Psychological distress and cortisol among pregnant women with inflammatory bowel disease

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

OVERVIEW BACKGROUND METHODS RESULTS DISCUSSION

BACKGROUND: INFLAMMATORY BOWEL DISEASE (IBD) Crohn s disease (CD) Ulcerative colitis (UC) Chronic No cure http://oncofertility.northwestern.edu/sites/oncofertility/files/legacy_files/ibd_map.png

http://www.athersys.com/images/ibdfigure1.jpg BACKGROUND: STRESS DOES STRESS CONTRIBUTE TO YOUR DISEASE? No 26% Bonaz & Bernstein, 2013 YES 74% Moser et al., 1993

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

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?

HYPOTHESIS Straub et al., 2002

METHODS: PARTICIPANTS N = 15 UC CD Age: 30.93 years

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

RESULTS: PSYCHOLOGICAL DISTRESS Mean SCL score 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 Anxiety p =.047 Mean PSQI score 10.00 Sleep disturbances 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 p =.031 Mean SSEQ score Perceived social support 70.00 60.00 50.00 40.00 30.00 20.00 10.00 p =.014 0.00 IBD Non-IBD 0.00 IBD Non-IBD 0.00 IBD Non-IBD

350.00 300.00 250.00 Total cortisol production p =.006 p <.001 Total cortisol production 200.00 150.00 100.00 50.00 0.00 IBD Non-IBD

5.00 4.50 4.00 Cortisol awakening response 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 IBD Non-IBD

140,000.00 RESULTS: AMYLASE Total saa production p =.020 120,000.00 100,000.00 p =.001 Total saa production 80,000.00 60,000.00 40,000.00 20,000.00 0.00 IBD Non-IBD

1,200.00 saa awakening response 1,000.00 saa awakening response 800.00 600.00 400.00 200.00 0.00 IBD Non-IBD

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)

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)

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!

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