Effects of Prenatal Education and Type Of Delivery On Stress Axes

Year 2021, , 475 - 479, 29.12.2021

Cihat Uçar , Mehmet Bülbül , Sedat Yıldız

https://doi.org/10.35440/hutfd.1005965

Abstract

Background: Training received during pregnancy may alter the prenatal stress level. The purpose of this study was to investigate the effects of prenatal education on the stress axis of the body, namely the hypothalamo- pituitary adrenal axis (HPA) and autonomic nervous system (ANS) in different delivery types (vaginal or caesarean section).
Materials and Methods: In this prospective study, women who were going to have caesarean or vagi-nal delivery were compared in terms of whether they undertook prenatal education (PNE) in pregnan-cy school or not. Among those of women having PNE, twenty women had caesarean delivery and, therefore, the number of women in other groups was decided accordingly. As a result, a total of 4 groups were formed as follows: women having PNE/caesarean delivery (n=20), having PNE/vaginal delivery (n=20), not having PNE/having caesarean delivery (n=20) and not having PNE/having vaginal delivery (n=20). In these women, the prenatal HPA and ANS activities were measured non-invasively with saliva cortisol and heart rate variability (HRV), respectively. HRV was measured by 5-min electro-cardiogram recording and time- and frequency-domains parameters were calculated.
Results: The (PNE) did not affect the prenatal cortisol and HRV parameters in none of the delivery types (vaginal and caesarean) (p>0.05). HRV parameters were higher in women having vaginal delivery than those of caesarean delivery (P<0.05). No correlations were observed between the cortisol and HRV parameters (P>0.05).
Conclusion: The prenatal education had no effect on HPA and ANS; however, the delivery type altered the HRV parameters. Saliva cortisol and HRV may be useful parameters in terms of examining the phys-iology of the birth process

Key Words: Cortisol, Heart rate variability, Prenatal education, Vaginal delivery, Caesarean delivery

Keywords

cortisol, heart rate variability, prenatal education, vaginal delivery, caesarean delivery

Stres Aksı Üzerine Doğum Tipi ve Prenatal Eğitimin Etkileri

Abstract

Amaç: Gebelik döneminde alınan eğitim doğum öncesi stres seviyesini değiştirebilir. Bu çalışmanın amacı, prenatal eğitimin farklı doğum tiplerinde (vajinal veya sezaryen), vücudun stres aksı üzerine yani hipotalomo-hipofiz adrenal aks (HPA) ve otonom sinir sistemi (ANS) üzerindeki etkilerini araştırmaktı.
Materyal ve Metod: Bu prospektif çalışmada sezaryen veya vajinal doğum yapacak kadınlar gebelik okulunda doğum öncesi eğitim (PNE) alıp almamaları açısından karşılaştırıldı. PNE'si olan kadınlardan yirmisi sezaryen ile doğum yapmış ve bu nedenle diğer gruplardaki kadın sayısı buna göre kararlaştırılmıştır. Sonuç olarak toplam 4 grup şu şekilde oluştu: PNE/sezaryen doğum yapanlar (n=20), PNE/vajinal doğum yapanlar (n=20), prenatal eğitim almayan/sezaryen doğum yapanlar (n=20) ve pre-natal eğitim almayan/vajinal doğum yapanlar (n=20). Bu kadınlarda doğum öncesi HPA ve ANS ak-tiviteleri, sırasıyla tükürük kortizolü ve kalp hızı değişkenliği (HRV) ile non invazif ölçüldü. HRV, 5 dakikalık elektrokardiyogram kaydı ile ölçüldü ve zaman-bağımlı ve frekans bağımlı parametreler hesaplandı.
Bulgular: Prenatal eğitim (PNE) her iki doğum tipinde (vajinal ve sezaryen) doğum öncesi kortizol ve HRV parametrelerini etkilememiştir (p>0.05). HRV parametreleri vajinal doğum yapanlarda sezaryen doğum yapanlardan daha yüksekti (p<0.05). Kortizol ve HRV parametreleri arasında herhangi bir korela-syon gözlenmedi (p>0.05).
Sonuç: Prenatal eğitimin HPA ve ANS etkisi olmamıştır fakat doğum tipi HRV parametrelerini değiştirmiştir. Tükürük kortizolü ve HRV, doğum sürecinin fizyolojisini incelemek açısından yararlı para-metreler olabilir.

