The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder

Vania Sandoz,Marius Rubo,Antje Horsch,Nadine Messerli-Bürgy,Magali Quillet Diop,Ulrike Ehlert,Alain Lacroix,Camille Deforges,Suzannah Stuijfzand

doi:10.3390/jpm11060472

Abstract

Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic–pituitary–adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.

Highlights

Changes in psychophysiological stress responses occurring during the early postpartum period after traumatic childbirth have not been investigated so far
These changes might play a significant role in the development of childbirth-related posttraumatic stress disorder (CB-Posttraumatic Stress DisorderPosttraumatic stress disorder (PTSD))
Results revealed that the Lausanne Infant Crying Stress Paradigm (LICSP) elicits autonomic nervous system (ANS) and subjective stress responses in women in the early postpartum period

Summary

Introduction

Posttraumatic stress disorder (PTSD) may develop following a traumatic event, as defined by the PTSD stressor criterion of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Four symptom clusters (criteria B–E of the DSM-5) characterize this disorder: intrusions, avoidance of trauma-related cues, negative cognitions and mood, and hyperarousal [1]. PTSD can be diagnosed one month following the traumatic stressor [1], even if an acute posttraumatic stress response can be observed in the meantime [2]. The question arises to understand why after having been exposed to a traumatic event, only some individuals develop PTSD symptoms [3]. According to psychobiological findings, altered stress reactivity, such as a dysregulation of the hypothalamic–pituitary– adrenal (HPA) axis or the autonomic nervous system (ANS), may play a major role in the development of PTSD [4,5]

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Results