental Health During Pregnancy and PostpartumStress Responses and CortisolMindfulness and Compassion Interventions

The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women

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Urizar, Guido G., Yim, Ilona S., Rodriguez, Anthony, Schetter, Christine Dunkel·2019·Psychoneuroendocrinology
DOI 10.1016/j.psyneuen.2019.02.022
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Abstract

Background Dysregulations in maternal hypothalamus-pituitary-adrenal function and the end product, cortisol, have been associated with a heightened risk for stress-related health complications during pregnancy and post partum. Given the adverse health impact that maternal cortisol may have on expectant mothers and their infants, empirically-based prenatal interventions are needed to target optimal management of stress and its biological effects in at-risk pregnant women, a primary example of which is cognitive behavioral stress management (CBSM). This randomized-controlled trial examined the effects of a prenatal CBSM intervention on reduction in perceived stress and regulation of salivary cortisol patterns [i.e., overall cortisol output (area under the curve), cortisol awakening response (CAR), diurnal slope] during pregnancy and the early postpartum period, as compared to a control group. Methods One hundred low-income pregnant women (71% Latina; 76% annual income < $20 K) with low or high anxiety during pregnancy were randomized (stratified by anxiety) to either an eight-week CBSM group intervention (n = 55) or a control group (n = 45). They provided seven salivary cortisol samples (four am samples, 12 pm, 4 pm, and 8 pm samples on one collection day) at baseline (1 st trimester; < 17 weeks of gestation), after their prenatal program (2 nd trimester), and also in the third trimester and at three months post partum. Results Women receiving CBSM had lower perceived stress levels throughout pregnancy and early post partum compared to women in the control group (p = .020). Among women with high prenatal anxiety, those in CBSM showed a steeper decline in their diurnal cortisol at three months post partum compared to those in the control group (p = .015). Further, non-Latina women in CBSM had a lower CAR at three months post partum compared to non-Latina women in the control group (p = .025); these randomization group differences on the CAR were not observed among Latina women. Conclusions These findings provide preliminary support for the efficacy of prenatal CBSM interventions in improving stress outcomes among low-income pregnant women and suggest the need to test the effects of these interventions on a larger scale for improving maternal and infant health outcomes long-term.

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  • The Pregnancy Related Anxiety Scale shows good reliability and internal consistency and has been used with Latinas in clinical treatment studies.

    “The measure shows good reliability and internal consistency and has been used with Latinas in clinical treatment studies (Urizar et al., 2019).”

    From Exposure Therapy Acceptability Among Pregnant Latinas With Anxiety: A Qualitative Content Analysis (2025) · cites this paper as Urizar et al., 2019

    Section 2.4.2 reports good internal consistency for the 10-item Prenatal Anxiety Scale, and Section 2.1 shows that it was used in a randomized intervention study whose participants were 71% Latina. The paper does not identify the instrument as the Pregnancy Related Anxiety Scale or report a separate reliability measure beyond internal consistency. Page numbers were not available in our copy. (LLM, conf=0.82)

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Cited by

Sorted by citations

Authors
Urizar, G. G., Yim, I. S., Rodriguez, A., & Schetter, C. D.
Affiliations
  • California State University System (US)
  • University of California, Irvine (US)
  • University of California, Los Angeles (US)
Corresponding author
Urizar, Guido G.
ORCID
Venue
Psychoneuroendocrinology
Publisher
Elsevier BV
Published
2019-06
Volume
104
Pages
174-184
ISSN
0306-4530 (ISSN-L)
DOI
10.1016/j.psyneuen.2019.02.022
OpenAlex
W2916985387
Cited by
58
References
8
Citations by year
2026: 2 · 2025: 8 · 2024: 8 · 2023: 11 · 2022: 5 · 2021: 11 · 2020: 9 · 2019: 3 · 2015: 1
FWCI
6.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychoneuroendocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of General Medical Sciences of the National Institutes of Health (UL1GM118979, TL4GM118980, RL5GM118978)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
cognitive-behavioral stress management, perceived stress, salivary cortisol, cortisol awakening response, diurnal cortisol slope, hypothalamic-pituitary-adrenal axis, low-income pregnant women, Hispanic women, prenatal anxiety, postpartum period, maternal mental health
MeSH terms
Adult, Anxiety, Circadian Rhythm, Female, Humans, Hydrocortisone, Poverty, Pregnancy, Psychotherapy, Saliva, Socioeconomic Factors, Stress, Psychological, Cognitive Behavioral Therapy, Pregnant Women, Pregnant People

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