Psychological distress and cortisol among pregnant women with inflammatory bowel disease

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1 Psychological distress and cortisol among pregnant women with inflammatory bowel disease MADE POSSIBLE BY THE MARKIN UNDERGRADUATE STUDENT RESEARCH PROGRAM IN HEALTH & WELLNESS By: Jennifer Khil, Faculty of Arts Faculty Mentor: Dr. Gerry Giesbrecht, Cumming School of Medicine

2 OVERVIEW BACKGROUND METHODS RESULTS DISCUSSION

3 BACKGROUND: INFLAMMATORY BOWEL DISEASE (IBD) Crohn s disease (CD) Ulcerative colitis (UC) Chronic No cure

4 BACKGROUND: STRESS DOES STRESS CONTRIBUTE TO YOUR DISEASE? No 26% Bonaz & Bernstein, 2013 YES 74% Moser et al., 1993

5 BACKGROUND: PREGNANCY & BIRTH OUTCOMES Preterm birth, small babies, motor delays, long-term risks Fertility Outcomes Riis et al., 2006; Mahadevan et al., 2011; Davis, Glynn, Waffarn, & Sandman, 2010; Class, Lichtenstein, Langstrom, & D Onofrio, 2011; Robinson et al., 2011; Alder, Fink, Bitzer, Hosli, & Holzgreve, 2007; Barker, 1998

6 Pregnancy causes stress Stress impacts pregnancy Does IBD affect pregnancy outcomes? Does stress affect pregnancy outcomes and do IBD patients simply experience more stress? Do IBD and stress affect pregnancy independently and at once?

7

8 HYPOTHESIS Straub et al., 2002

9 METHODS: PARTICIPANTS N = 15 UC CD Age: years

10 Days 1 & 2 Timepoints: Early pregnancy (1) Late pregnancy (2)

11 RESULTS: PSYCHOLOGICAL DISTRESS Mean SCL score Anxiety p =.047 Mean PSQI score Sleep disturbances p =.031 Mean SSEQ score Perceived social support p = IBD Non-IBD 0.00 IBD Non-IBD 0.00 IBD Non-IBD

12 Total cortisol production p =.006 p <.001 Total cortisol production IBD Non-IBD

13 Cortisol awakening response IBD Non-IBD

14 140, RESULTS: AMYLASE Total saa production p = , , p =.001 Total saa production 80, , , , IBD Non-IBD

15 1, saa awakening response 1, saa awakening response IBD Non-IBD

16 DISCUSSION 1. More stress No cortisol differences 2. No CAR increase from T1 to T2 Less adjustment to pregnancy 3. Amylase elevated SNS activity Straub et al. (2002) 4. No change over time Increase in controls Kuo et al. (2000)

17 DISCUSSION Stress system behaviour pregnancy outcomes Pregnant IBD women = different stress system behaviour Changes which accompany IBD poor pregnancy outcomes in IBD Psychological support = better outcomes Stress-symptom management Garcia-Vega & Fernandez-Rodriguez (2004)

18 THANK YOU! Dr. Aaron Tubman & Stephanie Vahaaho Dr. Gerry Giesbrecht Philine Jaeger Kelly Gian Ying Wu & the Owerko Centre team & volunteers! & all of my supportive friends & family!

19 REFERENCES Alder, J., Fink, N., Bitzer, J., Hösli, I., & Holzgreve, W. (2007). Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. Journal of Maternal-Fetal & Neonatal Medicine, 20(3), 189. Barker, D. J. (1998). In utero programming of chronic disease. Clinical Science (London, England: 1979), 95(2), Bonaz, B. L., & Bernstein, C. N. (2013). Brain-gut interactions in inflammatory bowel disease. Gastroenterology, 144(1), Class, Q. A., Lichtenstein, P., Langstrom, N., & D'Onofrio, B. M. (2011). Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: A population study of 2.6 million pregnancies. Psychosomatic Medicine, 73(3), doi: /psy.0b013e31820a62ce Davis, E. P., Glynn, L. M., Waffarn, F., & Sandman, C. A. (2011). Prenatal maternal stress programs infant stress regulation. Journal of Child Psychology and Psychiatry, 52(2), Garcia-Vega, E., & Fernandez-Rodriguez, C. (2004). A stress management programme for Crohn s disease. Behaviour Research and Therapy, 42(4), Giesbrecht, G. F., Granger, D. A., Campbell, T., & Kaplan, B. (2013). Salivary alpha amylase during pregnancy: Diurnal course and associations with obstetric history, maternal demographics, and mood. Developmental Psychobiology, 55(2), Kuo, C. D., Chen, G. Y., Yang, M. J., Lo, H. M., & Tsai, Y. S. (2000). Biphasic changes in autonomic nervous activity during pregnancy. British Journal of Anaesthesia, 84(3), Mahadevan, U., Cucchiara, S., Hyams, J. S., Steinwurz, F., Nuti, F., Travis, S. P.,... Colombel, J. (2011). The london position statement of the world congress of gastroenterology on biological therapy for IBD with the european crohn's and colitis organisation: Pregnancy and pediatrics. The American Journal of Gastroenterology, 106(2), Moser, G., Maeir-Dobersberger, T., Vogelsang, H., & Lochs, H. (1993). Inflammatory bowel disease: Patient s beliefs about the etiology of their disease-a controlled study. Psychosom Med, 55, 131. Riis, L., Vind, I., Politi, P., Wolters, F., Vermeire, S., Tsianos, E.,... O'morain, C. (2006). Does pregnancy change the disease Course&quest; A study in a european cohort of patients with inflammatory bowel disease. The American Journal of Gastroenterology, 101(7), Robinson, M., Mattes, E., Oddy, W. H., Pennell, C. E., van Eekelen, A., McLean, N. J.,... Zubrick, S. R. (2011). Prenatal stress and risk of behavioral morbidity from age 2 to 14 years: The influence of the number, type, and timing of stressful life events. Development and Psychopathology, 23(02), Sandman, C. A., Davis, E. P., Buss, C., & Glynn, L. M. (2012). Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus. Neuroendocrinology, 95(1), doi: / Straub, R. H., Herfarth, H., Falk, W., Andus, T., & Schölmerich, J. (2002). Uncoupling of the sympathetic nervous system and the hypothalamic pituitary adrenal axis in inflammatory bowel disease? Journal of Neuroimmunology, 126(1), de Weerth, C., & Buitelaar, J. K. (2005). Cortisol awakening response in pregnant women. Psychoneuroendocrinology, 30(9),

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