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Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production

Caparros-Gonzalez, Rafael A. PhD, BSc, RN; Romero-Gonzalez, Borja BSc; Gonzalez-Perez, Raquel PhD; Lara-Cinisomo, Sandraluz PhD; Martin-Tortosa, Pablo L. RN; Oliver-Roig, Antonio PhD, RN; Peralta-Ramirez, Maria Isabel PhD

Section Editor(s): Parker, Leslie A.

doi: 10.1097/ANC.0000000000000660
Human Milk Science: Special Series

Background: Several factors can influence the production of mothers' own milk.

Purpose: To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation.

Methods: A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy.

Results: Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05).

Implications for Research: Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production.

Implications for Practice: Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.

Department of Nursing, Faculty of Health Sciences, University of Jaen, Jaen, Spain (Dr Caparros-Gonzalez); Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain (Drs Caparros-Gonzalez and Peralta-Ramirez and Mr Romero-Gonzalez); Department of Pharmacology, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs, University of Granada, Granada, Spain (Dr Gonzalez-Perez); Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois, Urbana-Champaign (Dr Lara-Cinisomo); Gynecology and Obstetrics Department, Hospital Antequera, Antequera, Malaga, Spain (Mr Martin-Tortosa); and Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain (Dr Oliver-Roig).

Correspondence: Maria Isabel Peralta-Ramirez, PhD, Mind, Brain, and Behavior Research Center (CIMCYC), Campus de Cartuja s/n, 18011, Universidad de Granada, Granada, Spain (

None of the authors have biomedical financial interests or potential conflicts of interest.

Institution where the work occurred: Gongora Health Center, Granada, Spain.

This work was supported by the I + D Project 2PSI2015-63494-P” of the Spanish Ministry of Science and Innovation (; cosupported by funds/European Regional Development Fund (ERDF) ± a way to build Europe (MIPR).

© 2019 by The National Association of Neonatal Nurses