Review Physiological stress reactivity in human pregnancy—a review Carolina de Weerth a,b, * , Jan K. Buitelaar a a Department of Psychiatry, University Medical Center Nijmegen, HP 333, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands b Department of Developmental Psychology, University of Nijmegen, P.O. Box 9104, Nijmegen HE 6500, The Netherlands Abstract Prenatal maternal stress has been found to have long-lasting effects on the behavioral and physiological development of the offspring. These programming effects on the fetus would be physiologically mediated through heightened and/or abnormal activity of the maternal sympathetic-adrenal-medullary system (SAM) and especially of her hypothalamic-pituitary-adrenocortical axis (HPA-axis). The abnormalities in maternal physiology could be present in her basal functioning, but also in her physiological reactivity to stressors, which constitutes the topic of this paper. This article reviews studies that have used laboratory challenges to study physiological stress reactivity in pregnant women. It concentrates on stress tests designed to produce pain or discomfort, or cognitive and psychological stress, and that assess changes in blood pressure, heart rate and/or cortisol as reactivity measures. The general conclusion is that physiological stress reactivity appears to be dampened during pregnancy. Nonetheless, the physiological responses to laboratory challenges are clearly present and display enough inter-individual variability to enable the study of links between responsivity patterns, psychosocial variables, fetal behavior, pregnancy outcome and offspring development. This paper also looks into the methodological limitations present in the reviewed studies. Options for sound design of stress test protocols are discussed and recommendations for future studies are presented. These methodological points are general and can therefore also be of use for researchers studying human stress reactivity in other populations and ages. q 2004 Elsevier Ltd. All rights reserved. Keywords: Prenatal stress; Stress reactivity; Stress tests; Laboratory challenge; Pregnancy; Cortisol; Heart rate; Blood pressure; Physiology; Methodology Contents 1. Prenatal stress and fetal programming ........................................................ 296 2. Mechanisms ........................................................................... 297 3. Maternal physiological stress reactivity ....................................................... 298 4. Basal stress physiology during pregnancy ..................................................... 298 4.1. Cardiovascular adaptations to pregnancy. Blood pressure and heart rate ........................... 298 4.2. Sympathetic-adrenal-medullary (SAM) system during pregnancy ................................ 299 4.3. HPA-axis during pregnancy ............................................................ 299 0149-7634/$ - see front matter q 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.neubiorev.2004.10.005 Neuroscience and Biobehavioral Reviews 29 (2005) 295–312 www.elsevier.com/locate/neubiorev * Corresponding author. Address: Department of Developmental Psychology, University of Nijmegen, P.O. Box 9104, Nijmegen HE 6500, The Netherlands. Tel.: C31 24 361 2637/5550; fax: C31 24 361 5501. E-mail address: c.deweerth@psych.ru.nl (C. de Weerth).