Aberoumand M1, Mojgan Barati2, Salimeh Chegini N3, Sareh Aberoumand2* and Hadi Kajbafnejad4
1Department of Clinical Biochemistry, Faculty of Medicine, Iran
2Infertility and Perinatology Research Center, Iran
3Department of Midwifery, Faculty of Nursing & Midwifery, Iran
4Department of Psychology, Iran
*Corresponding author: Sareh Aberoumand, Infertility and Perinatology Research Center, Iran
Submission: July 23, 2021;Published: September 03, 2021
ISSN: 2640-9666Volume4 Issue5
Background: Acid Phosphatase (ACP) is an enzyme used as a non-invasive biomarker to study the activity of the lysosomal sympathetic system. The aim of this study was to compare the levels of salivary ACP in stressed and non-stressed pregnant women in Ahvaz, Iran.
Study design: A causal-comparative study.
Methods: This was a causal-comparative study using purposive sampling technique. The subjects were randomly selected. The instruments used in this study were the Orly & Girdano stress and demographic questionnaires. Saliva samples were collected from 50 pregnant women with stress and 50 pregnant women without stress. Salivary ACP was determined and compared using paired independent sample t test.
Results: Overall, the findings of the present study showed that the differences mean of salivary ACP levels in the stressed pregnant women was significantly higher than pregnant women without stress (P<0.05).
Conclusion: We found differences in pregnant women with stress and without stress regarding to salivary ACP levels. The results of this study showed that stress causes an increase in salivary ACP secretion.
Keywords: Acid phosphatase; Saliva; Enzyme; Stress; Pregnant women; Biomarker
During pregnancy some women experience daily stress. These stresses include depression,
anxiety, anger, day-to-day challenges, sudden change of environment, social isolation, and
pathological conditions [1-3]. Psychological stress in women during pregnancy, childbirth
and breastfeeding has been found to decrease the gestation period, which results in low birth
weight [4] and can have another unfortunate consequence, including miscarriage, nausea and
vomiting, preeclampsia, and postpartum depression. Also, it may inhibit the immune system,
increase the risk of infectious wounds and neonatal infections. The typical somatic response
to these and other similar stressors is elevation of cortisol hormone. Cortisol is known to cross
the placenta and consequently influence various aspects of development in the human fetus
[2]. The effects of elevated cortisol levels on the fetus may vary from defective development
[5] to spontaneous abortion [6].
Biochemical research has shown that biochemical metabolites, including the hormones
cortisol catecholamines (such as epinephrine and norepinephrine) and Neuro-endocrine
markers, are reliable biological markers for biological stress system responses [7]. Plasma
measurements of epinephrine and norepinephrine are used to evaluate the Sympathetic-
Adrenal-Medullary (SAM) system. However, because many enzymes may be degraded in this method due to the preparation of serum or plasma, protein
(enzyme) salivary acid phosphatase can be used as an indicator
of SAM activity. Also, laboratory analysis of saliva has become
an important technique for the assessment of physiological and
pathological conditions, mostly due to the origin, composition,
and functions of saliva, as well as its interactions with other body
systems and structures. Other favorable aspects of saliva testing
include painless sampling, ease of storage, and low cost of analysis
as compared with blood [7,8].
New research in biomedical and psychological research shows
that salivary Acid Phosphatase (ACP) is salivary bio sensitive to
stress-related changes in the body and can reflect the activity
of the sympathetic nervous system. Simultaneous increase in
plasma acid phosphatase and catecholamine activity with physical
and psychological stressors has led to the hypothesis that acid
phosphatase can be a non-invasive alternative measure for
catecholamines. As mentioned, the stress can increase enzymatic
and hormonal activity. Therefore, this study is designed to answer
the question whether there is a difference between salivary ACP
activity in stressed and non-stressed pregnant women in Ahvaz,
Iran?
