In pregnancy increased maternal STAI trait stress score shows decreased insulin sensitivity and increased stress hormones

Psychoneuroendocrinology. 2017 Oct:84:11-16. doi: 10.1016/j.psyneuen.2017.06.008. Epub 2017 Jun 13.


Introduction: Chronic or acute stressors influence maternal and fetal Hypothalamus-Pituitary-Adrenal Axes (HPA) during pregnancy. In this study, the effect of maternal stress into maternal insulin sensitivity was investigated during pregnancy.

Materials and methods: Eighty-two pregnant women [aged 27.1±2.5 (mean±SD) yrs; BMI=25±2.2kg/m2] had at the 2nd and 3rd trimesters anthropometry, fasting blood samples (cortisol, Corticotropin Releasing Hormone (CRH), active amylin, Interleukin (IL6)), Oral Glucose Tolerance Test (OGTT) for glucose and insulin, state-trait anxiety inventory (STAI) trait and state questionnaires (for stress assessment).

Results: Maternal cortisol, CRH and STAI state score increased significantly from 2nd to 3rd trimester. At these trimesters women with STAI trait scores ≥40 had greater serum cortisol and CRH concentrations and lower insulin sensitivity index (ISI) values than those with scores <40 while STAI trait score predicted negatively ISI. At the 2nd trimester maternal CRH concentrations correlated positively with maternal STAI state, Homeostatic Model Assessment Insulin Resistance (HOMAR), 1st and 2nd phase insulin secretion and negatively with ISI. STAI trait correlated negatively with ISI. STAI state correlated positively with maternal systolic blood pressure and HOMAR. At the 3rd trimester STAI trait correlated negatively and positively with ISI and STAI state, respectively, while STAI state correlated positively with HOMAR. In women with STAI state scores ≥40, these scores correlated positively with maternal CRH.

Conclusions: In normal pregnant women, enhanced long-term stress is associated with decreased insulin sensitivity. Both long- and short- term stress are associated with enhanced maternal HPA axis and increased placental CRH secretion.

Keywords: CRH; Cortisol; Insulin sensitivity; Long-term stress; Pregnancy.

MeSH terms

  • Adrenocorticotropic Hormone / blood
  • Adrenocorticotropic Hormone / metabolism
  • Adult
  • Anxiety / metabolism*
  • Anxiety / psychology
  • Corticotropin-Releasing Hormone / analysis
  • Corticotropin-Releasing Hormone / blood
  • Female
  • Fetus / metabolism
  • Humans
  • Hydrocortisone / analysis
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / metabolism
  • Insulin / metabolism
  • Insulin Resistance / physiology*
  • Pituitary-Adrenal System / metabolism
  • Placenta / metabolism
  • Pregnancy / metabolism*
  • Pregnancy Trimester, Second
  • Pregnancy Trimester, Third
  • Stress, Psychological / complications
  • Stress, Psychological / metabolism


  • Insulin
  • Adrenocorticotropic Hormone
  • Corticotropin-Releasing Hormone
  • Hydrocortisone