Anahtar kelimeler: Kortizol, Kalp hızı değişkenliği, Prenatal eğitim, Vajinal doğum, Sezaryen doğum

Keywords

kortizol, kalp hızı değişkenliği, prenatal eğitim, vajinal doğum, sezaryen doğum

References

• Reference1 Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012 Mar;25(2):141-8.
• Reference2 Cherak SJ, Giesbrecht GF, Metcalfe A, Ronksley PE, Malebranche ME. The effect of gestational period on the association between maternal prenatal salivary cortisol and birth weight: A systematic review and meta-analysis. Psychoneuroendocrinology. 2018 Aug;94:49-62.
• Reference3 Tsigos C, Kyrou I, Kassi E, Chrousos GP. Stress: Endocrine Physiology and Pathophysiology. 2020 Oct 17. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
• Reference4 Levine A, Zagoory-Sharon O, Feldman R, Lewis JG, Weller A. Measuring cortisol in human psychobiological studies. Physiol Behav. 2007 Jan 30;90(1):43-53.
• Reference5 Kaushik A, Vasudev A, Arya SK, Pasha SK, Bhansali S. Recent advances in cortisol sensing technologies for point-of-care application. Biosens Bioelectron. 2014 Mar 15;53:499-512.
• Reference6 Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009 Feb;34(2):163-171.
• Reference7 Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014 Sep 30;5:1040.
• Reference8 Uçar C, Özgöçer T, Yıldız S. Effects of late-night eating of easily-or slowly-digestible meals on sleep, hypothalamo-pituitary-adrenal axis, and autonomic nervous system in healthy young males. Stress Health. 2021 Oct;37(4):640-649.
• Reference9 Ozgocer T, Yildiz S, Uçar C. Development and validation of an enzyme-linked immunosorbent assay for detection of cortisol in human saliva. J Immunoassay Immunochem. 2017;38(2):147-164.
• Reference10 Ozgocer T, Ucar C, Yildiz S. Cortisol awakening response is blunted and pain perception is increased during menses in cyclic women. Psychoneuroendocrinology. 2017 Mar;77:158-164.
• Reference11 Zhang H, Yao Z, Lin L, Sun X, Shi X, Zhang L. Early life stress predicts cortisol response to psychosocial stress in healthy young adults. Psych J. 2019 Sep;8(3):353-362.
• Reference12 Fogelman N, Canli T. Early life stress and cortisol: A meta-analysis. Horm Behav. 2018 Feb;98:63-76.
• Reference13 Benfield RD, Newton ER, Tanner CJ, Heitkemper MM. Cortisol as a biomarker of stress in term human labor: physiological and methodological issues. Biol Res Nurs. 2014 Jan;16(1):64-71.
• Reference14 Stjernholm YV, Nyberg A, Cardell M, Höybye C. Circulating maternal cortisol levels during vaginal delivery and elective cesarean section. Arch Gynecol Obstet. 2016 Aug;294(2):267-71.
• Reference15 Kiriakopoulos N, Grigoriadis S, Maziotis E, Philippou A, Rapani A, Giannelou P, et al. Investigating Stress Response during Vaginal Delivery and Elective Cesarean Section through Assessment of Levels of Cortisol, Interleukin 6 (IL-6), Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1). J Clin Med. 2019 Jul 27;8(8):1112.
• Reference16 Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014 Sep 16;130(12):1003-8.
• Reference17 Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 Mar-Apr;27(2):89-94.