what is breast cancer? symptoms of breast cancer - …sites.fas.harvard.edu/~anth1380/slides/lecture...

11

Lecture 22: WomenLecture 22: Women’’s Health Issuess Health Issues

•• Breast CancerBreast Cancer

•• DepressionDepression

•• Stress and female Stress and female

fecundityfecundity

(Behavioral Biology of Women-2007)

What is Breast Cancer?What is Breast Cancer? Symptoms of Breast CancerSymptoms of Breast Cancer

•• Change in outline, Change in outline, shape or size of breastshape or size of breast

•• Puckering of dimpling Puckering of dimpling of skinof skin

•• Lump or thickening in Lump or thickening in the breast or armpitthe breast or armpit

•• Flaking skin or Flaking skin or discharge from nippledischarge from nipple

•• UnusualUnusual pain or pain or discomfortdiscomfort

Breast Cancer in MenBreast Cancer in Men

22

Breast Cancer is related Breast Cancer is related

toto Ovarian Hormone Ovarian Hormone

ExposureExposure

WhatWhat risk factors risk factors

increase exposure to increase exposure to

ovarian hormones?ovarian hormones?

Population variation in progesterone Population variation in progesterone

and breast cancer incidenceand breast cancer incidence

2.4

2.9

3.4

3.9

4.4

Log mid-luteal progesterone (pmol/l)

Log breast cancer incidence rate

(per 100,000)

5.3 5.4 5.5 5.6 5.7 5.8 6.0

U.S.A. (87.1)

Poland (36.0)

Nepal (21.2)

Bolivia (21.5)

Congo (10.7)

Jasienska & Thune 2001

Population Differences in Exposure to EstrogenPopulation Differences in Exposure to Estrogen

Individual Differences in Ovarian Hormone Individual Differences in Ovarian Hormone

Exposure in Same PopulationExposure in Same Population

100

200

300

400

500

600

700

-18 -16 -14 -12 -10 -8 -6 -4 -2

reverse cycle day

Salivary progesterone (pmol/L)

Cycle Differences within Cycle Differences within

one Womanone Woman

100

300

500

700

Salivary progesterone (pmol/L)

-18 -16 -14 -12 -10 -8 -6 -4 -2

Reverse cycle day

October

September

August

July

33




��DietDiet

Breast Cancer and DietBreast Cancer and Diet

Dietary constituents or increased hormonal Dietary constituents or increased hormonal

levels because of high calorie intake?levels because of high calorie intake?

Tea Drinking and Tea Drinking and EstradiolEstradiol

Mary Mary CassattCassatt, 1880, 1880

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Kapiszewska, Thune, Ellison & Jasienska (submitted)

•• Flavonoids Flavonoids found in found in

high levels in teahigh levels in tea

•• Inhibit Inhibit aromatase aromatase of of

androgen to androgen to

estrogenestrogen

•• Bind with estrogen Bind with estrogen

receptorsreceptors

Tea Drinking and Tea Drinking and EstradiolEstradiol

Aligned day of menstrual cycle

-8 -6 -4 -2 +2 +4 +6 +80

10

20

30

40

Salivary Estradiol (pmol/L)

low consumption

high consumption

Kapiszewska, Thune, Ellison & Jasienska (submitted)

•• Flavonoids Flavonoids found in found in

high levels in teahigh levels in tea

•• Inhibit Inhibit aromatase aromatase of of

androgen to estrogenandrogen to estrogen

•• Bind with estrogen Bind with estrogen

receptorsreceptors

•• Lowers estrogen levelsLowers estrogen levels




��DietDiet

��ExerciseExercise

Breast Cancer and ExerciseBreast Cancer and Exercise

•• Lower ovarian Lower ovarian

hormone productionhormone production

•• Later menarcheLater menarche

•• Lower set points?Lower set points?

