title: The relation of psychological distress to salivary and serum cortisol levels in pregnant women shortly after the diagnosis of a structural fetal anomaly.
abstract: OBJECTIVE
  To examine the association between psychological distress and levels of salivary cortisol (SalC) and the ratio of serum cortisol to cortisol-binding globulin (SC/CBG) in pregnant women shortly after the diagnosis of a structural fetal anomaly. DESIGN. A prospective, observational study.
  
  
  METHODS
  Tertiary referral center for fetal medicine.
  
  
  METHODS
  Pregnant women with (study group, n=126) and without a fetal structural anomaly (comparison group, n=106) were included. Gestational age (GA) was >12weeks.
  
  
  METHODS
  Psychological distress was assessed by Impact of Event Scale (IES-22), General Health Questionnaire (GHQ-28) and Edinburgh Postnatal Depression Scale (EPDS). Salivary cortisol was measured in the evening and SC/CBG in the morning. MAIN OUTCOME MEASURES. Levels of SalC (in nanomoles per liter) and SC/CBG.
  
  
  RESULTS
  Median (range) GA at assessment was 19 (12-38) and 19 (13-22)weeks in the study and the comparison group, respectively. The study group had significantly higher psychological distress levels (p≤0.001) than the comparison group in all outcome measures. Salivary cortisol correlated with GA in both groups (p<0.004). In subanalyses including only women with GA 18-22 weeks, and excluding smokers or women with chronic diseases or medication which might interfere with cortisol levels, there were no relations of SalC or SC/CBG with the psychometric variables in the study group. CONCLUSIONS. Women with detected fetal malformation had high psychological distress scores. The lack of association between psychological distress and SalC or SC/CBG suggests a blunted response of the hypothalamic-pituitary-adrenal axis following recent psychological stress activation in the second trimester of pregnancy.
authors: Obstetrics.
authors: Anne
authors: A
authors: Kaasen
authors: Obstetrics.
authors: Anne
authors: A
authors: Helbig
authors: Neuropsychiatry and Psychosomatic Medicine.|University of Oslo, Oslo.
authors: Ulrik F
authors: UF
authors: Malt
authors: Specialized Endocrinology, Oslo University Hospital - Rikshospitalet, Oslo.
authors: Kristin
authors: K
authors: Godang
authors: University of Oslo, Oslo.|Specialized Endocrinology, Oslo University Hospital - Rikshospitalet, Oslo.
authors: Jens
authors: J
authors: Bollerslev
authors: Nofima, Ås, Norway.|Faculty of Life Sciences, Department of Food Science, University of Copenhagen, Copenhagen, Denmark.
authors: Tormod
authors: T
authors: Naes
authors: Obstetrics.|University of Oslo, Oslo.
authors: Guttorm
authors: G
authors: Haugen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002352:Carrier Proteins / Q000097:blood; D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000523:psychology*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D011247:Pregnancy; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism*; D013315:Stress, Psychological / Q000209:etiology / Q000378:metabolism*; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal
chemical_list: D002352:Carrier Proteins; C027091:cortisol binding globulin; D006854:Hydrocortisone