Salivary cortisol in pregnant women suffering from blood and injection phobia

Stress and/or anxiety during pregnancy affect maternal and fetal well-being and can cause premature delivery and postnatal
pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress, including
anxiety and sometimes panic attacks, during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions
of maternal psychological factors may be transduced to the fetus. The aim of this study was to investigate whether pregnant
women suffering from blood and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary
cortisol profiles compared with healthy controls. The sample consisted of 110 pregnant women with blood and injection phobia
and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in weeks 25 and 36 for the assay
of cortisol. In gestational week 25, when blood was drawn for the mandatory blood testing, extra blood was taken to analyze
corticotrophin-releasing factor, adrenocorticotropic hormone, and cortisol in serum. The diurnal decline in salivary cortisol
as well as increased cortisol levels were observed during pregnancy. Pregnant women suffering from blood and injection phobia
had a higher output of cortisol compared with women without the phobia (F = 6.25, df = 1, p = 0.014), but no marked difference in the diurnal cortisol rhythm was found between groups. Our findings indicate that untreated
blood and injection phobia during pregnancy increases cortisol concentrations. Blood and injection phobia is treatable, and
cognitive behavioral therapy can be used. Women with blood and injection phobia during pregnancy therefore need to be recognized
and offered treatment without delay in early pregnancy.