44

Progesterone profiles: women with high Progesterone profiles: women with high

and moderateand moderate physical activityphysical activity

Jasienska & Ellison, Proc. Royal Soc. London (1998)

Estradiol Estradiol profiles: women with low, profiles: women with low,

moderate or high physical activitymoderate or high physical activity

High Activity

Moderate Activity

Low Activity

Aligned Days of Menstrual Cycle

15

20

25

30

35

Estradiol (pmol/L)

-8 -6 -4 -2 0 +2 +4 +6 +8

Jasienska et al submitted




��DietDiet


��Reproductive Reproductive

HistoryHistory

Breast Cancer Risk FactorsBreast Cancer Risk Factors

•• Early menarcheEarly menarche

•• Late menopauseLate menopause

•• Low parityLow parity

•• Late age of first Late age of first

fullfull--term pregnancyterm pregnancy

((KvaleKvale, 1992), 1992)

Breast Cancer Risk Breast Cancer Risk

and Age at First and Age at First

BirthBirth

Subsistence Patterns and Life History: Subsistence Patterns and Life History:

Differences in Exposure to EstrogenDifferences in Exposure to Estrogen

55




��DietDiet



HistoryHistory

��LactationLactation

Breast Feeding and Lower Breast Breast Feeding and Lower Breast

Cancer RatesCancer Rates

•• Lower risk withLower risk with

��Increased duration of Increased duration of breast feedingbreast feeding

��Number of children Number of children breast fedbreast fed




��DietDiet



HistoryHistory


��Body Body

CompositionComposition

MidMid--cycle cycle estradiol estradiol in women with different in women with different

combinations of breast size and WHRcombinations of breast size and WHR

5

10

15

20

25

30salivary estradiol (pmol/L)

narrow waist large

breasts

narrow waist small breasts

broad waist large

breasts

broad waist small breasts

Jasienska et al 2004

salivary estradiol (pmol/L)

10

20

30

40

50

cycle day

0 4 8-4-8

narrow waist

broad waist


Estradiol Estradiol in women with in women with

low and high waistlow and high waist--hip ratiohip ratioProgesterone in women with Progesterone in women with

low and high waistlow and high waist--hip ratiohip ratio

salivary progesterone (pmol/L)

50

100

150

200

250

reverse cycle day

-1-5-9-13

narrow waist

broad waist


66

Estradiol Estradiol in women with in women with

larger and smaller breastslarger and smaller breasts

larger breasts

smaller breasts

10

20

30

40

50

salivary estradiol (pmol/L)

aligned cycle day

0 4 8-4-8





��DietDiet



HistoryHistory


��Body Body

CompositionComposition

��Birth WeightBirth Weight

Estradiol Estradiol in relation to size at birthin relation to size at birth

Low Moderate High

14

16

18

20

Ponderal index tertiles

Estradiol (pmol/L)

Jasienska et al Jasienska et al AmerAmer. J. Human Biology. J. Human Biology (2006)(2006)

What can we do about breast cancer?What can we do about breast cancer?

What can we do about it?What can we do about it? Estradiol Estradiol in relation toin relation to size at birth and size at birth and

physical activityphysical activity

high activitymoderate activitylow activity

Small size Large size

12

16

20

24

Estradiol (pmol/L)

Jasienska et al. submitted

77

What can we do about it?What can we do about it? What can we do about it?What can we do about it?

•• Hormone therapy:Hormone therapy:

��PikePike’’s Pills Pill

What can we do about it?What can we do about it?






��Shot of progesteroneShot of progesterone

What can we do What can we do

about it?about it?



��Shot of progesteroneShot of progesterone

��TamoxifenTamoxifen


•• Make lactation Make lactation

easier for mothers:easier for mothers:

��Allow time and Allow time and space to pump space to pump breast milk at breast milk at workwork

��Provide onProvide on--site site child care so can child care so can breast feed at breast feed at workwork

��Longer maternity Longer maternity leaveleave

88

Biology of depression, psychosocial stress Biology of depression, psychosocial stress

and female fecundityand female fecundity

DSM Criteria for Depression DSM Criteria for Depression

DiagnosisDiagnosis

Beck Depression InventoryBeck Depression Inventory

•• The most common measure used in large The most common measure used in large

research surveys is the Beck Depression research surveys is the Beck Depression

Inventory.Inventory.

