Stress during pregnancy: An ecological momentary assessment of stressors among Black and White women with implications for maternal health

Feasibility and tolerability of physiologic monitoring among pregnant nurses and nursing teams

BACKGROUND

Most studies of stress during pregnancy have relied on self-reported and recalled measures, leaving a knowledge gap about the impact of acute, or momentary, stressors. Heart rate, blood pressure, and cortisol are physiologic measures known to increase acutely in response to acute stress. The feasibility of collecting these measures has not been widely reported among pregnant workers outside of a controlled laboratory setting.

METHODS

This pilot study assessed the feasibility and tolerability of measuring ambulatory heart rate, blood pressure, and diurnal urine cortisol during periods of work and rest among pregnant nurses, nursing assistants, and clinical technicians.

RESULTS

Over a 9-month enrollment period, we received 31 inquiries from potential candidates, of whom 18 met our eligibility criteria and 12 accepted enrollment (67% acceptance rate). Over the study period, 4 enrollees withdrew their participation, and 8 were retained until the end of the study (67% completion rate). Our feasibility threshold was the acquisition of ≥ 80% of expected measurements for heart rate, blood pressure, and urine cortisol among retained participants. We achieved our feasibility target for blood pressure recordings (acquiring 84% of expected measures) but not for heart rate recordings (acquiring 60% of expected measures). Urine cortisol levels were successfully obtained 97% of the time. Through qualitative analysis of comments provided by study participants, we identified three major themes surrounding barriers to completing physiological monitoring: (1) personal discomfort and technical issues with study equipment, (2) work or activity interference, and (3) concerns about study design.

CONCLUSIONS

While physiologic monitoring of pregnant workers is important for learning about how work might impact pregnancy outcomes, equipment challenges pose a significant barrier to study participation. Future studies should allow for a significant withdrawal rate or explore alternative equipment options.

Visualizing user demands through storyboarding in the mHealth app development for pregnant women: a conceptual framework

In the co-design process of mHealth apps, the intuitiveness of user experience (UE) and user demands (UDs) are very important to the stakeholders. However, there is little research on how UE and UD are visually presented to stakeholders. Similar literature related to the design perspective of pregnant women is rare. Therefore, there is a need to propose a conceptual framework from a design perspective to visualize UD for stakeholders to enhance their communication efficiency and engage their creativity. In the research, we attempt to propose a storyboarding strategy for developing mHealth apps to visualize UDs for stakeholders. This article presents a systematic literature review synthesis process on selected literature on identifying the best storyboarding strategy of mHealth apps for pregnant women that could visualize UDs. Results from the study found the potential application of a storyboarding strategy for visualizing pregnant ladies' demands in developing the mHealth app's early design phase. This study contributes to proposing a conceptual framework for cartoon-like storyboarding in the early design phase of mHealth app development to visualize pregnant ladies' demands to foster user health behavior. This study is significant for integrating UDs into developing mHealth apps for pregnant women. Future studies are recommended to determine the characteristics of storyboarding in developing mHealth apps for pregnant women.

Effects of improved on-farm crop storage on DNA methylation of mothers and their infants: evidence from a randomized controlled trial in Kenya

BACKGROUND

Stress during pregnancy can lead to adverse maternal and infant health outcomes through epigenetic changes in the hypothalamic-pituitary-adrenal axis. Among farmers in low-income countries, one important stressor is food insecurity, which can be reduced using hermetic storage bags. This study aimed to determine, for the first time, whether a hermetic storage bag intervention during pregnancy positively affects maternal and infant DNA methylation of the hypothalamic-pituitary-adrenal axis-related genes FKBP5 and NR3C1. We further analyzed whether anthropometrics, stress, and mental health were associated with DNA methylation.

METHODS

This study was part of a larger matched-pair randomized controlled trial focusing on the impact of improved on-farm storage on food security, poverty, and net income of smallholder farming households. A total of N = 149 mothers were recruited by telephone and invited to attend a study appointment at health facilities in Kakamega County, Western Kenya, with their infants in April or May 2021. During the appointment, anthropometric measurements were taken, questionnaires on stress and mental health were administered, and saliva samples were collected. Logistic and multiple linear regression were used to examine the effect of the intervention and related measures on DNA methylation.

RESULTS

Mothers in the intervention group showed higher mean NR3C1 methylation levels than those in the control group, corrected for multiple testing. Maternal postpartum body mass index was positively associated with infant NR3C1 CpG3 DNA methylation. The more stressful life events a mother had experienced in the previous 12 months (including during pregnancy), the lower her FKBP5 CpG3 methylation levels.

CONCLUSIONS

Food insecurity and stressful life events during pregnancy seem to exert significant effects on maternal DNA methylation. While these stressors did not appear to impact infant DNA methylation in the present study, maternal postpartum body mass index was significantly related to infant methylation. These findings suggest that while infants may be protected from excessive maternal glucocorticoids by placental barrier activity, maternal metabolic status is still reflected in their epigenetic make-up. Trial registration This study was part of a larger matched-pair randomized controlled trial on the impact of improved on-farm crop storage on welfare, nutrition, and human health. Registration can be found in the American Economic Association (AEA) RCT Registry, RCT ID: AEARCTR-0005845.

Interactions between perceived stress and microbial-host immune components: two demographically and geographically distinct pregnancy cohorts

Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota, reflecting environment and social interactions, alongside host immune responses have the potential to better understand perceived stress and identify when stress is excessive in pregnancy. Two U.S. cohorts of 84 pregnant individuals, composed of urban women of color and suburban white women, completed the Perceived Stress Scale-10 (PSS-10) and provided fecal and blood samples at two time points. Confirmatory Factor Analysis assessed the robustness of a two-factor PSS-10 model (Emotional Distress/ED and Self-Efficacy/SE). Gut microbiota composition was measured by 16 S rRNA amplicon sequencing and the immune system activity was assessed with a panel of 21 T-cell related cytokines and chemokines. ED levels were higher in the suburban compared to the urban cohort, but levels of SE were similar. ED and SE levels were associated with distinct taxonomical signatures and the gut microbiota data improved the prediction of SE levels compared with models based on socio-demographic characteristics alone. Integration of self-reported symptoms, microbial and immune information revealed a possible mediation effect of Bacteroides uniformis between the immune system (through CXCL11) and SE. The study identified links between distinct taxonomical and immunological signatures with perceived stress. The data are congruent with a model where gut microbiome and immune factors, both impacting and reflecting factors such as close social relationships and dietary fiber, may modulate neural plasticity resulting in increased SE during pregnancy. The predictive value of these peripheral markers merit further study.