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Responses to Laboratory Psychosocial Stress in Postpartum Women

Department of Psychiatry, Weill Medical College, Cornell University, New York, NY (M.A.); VA San Diego Health Care System, San Diego, CA (L.S.R.); Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, MD (Y.-M.L.); Department of Psychology, The University at Albany-SUNY, Albany, NY (C.A.F.); Department of Psychiatry (S.W.P., C.S.C.), University of Illinois, Chicago Medical School, Chicago, IL.

Address correspondence to Margaret Altemus, MD, Box 244, Weill Medical College, Cornell University, 1300 York Avenue, New York, NY 10021. Email: maltemus{at}med.cornell.edu

OBJECTIVE: Lactation has been associated with attenuated hormonal responses to exercise stress in humans. This study was designed to determine the effect of lactation on hypothalamic-pituitary-adrenal axis, autonomic nervous system, and anxiety responses to psychological stress.

METHOD: The Trier Social Stress Test was administered to 24 lactating women, 13 postpartum nonlactating women, and 14 healthy control women in the early follicular phase of the menstrual cycle. Lactating women were stressed at least 40 minutes after last feeding their infant.

RESULTS: ACTH, cortisol, heart rate, diastolic blood pressure, systolic blood pressure, and subjective anxiety ratings were all significantly increased in response to the psychological stress (all p < .0001). There were no differences among the three groups in any of these responses to the stress. However, postpartum nonlactating women did have a persistently higher systolic blood pressure and lower cardiac vagal tone than the lactating women and control subjects. In addition, the typical negative correlation between cardiac vagal tone and heart rate was consistently higher in lactating women than nonlactating postpartum women and controls, which suggests stronger vagal control of heart rate in lactating women. In addition, there was no change in oxytocin or allopregnanolone in response to the stress, and baseline oxytocin and allopregnanolone levels did not differ among the three groups.

CONCLUSIONS: These results indicate that physiological and subjective responses to social stress are not attenuated in lactating women tested at least one hour after feeding their infant. However, enhanced vagal control of cardiac reactivity was observed in lactating women. In addition, postpartum women who did not lactate showed evidence of increased sympathetic and decreased parasympathetic nervous system tone.

Key Words: stress • lactation • oxytocin • allopregnanolone • cortisol • vagal tone

Abbreviations: ACTH = adrenocorticotropin; AUC = area under the curve

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