•• Take it if you want toTake it if you want to--

Beck Depression InventoryBeck Depression Inventory

5 minutes, score yourself5 minutes, score yourself

•• Average for college populations is Average for college populations is

12.56 with a SD of 9.93.12.56 with a SD of 9.93.

•• 00--13 minimal, 1413 minimal, 14--19 mild, 2019 mild, 20--28 28

moderate, 29moderate, 29--63 severe63 severe

•• If youIf you’’re feeling depressed, re feeling depressed,

Harvard provides free help at UHS Harvard provides free help at UHS

mental health, stop in or call 5mental health, stop in or call 5--

20422042

Biology of DepressionBiology of Depression

��Sex DifferencesSex Differences

Sex Differences in Depression?Sex Differences in Depression?

•• Epidemiological studies Epidemiological studies indicate that 12 percent of indicate that 12 percent of U.S. women compared to U.S. women compared to 6 percent of U.S. men 6 percent of U.S. men have suffered a have suffered a significant clinical significant clinical depression. depression.

•• Many studies suggest that Many studies suggest that

this is a low estimate this is a low estimate

based on people who seek based on people who seek

treatment.treatment.

99

Impact of Depression on WomenImpact of Depression on Women

•• World Health World Health

Organization found Organization found

depression to be THE depression to be THE

leading cause of leading cause of

““disease burdendisease burden””

among women, noting among women, noting

that if affects 20% of that if affects 20% of

women in developed women in developed

world.world.


•• 15% of depressed women 15% of depressed women attempt suicideattempt suicide


•• NIMH estimates that NIMH estimates that depression claims $30.4 depression claims $30.4 billion in treatment and billion in treatment and lost productivity each yearlost productivity each year

Why is depression more common Why is depression more common

in women?in women?

��Hormonal (some evidence)Hormonal (some evidence)

��Learned helplessness, Learned helplessness,

��Power/status, oppression, abuse, Power/status, oppression, abuse,

povertypoverty

��RuminationRumination……still not clear.still not clear.



�� CrossCross--cultural?cultural?

Cross Cultural Evidence of Sex Cross Cultural Evidence of Sex

DifferenceDifference

•• Important to examine Important to examine

rates of depression in rates of depression in

men and women men and women

outside the West to outside the West to

determine how determine how

widespread the sex widespread the sex

difference is. difference is.

•• PsychologicalPsychological

AnthroplogyAnthroplogy

1010



•• If sex difference is not If sex difference is not

found in other places found in other places

or if there is a pattern, or if there is a pattern,

may point to social, may point to social,

environmental causes.environmental causes.



•• Prof. Randy Prof. Randy Nesse Nesse at at

U of Michigan U of Michigan

believes that social believes that social

differences between differences between

now and EEA may now and EEA may

lead to increases in lead to increases in

anxiety and anxiety and

depression.depression.



•• However, almost all societies However, almost all societies studied studied -- show a higher prevalence show a higher prevalence of depression in women.of depression in women.



•• Almost all societies studied Almost all societies studied --show a higher prevalence of show a higher prevalence of depression in women.depression in women.

•• A few donA few don’’t:t:

–– In the U.S.: In the U.S.:

__ Old Order Amish, Old Order Amish,

__ college studentscollege students

__ widowed adultswidowed adults



•• Also, cross culturally, studies in Nigeria and Iran Also, cross culturally, studies in Nigeria and Iran

have shown no sex difference in depression rates. have shown no sex difference in depression rates.




��GeneticsGenetics

1111

Genetics of DepressionGenetics of Depression

Some evidence of genetic influenceSome evidence of genetic influence--depression runs in familiesdepression runs in families

•• Specific genes involved unknownSpecific genes involved unknown

•• No evidence that females are No evidence that females are

disproportionately likely to disproportionately likely to ““inheritinherit””

depressive tendencies, but females are still depressive tendencies, but females are still

twice as likely to be depressed.twice as likely to be depressed.


