Cortisol awakening response in infants during the first six postnatal months and its relation to birth outcome

Context: The rise of cortisol concentrations after awakening is well documented in adults and children and commonly used as easily accessible marker of hypothalamic-pituitary-adrenal (HPA) reactivity. Objective: The purpose of this study was to demonstrate the existence of a salivary cortisol awakening response (CAR) in infants, and to estimate its association with birth outcome. Setting: The study was conducted in the general community. Participants: Healthy infants up to six months age (N=64). Main outcome measures: Mothers were instructed to collect their infant’s saliva immediately and 30 min after awakening on two days within 45 days, irrespective of awakening time. Information on birth outcome was collected from medical records and questionnaires. Results: Linear mixed models analysis revealed a significant rise of infant salivary cortisol concentrations within 30 minutes after awakening (b=0.128, SE=0.024, t61=5.31, p<0.001), which was quite stable across the two sampling days (r=0.40, p=0.002). The infant CAR was predicted by length of gestation (t61=2.43, p=0.018). Conclusions: The current data demonstrate the existence of a CAR in infants as early as during the first six postnatal months; its relationship with length of gestation supports its usefulness for questions related to developmental neuroscience. Therefore, the infant CAR emerges as non-invasive biomarker of HPA axis dynamics at this early stage of life, with relevance for future research and potential clinical applications

Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study

Background: Identifying risk factors for adverse health outcomes in children is important. The intrauterine environment plays a pivotal role for health and disease across life

Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans : a systematic review

BACKGROUND: Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking. METHODS: We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function. RESULTS: Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment. CONCLUSIONS: This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits

Maternal Psychosocial Stress during Pregnancy and Placenta Weight: Evidence from a National Cohort Study

To study in a large-scale cohort with prospective data the associations between psychosocial stress during pregnancy and placenta weight at birth. Animal data suggest that the placenta is involved in stress-related fetal programming.; We defined a priori two types of psychosocial stress during pregnancy, life stress (perceived burdens in major areas of life) and emotional symptoms (e.g. anxiety). We estimated the associations of maternal stress during pregnancy with placenta weight at birth, controlled for length of gestation, by predicting gestational age- and sex-specific z-scores of placenta weight through multiple regression analysis, adjusted for potential confounders (N?=?78,017 singleton pregnancies). Life stress (per increase in stress score by 1, range: 0-18) during pregnancy was associated with increased placenta weight at birth (z-score, reported in 10(-3); B, 14.33; CI, 10.12-18.54). In contrast, emotional symptoms during pregnancy were not associated with placenta weight at birth.; Maternal life stress but not emotional symptoms during pregnancy was associated with increased placenta weight at birth; yet, the association-estimate was rather small. Our results may contribute to a better understanding of the role of the placenta in the regulation of intrauterine processes in response to maternal stress

Psychotherapy: Quo vadis?

Background: The science and practice of psychotherapy is continuously developing. The goal of this article is to describe new impulses, guiding current advancements in the field. Methods: This paper provides a selective narrative review, synthesizing and condensing relevant literature identified through various sources, including MEDLINE, EMBASE, PsycINFO, and "Web of Science", as well as citation tracking, to elaborate key developments in the field of psychotherapy Results: We describe several dynamics: 1) Following up the so-called "third wave of cognitive behavioral therapy", new interventions arise that have at their core fostering interpersonal virtues, such as compassion, forgiveness, and gratitude; 2) Based on technological quantum leaps, new interventions arise that exploit current developments in the field of new media, information, and communication technologies, as well as brain imaging, such as digital interventions for mental disorders and new forms of neurofeedback; 3) Inspired by the field of positive psychology, there is a revival of the promotion of strength and resilience in therapeutic contexts; 4) In light of the new paradigm "precision medicine", the issue of differential and adaptive indication of psychotherapy, addressed with new methods, regains relevance and drives a new field of "precision psychotherapy". 5) Last but not least, the "embodied turn" opens the door for body psychotherapy to gain relevance in academic psychotherapy. Conclusion: These and further developments, such as the use of systemic and network approaches as well as machine learning techniques, outline the vivid activities in the field of psychotherapy

Anticipated fear and anxiety of Automated Driving Systems: Estimating the prevalence in a national representative survey

Background Automated Driving Systems (ADS) may reshape mobility. Yet, related fear and anxiety are largely unknown. We estimated the prevalence and risk factors of anticipated anxiety towards ADS. Method In a nationally representative face-to-face household survey, we assessed anticipated levels of anxiety towards ADS based on DSM-5 specific phobia criteria, using structured diagnostic interviews. We estimated weighted prevalences and conducted adjusted logistic regression models. Results Of N = 2076 respondents, 40.82% (95%-confidence interval (CI) 37.73–43.98) anticipated experiencing some symptoms of phobia of ADS, 15.22% (CI 13.19–17.51) anticipated subthreshold phobia, and 3.39% (CI 2.42–4.75) anticipated full-blown phobia of ADS. Of subjects anticipating subthreshold phobia, 74.02% showed no strong, enduring fears of driving non-automated cars and 65.07% presented no other specific phobias (full-blown anticipated phobia: 50.37% and 50.03%, respectively). Anticipated phobia highly overlapped with anticipating marked or strong fears of passively encountering ADS in traffic (odds ratio 312.4–1982.2). Conclusion About 20% of subjects anticipated at least subthreshold and 4% of subjects anticipated full-blown phobia of ADS. It appears to be distinct from fears related to non-automated driving and other specific phobias. Our findings call for prevention and treatment of phobia of ADS as they become increasingly ubiquitous