The Effects of Psychological Intervention on Pregnant Women with Elevated Cortisol Levels and Adverse Birth Events

Elevated levels of stress, anxiety, and depression during pregnancy are thought to influence cortisol levels. Dysregulations in cortisol, as a byproduct of the hypothalamic-pituitary axis, have been associated with preterm birth and adverse birth outcomes. Studies have demonstrated poorer long-term effects of antenatal stress on child neurodevelopment, temperament, and cognition. Psychological interventions of cognitive behavioral therapy (CBT), mindfulness, and gratitude have shown to have a positive effect on psychological wellbeing across various populations. The purpose of this literature review was to analyze a collection of randomized-controlled trials to conclude if psychological interventions during pregnancy for women with elevated levels of stress, may lead to fewer adverse birth events. A literature search was conducted in October and November of 2019 using PubMed and Google Scholar to retrieve 10 research articles meeting inclusion criteria. This study evaluated 3 variables including cortisol, stress, and adverse birth outcomes. The various psychological interventions included cognitive behavioral therapy, mindfulness, and gratitude. Several studies had evidence of at least one cortisol measurement declining with a psychological intervention. A few of the studies showed promising results that psychological interventions reduced perceived stress and/or cortisol levels. Though many of the articles are limited in their ability to draw generalizable conclusions due to limited sample size, significant participant dropout rates, differing intervention strategies, and varying protocols for measuring stress and cortisol levels. The overall evidence is lacking to support psychological interventions reducing stress levels or adverse birth events during pregnancy in women with elevated cortisol