•• Study of 2,060 female Study of 2,060 female twins. Two groups twins. Two groups those with family those with family history and those history and those without. without.

•• Compared women in Compared women in both groups who had both groups who had experienced recent experienced recent trauma (e.g divorce, trauma (e.g divorce,

death of loved one, etc).death of loved one, etc).


Twin studyTwin study-- Effect of family history on vulnerability to Effect of family history on vulnerability to

depression after trauma (divorce, death of loved one, etc.)depression after trauma (divorce, death of loved one, etc.)

0

2

4

6

8

10

12

14

Depression Rate in

Response to Trauma

twins without family history twins with family history





��GeneticsGenetics

��HormonesHormones

Hormones Implicated in Biology Hormones Implicated in Biology

of Depressionof Depression

•• MelatoninMelatonin

•• CortisolCortisol

•• Reproductive hormones Reproductive hormones (estrogen?)(estrogen?)

1212

Hormones: MelatoninHormones: Melatonin

•• Hormone secreted by the pineal gland Hormone secreted by the pineal gland when it is darkwhen it is dark


•• Melatonin levels drop in the morning when Melatonin levels drop in the morning when light hits the retinalight hits the retina

•• During winter months with less light, wild During winter months with less light, wild animals show more melatoninanimals show more melatonin

Hormones: Melatonin and Hormones: Melatonin and

DepressionDepression•• SAD (seasonal affective SAD (seasonal affective

disorder) disorder) –– 3 times more 3 times more common in womencommon in women

•• Women might be more Women might be more responsive to changes in responsive to changes in light/dark cycle.light/dark cycle.

•• Sex differenceSex difference-- artificial light artificial light seems to act like natural light seems to act like natural light on menon men’’s melatonin levels but s melatonin levels but not on womennot on women’’s.s.

•• UV light boxes seem to help!UV light boxes seem to help!


•• Common supplement Common supplement

available at health available at health

food storesfood stores

•• Often used for jet lagOften used for jet lag

•• Unregulated by FDAUnregulated by FDA

•• Be careful! No good Be careful! No good

studies of long term studies of long term

use.use.

Cortisol Cortisol

HPA axisHPA axis

HPA axis hyperactivity and HPA axis hyperactivity and

depressiondepression

•• Many (about half of all) depressed patients Many (about half of all) depressed patients

exhibit elevated levels of exhibit elevated levels of cortisolcortisol

1313

HPA axis hyperactivity and HPA axis hyperactivity and


•• Many (about half of all) depressed patients Many (about half of all) depressed patients

exhibit elevated levels of exhibit elevated levels of cortisolcortisol

•• Even more depressed patients show HPA Even more depressed patients show HPA

hyperactivityhyperactivity-- negative feedback negative feedback

mechanisms sluggish (feedback resistance)mechanisms sluggish (feedback resistance)

Hormones: Hormones: Cortisol Cortisol and and


•• 19701970’’s, many depressed patients exhibited s, many depressed patients exhibited

elevated levels of elevated levels of cortisolcortisol

•• Even more depressed patients how HPA Even more depressed patients how HPA

hyperactivityhyperactivity-- negative feedback mechanisms negative feedback mechanisms

sluggishsluggish

•• Hyperactive Hyperactive Corticotropin Corticotropin Releasing Factor Releasing Factor

(CRF)(CRF)--producing neurons in hypothalamus might producing neurons in hypothalamus might

be the culprit be the culprit -- studies of suicidal brains show studies of suicidal brains show

more CRF neurons.more CRF neurons.

Hormones: Do reproductive Hormones: Do reproductive

hormones influence depression? hormones influence depression?

Estrogen and DepressionEstrogen and Depression

•• Prenatal hormone Prenatal hormone

exposure might influence exposure might influence

brain development in a brain development in a

way that creates different way that creates different

vulnerabilities and hence vulnerabilities and hence

the sex difference in the sex difference in


Hormones: Do reproductive Hormones: Do reproductive

hormones influence depression? hormones influence depression?

