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Cited by 44Child Nutrition and Water AccessBirth, Development, and HealthMaternal Mental Health During Pregnancy and Postpartum

Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data from a randomized controlled trial in rural Malawi

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Stewart, Christine P., Oaks, Brietta M., Laugero, Kevin D., Ashorn, Ulla, Harjunmaa, Ulla, Kumwenda, Chiza, Chaima, David, Maleta, Kenneth +2 more·2015·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-015-0793-8PMC PMC4688934
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Abstract

BACKGROUND: Prenatal micronutrient supplements have been found to increase birth weight, but mechanisms for increased growth are poorly understood. Our hypotheses were that 1) women who receive lipid-based nutrient supplements (LNS) during pregnancy would have lower mean salivary cortisol concentration at 28 wk and 36 wk gestation compared to the multiple micronutrient (MMN) and iron-folic acid (IFA) supplement groups and 2) both salivary cortisol and perceived stress during pregnancy would be associated with shorter duration of gestation and smaller size at birth. METHODS: Women were enrolled in the trial in early pregnancy and randomized to receive LNS, MMN, or iron-folic acid (IFA) supplements daily throughout pregnancy. At enrollment, 28 wk and 36 wk gestation, saliva samples were collected and their cortisol concentration was measured. Self-report of perceived stress was measured using questionnaires. Gestation duration was indicated by ultrasound dating and newborn anthropometric measurements (weight, length, head circumference) provided indicators of intrauterine growth. RESULTS: Of the 1391 women enrolled in the trial, 1372, 906 and 1049 saliva samples were collected from women at baseline, 28 wk and 36 wk, respectively. There were no significant differences in mean cortisol concentrations by intervention group at 28 wk or 36 wk gestation. Cortisol concentrations were negatively associated with duration of gestation (Baseline: β = -0.05, p = 0.039; 36 wk: β = -0.04, p = 0.037) and birth weight (28 wk: β = -0.08, p = 0.035; 36 wk: β = -0.11, p = 0.003) but not associated with length-for-age or head circumference-for-age z-scores. Perceived stress at 36 wk was significantly associated with shorter newborn LAZ (p = 0.001). There were no significant associations with the risk of small for gestational age, preterm birth, or low birth weight. CONCLUSIONS: Maternal salivary cortisol concentration was strongly associated with birth weight and duration of gestation in rural Malawi, but these data do not support the hypothesis that LNS provision to pregnant women would influence their salivary cortisol concentrations. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01239693.

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  • Some studies have demonstrated elevated HPA activity in women with stress and preterm delivery, including elevated cortisol and CRH levels.

    “Some studies have demonstrated elevated HPA activity in these women, including elevated cortisol and CRH levels [77,78,79].”

    From Stress and the HPA Axis: Balancing Homeostasis and Fertility. (2017) · cites this paper as [78]

    The Results (Associations with birth outcomes; page unavailable) associate higher maternal cortisol with shorter gestation, and the Background identifies cortisol as part of the HPA stress response. But the paper does not demonstrate elevated cortisol and CRH together in women with stress and preterm delivery: the Discussion says CRH was not measured, and the reported gestation finding is not specifically a preterm-delivery finding. (LLM, conf=0.86)

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Authors
Stewart, C. P., Oaks, B. M., Laugero, K. D., Ashorn, U., Harjunmaa, U., Kumwenda, C., Chaima, D., Maleta, K., Ashorn, P., & Dewey, K. G.
Affiliations
  • University of California, Davis (US)
  • Agricultural Research Service (US)
  • University of Malawi (MW)
  • Tampere University Hospital (FI)
Corresponding author
Stewart, Christine P.
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
15
Issue
1
Pages
346-346
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-015-0793-8
PMC
PMC4688934
OpenAlex
W2198989627
Cited by
44
References
4
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 6 · 2016: 1
FWCI
3.53
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Tampere University Institutional Repository (Tampere University) (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Tampere University Institutional Repository (Tampere University) (submittedVersion)
  • Greater South Information System
Funders
  • U.S. Department of Agriculture (5306‐51530‐019‐00, 5306‐51530‐019)
  • United States Agency for International Development (No. AID-OAA-A-12-00005, AIDOAAA1200005, FHI360)
  • Bill and Melinda Gates Foundation (FHI 360)
  • FHI 360
  • University of California, Davis
  • Agricultural Research Service (5306‐51530‐019‐00)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
lipid-based nutrient supplements, prenatal micronutrient supplementation, multiple micronutrient supplements, birth weight, gestation length, fetal growth, neonatal anthropometry, small for gestational age, preterm birth, rural Malawi, maternal nutrition intervention, length-for-age z-score
MeSH terms
Adolescent, Adult, Birth Weight, Female, Folic Acid, Gestational Age, Humans, Hydrocortisone, Infant, Newborn, Iron, Malawi, Middle Aged, Pregnancy, Rural Population, Stress, Psychological, Micronutrients, Dietary Supplements, Maternal Nutritional Physiological Phenomena, Young Adult, Self Report

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