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

Christine P. Stewart, Brietta M. Oaks, Kevin D. Laugero, Ulla Ashorn, Ulla Harjunmaa, Chiza Kumwenda, David Chaima, Kenneth Maleta, Per Ashorn, Kathryn G. Dewey

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish (US)
Article number346
JournalBMC Pregnancy and Childbirth
Volume15
Issue number1
DOIs
StatePublished - Dec 22 2015
Externally publishedYes

Fingerprint

Malawi
Hydrocortisone
Randomized Controlled Trials
Mothers
Parturition
Lipids
Food
Pregnancy
Micronutrients
Birth Weight
Saliva
Folic Acid
Iron
Head
Newborn Infant
Premature Birth
Low Birth Weight Infant
Growth
Self Report
Gestational Age

Keywords

  • Birth weigh
  • Cortisol
  • Malawi
  • Multiple micronutrient supplements
  • Pregnancy
  • Preterm birth
  • Stress
  • tLipid-based nutrient supplements

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

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. / Stewart, Christine P.; Oaks, Brietta M.; Laugero, Kevin D.; Ashorn, Ulla; Harjunmaa, Ulla; Kumwenda, Chiza; Chaima, David; Maleta, Kenneth; Ashorn, Per; Dewey, Kathryn G.

In: BMC Pregnancy and Childbirth, Vol. 15, No. 1, 346, 22.12.2015.

Research output: Contribution to journalArticle

Stewart, Christine P. ; Oaks, Brietta M. ; Laugero, Kevin D. ; Ashorn, Ulla ; Harjunmaa, Ulla ; Kumwenda, Chiza ; Chaima, David ; Maleta, Kenneth ; Ashorn, Per ; Dewey, Kathryn G. / 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. In: BMC Pregnancy and Childbirth. 2015 ; Vol. 15, No. 1.
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T2 - An analysis of data from a randomized controlled trial in rural Malawi

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AU - Oaks, Brietta M.

AU - Laugero, Kevin D.

AU - Ashorn, Ulla

AU - Harjunmaa, Ulla

AU - Kumwenda, Chiza

AU - Chaima, David

AU - Maleta, Kenneth

AU - Ashorn, Per

AU - Dewey, Kathryn G.

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N2 - 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.

AB - 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.

KW - Birth weigh

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KW - Pregnancy

KW - Preterm birth

KW - Stress

KW - tLipid-based nutrient supplements

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