Estrogen and DepressionEstrogen and Depression

•• Sex difference in Sex difference in

depression shows up at depression shows up at

pubertypuberty

Hormones: Do reproductive hormones influence Hormones: Do reproductive hormones influence

depression? Estrogen and Depressiondepression? Estrogen and Depression

•• High depression rates High depression rates are common at times are common at times of changing of changing hormones:hormones:

��PubertyPuberty

��PregnancyPregnancy

��PostPost--partumpartum

��PerimenopausallyPerimenopausally

Does estrogen influence Does estrogen influence cortisolcortisol? ?

•• Evidence that estrogen might increase Evidence that estrogen might increase

cortisol cortisol secretion.secretion.

•• Estrogen seems to decreaseEstrogen seems to decrease cortisolcortisol’’s s negative feedback mechanismnegative feedback mechanism

•• If estrogen raisesIf estrogen raises cortisol cortisol after stressful after stressful events and then decreasesevents and then decreases cortisolcortisol’’s s ability ability to shut down, then estrogen might make to shut down, then estrogen might make women more prone to depressionwomen more prone to depression

1414

Do you think that Do you think that

psychological stress has ever psychological stress has ever

influenced your menstrual influenced your menstrual

cycle?cycle?

Psychosocial Stress & Ovarian FunctionPsychosocial Stress & Ovarian Function Is there good Is there good scientificscientific evidence that evidence that

psychosocial stress influences psychosocial stress influences

ovarian function?ovarian function?

•• Not really Not really ---- Lots of studies, some find an Lots of studies, some find an

effect of psychological stress some doneffect of psychological stress some don’’t.t.

Is there good scientific evidence Is there good scientific evidence

that psychosocial stress influences that psychosocial stress influences


•• Not really Not really ---- Lots of studies, some find an Lots of studies, some find an

effect of psychological stress some doneffect of psychological stress some don’’t.t.

•• Clarvit Clarvit (l988) followed female medical (l988) followed female medical

students for a year and found no effect of students for a year and found no effect of

examinations or perceived stress on examinations or perceived stress on

menstrual cycles.menstrual cycles.

Is there good scientific evidence that Is there good scientific evidence that

psychosocial stress influences psychosocial stress influences


•• Not really Not really ---- Lots of studies, some find an effect of psychological Lots of studies, some find an effect of psychological stress some donstress some don’’t.t.

•• Clarvit Clarvit (l988) followed female medical students for a year and (l988) followed female medical students for a year and found no effect of examinations or perceived stress on menstrualfound no effect of examinations or perceived stress on menstrualcycles.cycles.

•• Harlow and Harlow and Mantanoski Mantanoski (l991) followed 1st year (l991) followed 1st year college women and found an increased risk of college women and found an increased risk of long cycles in response to higher stress levels.long cycles in response to higher stress levels.

•• Fenster Fenster et al. (l999) found that work place stress et al. (l999) found that work place stress was associated with shorter menstrual cycles. was associated with shorter menstrual cycles.

MCAT StudyMCAT Study

•• Recruited Harvard women taking the Recruited Harvard women taking the

MCAT and same age matched controls not MCAT and same age matched controls not

taking the MCATtaking the MCAT

(Ellison & Lipson, in prep)(Ellison & Lipson, in prep)

MCAT studyMCAT study

•• Recruited Harvard women taking the MCAT Recruited Harvard women taking the MCAT

and same age matched controls not taking and same age matched controls not taking

the MCATthe MCAT

•• Wanted to test whether or Wanted to test whether or

not the stress of taking the not the stress of taking the

MCAT would affect MCAT would affect

perceived stress,perceived stress, cortisol cortisol

levels and/or ovarian levels and/or ovarian

function both between and function both between and

within women.within women.


1515

MCAT studyMCAT study

•• Recruited Harvard women taking the MCAT Recruited Harvard women taking the MCAT

and same age matched controls not taking the and same age matched controls not taking the

MCATMCAT

•• Wanting to test whether or not the stress of Wanting to test whether or not the stress of

taking the MCAT would affect perceived stress,taking the MCAT would affect perceived stress,

cortisol cortisol levels and/or ovarian function both levels and/or ovarian function both

between and within women.between and within women.

