Investigating Stress Response during Vaginal Delivery and Elective Cesarean Section through Assessment of Levels of Cortisol, Interleukin 6 (IL-6), Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1)

Nikolaos Kiriakopoulos, Sokratis Grigoriadis, Evangelos Maziotis, Anastasios Philippou, Anna Rapani, Polina Giannelou, Petroula Tsioulou, Konstantinos Sfakianoudis, Adamantia Kontogeorgi, Panagiotis Bakas, George Mastorakos, Michael Koutsilieris, Mara Simopoulou, Nikolaos Kiriakopoulos, Sokratis Grigoriadis, Evangelos Maziotis, Anastasios Philippou, Anna Rapani, Polina Giannelou, Petroula Tsioulou, Konstantinos Sfakianoudis, Adamantia Kontogeorgi, Panagiotis Bakas, George Mastorakos, Michael Koutsilieris, Mara Simopoulou

Abstract

Background: How do stress related phenomena during labor differ between vaginal delivery (VD) and elective cesarean section (CS), remains of heightened interest. The purpose of this study is to investigate discrepancies regarding the stress response during VD and CS.

Methods: Cortisol, interleukin 6 (IL-6), growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels from parturients' peripheral blood were evaluated on three time-points, namely during the first stage of labor (TP1), two hours post labor (TP2) and 48 h post labor (TP3). Levels were also evaluated from the umbilical cord blood. A total of 50 women were enrolled in this prospective cohort study, with 24 and 26 subjected to CS and VD, respectively.

Results: No statistically significant differences were observed between the two groups at TP1. Only GH levels presented the same pattern during the three time-points among both groups. In the umbilical cord blood, the CS group presented statistically significant higher IGF-1 and GH levels. In the umbilical cord blood, IGF-1 and GH levels were positively correlated, while GH and cortisol levels were negatively correlated.

Conclusion: CS is a less stressful procedure than VD and is further associated with less intense inflammation, albeit with a longer inflammatory response period. Labor physiology during CS differs considerably regarding respective observations during VD. This merits extensive investigation in order to decipher these data for optimal clinical practice and guidelines.

Keywords: caesarean section; cortisol; delivery mode; growth hormone; insulin-like growth factor 1; interleukin 6; stress; vaginal delivery.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cortisol levels reported in the caesarean section (CSG) group and in the vaginal delivery group (VDG), respectively, on each of the three separate time-points (TP1: Prior to labor; TP2: 120 min following placenta delivery; TP3: 48 h following placenta delivery).
Figure 2
Figure 2
Interleukin-6 (IL-6) levels reported in the CSG and in the VDG, respectively, on each of the three separate time-points (TP1: Prior to labor; TP2: 120 min following placenta delivery; TP3: 48 h following placenta delivery).
Figure 3
Figure 3
Insulin-like growth factor 1 (IGF-1 levels reported in the CSG and in the VDG, respectively, on each of the three separate time-points (TP1: Prior to labor; TP2: 120 min following placenta delivery; TP3: 48 h following placenta delivery).
Figure 4
Figure 4
Growth hormone (GH) levels reported in the CSG and in the VDG, respectively, on each of the three separate time-points (TP1: Prior to labor; TP2: 120 min following placenta delivery; TP3: 48 h following placenta delivery).

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