27 - Associations Between Reported Maternal Stress in the NICU, Human Milk Biomarkers and Infant Health

Poster Number: 27
Publication Number: 27.201

Casey Rosen-Carole, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Bridget E. Young, University of Rochester, Rochester, NY, United States; Hongyue Wang, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Sharvari A. Sonawane, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Susan E. Greenman, University of Rochester School of Medicine and Dentistry, Seattle, WA, United States; Ravi Misra, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Kirsi Jarvinen, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Carl T.. D'Angio, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Background: Maternal stress is pervasive in the Neonatal Intensive Care Unit (NICU). Further, maternal stress is associated with changes in human milk (HM) immunomodulatory agents, which may thereby impact neonatal health. 

Objective: We sought to determine whether immunologic markers in mothers and their milk associate with reported measures of stress or with their infant’s health, and how these associations persist over time.

Design/Methods: This was a cohort study of exclusively breastfeeding mothers and their singleton moderately-preterm infants in the NICU. We collected maternal serum, maternal saliva, first-morning whole milk and stress questionnaires at 1 and 5 weeks postpartum. We analyzed samples for HM IgA and HM and salivary cortisol, and compared these with maternal stress, infant illness and infant neurodevelopment using the Test of Infant Motor Performance. We analyzed spearman and pearson partial correlations after adjusting for gestational age (GA), corrected GA, and infant DOL.


Results: We enrolled 26 dyads (28.1 years; 69% White; 19% Black; 8% Hispanic). Weak and non-significant correlations were found between HM or salivary cortisol and HM IgA and maternal age, parity, infant GA or time to lactogenesis 2. Cortisol: HM and salivary cortisol were closely associated in week 1 but not week 5 (Figure 1). Though mean salivary cortisol remained stable over time (2.41 ng/mL (SD 2.43) to 2.32 (SD 1.77), p=0.17), mean HM cortisol increased (1.96ng/mL (SD 1.93) to 5.93ng/mL (SD 3.83), p< 0.001). Stress measures were significantly inversely associated with HM cortisol at week 1 but not week 5 for (Table 1). Salivary cortisol was positively associated with PROMIS clarity of thought at week 1. The increase in HM cortisol over time correlated with the increase in maternal anxiety, as reported by the STAI scale (r 0.58, p=0.03). IgA: Human milk IgA decreased over time (1.13-0.89 mg/mL, p< 0.0001), and was significantly associated with high stress on the PSS:NICU scale. IgA was also significantly associated with the infant illness (SNAP) score at week 1 (r -0.74, p=0.05). No associations were found between maternal stress, cortisol, or IgA and neurodevelopment at discharge (TIMP).

Conclusion(s): Reported stress in NICU mothers more tightly correlated with HM than salivary cortisol at 1 week postpartum, suggesting a possible secretory mechanism or programming effect. Maternal stress was associated with higher HM IgA and HM IgA was associated with lower measures of infant illness.