•• No hormonal differences between No hormonal differences between

MCAT takers and controlsMCAT takers and controls


Does Psychosocial stress reduce fecundity?Does Psychosocial stress reduce fecundity?

Psychosocial Stress & Ovarian FunctionPsychosocial Stress & Ovarian Function Does Psychosocial Does Psychosocial

Stress/Depression influence Stress/Depression influence

female fecundity?female fecundity?

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Adopt Didn't Adopt

% Conceived

(Lamb & Leurgans, 1979)

Study of Adoption and FecundityStudy of Adoption and Fecundity

1616

Why would psychosocial Why would psychosocial

stress/depression ?stress/depression ?

•• Wasser Wasser and colleagues (l986, l992, l994, and colleagues (l986, l992, l994,

l999) put forth l999) put forth Reproductive SuppressionReproductive Suppression

ModelModel to explain why social animals, to explain why social animals,

including humans might suppress including humans might suppress

reproduction when there is insufficient reproduction when there is insufficient

social support to help with child rearing.social support to help with child rearing.

Why would psychosocial Why would psychosocial

stress/depression ?stress/depression ?

•• Wasser Wasser and colleagues (l986, l992, l994, l999) and colleagues (l986, l992, l994, l999)

put forth put forth Reproductive SuppressionReproductive Suppression ModelModel to to

explain why social animals, including humans explain why social animals, including humans

might suppress reproduction when there is might suppress reproduction when there is

insufficient social support to help with child insufficient social support to help with child

rearing.rearing.

•• Similar adaptive reasoning Similar adaptive reasoning

used to explain suppression used to explain suppression

due to energetic stressors.due to energetic stressors.


0

0.1

0.2

0.3

0.4

0.5

0.6

Support Cog/Behav Control

% Conceived •• Mind/Body Medical Mind/Body Medical

Institute at Beth Israel Institute at Beth Israel

Deaconess HospitalDeaconess Hospital

•• 10 week stress reduction 10 week stress reduction

program program

(cognitive/behavioral (cognitive/behavioral

changes) for infertile changes) for infertile

womenwomen

•• 3 groups: control, 3 groups: control,

support and support and

cognitive/behavioralcognitive/behavioralDomar et al

Mechanism of the Mind/Body Mechanism of the Mind/Body

InstituteInstitute’’s Higher Conception Rates?s Higher Conception Rates?

•• Recruited 16 women Recruited 16 women

who had been trying to who had been trying to

conceive for at least 12 conceive for at least 12

months who were not months who were not

taking fertility taking fertility

medications and medications and

wanted a free Mind wanted a free Mind

Body groupBody group

0

0.1

0.2

0.3

0.4

0.5

0.6

Support Cog/Behav Control

% Conceived



•• Recruited 16 women who had been trying to Recruited 16 women who had been trying to

conceive for at least 12 months who were conceive for at least 12 months who were

not taking fertility medications and wanted not taking fertility medications and wanted

a free Mind Body group a free Mind Body group

•• Collected daily salivaCollected daily saliva’’s one month before s one month before

and one month after.and one month after.



•• Recruited 16 women who had been trying to Recruited 16 women who had been trying to conceive for at least 12 months who were conceive for at least 12 months who were not taking fertility medications and wanted not taking fertility medications and wanted a free Mind Body group a free Mind Body group

•• Collected daily salivaCollected daily saliva’’s one month before s one month before and one month after.and one month after.

•• Measured Measured cortisolcortisol, estradiol and , estradiol and progesteroneprogesterone

1717

ResultsResults

0

0.2

0.4

0.6

0.8

1

1.2

before MB after MB

cortisol

progesterone

estradiol

coital freq

• No significant change in any of the hormone measures

• Coital frequency increased 33% the month after the M/B

group compared to before


Why would psychosocial stress reduce Why would psychosocial stress reduce

fecundity?fecundity?

Why is the data so confusing?Why is the data so confusing?

