SPECIAL SESSION: Chronic Stress, the Microbiome, and Adverse Maternal-Infant Outcomes

Description/Overview: This session will present cutting edge research on the bidirectional relationships between chronic stress and the microbiome as risk factors for adverse maternal and infant health outcomes. Exposure to a stressor is known to increase activation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased levels of the stress hormone cortisol. In addition, chronic stress is associated not only with increased cortisol, but also an increase in pro-inflammatory cytokines including interleukin-6. Both elevated cortisol and elevated inflammatory cytokines are known risk factors for preterm birth, gestational hypertension, and gestational diabetes. They also can affect infant outcomes, including infant emotional and neurocognitive neurodevelopment. Recently, chronic stress has also been shown to affect the microbiome; the bacteria that live on us and in us, and play a significant role in metabolism, training of the immune response, and influencing mood via stimulation of the microbiome-gut-brain axis. In pregnant women, dysbiosis of the microbiome, meaning a less than optimal composition of organisms, present in the oral, vaginal, or gut, has been linked to adverse birth outcomes, including preterm birth. For infants, the gut microbiome develops during and after the birth process, with variations in the composition of the infant gut microbiome depending on the method of birth (vaginal or surgical) and infant feeding choices (breast versus bottle). Variations in infant gut microbiome also appear to influence infant growth and, in animal studies, infant neurodevelopment. This Session presentation will describe the mechanisms by which chronic stress during pregnancy may affect the maternal microbiome and influence birth outcomes, and how in the newborn, the microbiome is colonized and impacted by stress as well as diet, immunization, and infection. Implications for clinicians, including nurses, nurse midwives and other nurse practitioners caring for women and infants will be reviewed with recommendations for practice and described. By including consideration of chronic stress and its effects on the microbiome of both pregnant women and infants, we will gain a more holistic understanding of the risks and protective factors influencing pregnancy and infant health.