The relationship between The relationship between

psychosocial stress and ovarian psychosocial stress and ovarian

function is not a simple one!function is not a simple one!

What are potential mechanisms What are potential mechanisms

through which psychosocial stress through which psychosocial stress

might suppress fecundity?might suppress fecundity?

•• BehavioralBehavioral�� SmokingSmoking

�� CaffeineCaffeine

�� Coital frequencyCoital frequency

•• PhysiologicalPhysiological

��EndocrineEndocrine

__ Ovarian function?Ovarian function?

EducationalEducational

Poster forPoster for

ExpectantExpectant

MothersMothers

National

Child Welfare

Assoc., 1919

Prenatal stress in rhesus monkeysPrenatal stress in rhesus monkeys

•• Offspring had Offspring had –– lower birth weights, lower birth weights,

–– impaired impaired neuromotor neuromotor development, development,

–– attention deficits, attention deficits,

–– impaired cognitive function impaired cognitive function

–– higher frequency of abnormal coping higher frequency of abnormal coping behaviors behaviors

–– impaired social behaviors impaired social behaviors

1818

Are there prenatal stress effects Are there prenatal stress effects

on human infants/children?on human infants/children?

•• Studies have included pregnant Studies have included pregnant

women who were women who were

–– exposed to unpredictable aircraft exposed to unpredictable aircraft

noise, noise,

–– familial and family discord familial and family discord

–– and death of a husband during and death of a husband during

WWIIWWII

Humans Humans -- Maternal stress during Maternal stress during

pregnancy is pregnancy is correlatedcorrelated with infants with infants

that have:that have:

•• Reduced birth weightsReduced birth weights

•• Developmental delaysDevelopmental delays

•• Attentional Attentional deficits, deficits,

•• HyperanxietyHyperanxiety

•• Impaired social Impaired social

behaviorsbehaviors

(reviewed in(reviewed in Weinstock Weinstock et al., l997)et al., l997)

Exposure to high Exposure to high glucocorticoids glucocorticoids (i.e. CRH (i.e. CRH Corticotropin Corticotropin

Releasing Hormone)Releasing Hormone) during pregnancyduring pregnancy

•• Associated with low birth Associated with low birth

weight weight

•• Low birth weight Low birth weight

associated with increased associated with increased

risk of adult cardiovascular risk of adult cardiovascular

disease, hypertension, disease, hypertension,

insulin resistance, insulin resistance,

hyperlipidemia hyperlipidemia

Are there prenatal stress effects Are there prenatal stress effects

on human infants/children?on human infants/children?

•• However However …… Most studies are Most studies are

retrospective and lack suitable retrospective and lack suitable

control groupcontrol group

Erickson et al. (2001) JCEM 86(6)

CRHCRH Levels Related to Levels Related to

Preterm BirthPreterm Birth

• Low level of education, public assistance, working and/or walking/standing more than 6 hours per day. and not wearing a seat belt were all significantly associated with preterm birth –

• Interestingly, self-reported social stress was not

Cortisol Cortisol and Early Pregnancy Lossand Early Pregnancy Loss

•• Women with unsuccessful Women with unsuccessful pregnancy had highest pregnancy had highest cortisol cortisol levelslevels

•• Unsuccessful pregnancies Unsuccessful pregnancies had higher had higher cortisol cortisol peakspeaks

•• Pregnancies with Pregnancies with increased increased cortisol cortisol compared to baseline compared to baseline were 2.7 x as likely to endwere 2.7 x as likely to endin miscarriagein miscarriage

•• But But …… dondon’’t know cause t know cause of high of high cortisol cortisol in these in these womenwomen

(Nepomnaschy et al., 2006)

1919

•• BehaviorBehavior

–– Birth and childcare practices Birth and childcare practices

–– Violence against womenViolence against women

–– Female infanticide and neglectFemale infanticide and neglect

•• PhysiologyPhysiology

–– Breast CancerBreast Cancer

–– WHRWHR

–– InfertilityInfertility

•• WomenWomen’’s Lives: Choices for s Lives: Choices for work and Motherhoodwork and Motherhood

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