In this causal-comparative study, 50 pregnant women with
stress and 50 pregnant women without stress were compared. The
population under study included all pregnant women who referred
to gynecology and obstetrics clinic of Imam Khomeini hospital in
Ahvaz, Iran in 2020. The research sample included 100 pregnant
women who were selected through simple random sampling
method from among the population according to the sample size
and based on inclusion and exclusion criteria. The instruments used
to collect the data were demographic and Orly & Giordano Stress
Questionnaires. The method of data collection in this study was
that after coordination with gynecologists and stating the purpose
of the study, the subjects were asked to fill in the questionnaire. In
the next step, their saliva samples are collected in passive tubes for
five minutes.
Orly & Giordano Stress Questionnaire was created in 1980. This
questionnaire is composed of 14 items and 4 subscales of haste
(6 questions), competitive (4 questions), greed (2 questions) and
unplanned work (2 questions), which is used for self-assessment
of personality according to use for type A and B character patterns.
The answer to this questionnaire is based on a scale (almost always
true of me=a, usually true of me = b, rarely true of me=c, never true
of me=d). Since this questionnaire was standard, it possessed a
good level of validity. Besides, the reliability of this scale based on
Cronbach’s alpha coefficients was obtained by Costa and McCray
for the N, E, O, A, and C properties of 0.66, 0.77, 0.73, 0.68, and
0.81, respectively. In the present study, the reliability coefficients
of the questionnaire using Cronbach’s alpha for neuroticism (0.76),
go-orientation (0.58), openness to experience (0.77), agreeability
(0.72), and conscientiousness (0.81) was calculated.
Simultaneously with filling in the questionnaire, saliva sample
was taken to measure the ACP enzyme under the same conditions.
For saliva sampling, the research samples were asked to collect
their saliva for five minutes in designated tubes by passive
method. Saliva samples in two stages were immediately sent to
the biochemistry laboratory for analysis by spectrophotometric
test, under cold conditions (carrying a tube containing saliva near
ice). All samplings were performed in the morning at 9-12 o’clock.
Inclusion criteria included lack of infectious disease, autoimmunity,
inherited immunodeficiency, mental illness, no immunosuppressive
drugs, no vaccine or blood transfusions, no smoking, and no surgery
during the two months prior to Sampling was salivary.
Statistical analysis
In the present study, two methods of descriptive and inferential statistics were used to analyze the research data. In order to describe the current situation, (frequency, frequency percentage, average, standard deviation, minimum and maximum scores) have been used. The normality of data distribution was evaluated using Kolmogorov-Smirnov test (K S). To analyze the information and data obtained in the hypotheses (independent t-test and multivariate analysis of variance) in the form of 21 SPSS software was used and all research hypotheses were tested at the significance level of 0.05 (P <0.05).
The characteristics of the participants for this study including age, educational status, job and parity have been presented in Table 1. There was a significant difference between salivary acid phosphatase activity in stressed and non-stressed pregnant women (P<0.05) (Table 2). The mean (SD) of Orly & Girdano stress questionnaire scores in stressed pregnant women was 8.4 (2.1) and in non-stressed pregnant women was 2.9 (0.9) (Table 3).
Stress is an adaptive response to environmental challenges,
but stressors during pregnancy may have a negative effect on the
health of pregnant women and their infants [9]. During pregnancy
and childbirth, dramatic changes have occurred in women’s
moods that make them very sensitive to psychological stimuli and
sometimes cause psychological problems in them. Therefore, in this
period, the possibility of developing conditions such as psychosis,
depression, anxiety, morbid fear and obsessive-compulsive
disorder is high [10]. The two indicators of mental health and social
support during pregnancy are likely to have significant effects on
fetal development, pregnancy outcomes, birth weight and birth
time. Due to the lack of reporting such a study in Iran, the present
study was performed with the purpose of comparing the activity
of salivary acid phosphatase and beta pregnant women with stress
and without stress in Ahvaz, Iran.
The results of this study showed that the mean activity of
salivary acid phosphatase enzyme in pregnant women with stress
is higher than pregnant women without stress. So far, no study has
been conducted with the aim of our study that can compare the
results. However, several studies have measured the levels of other
stress hormones in pregnant women as well as during childbirth,
some of which confirm the results of our study, which we will
mention below.
In the study of Pluess et al. [11], maternal anxiety at the
beginning and end of pregnancy was significantly associated with
salivary cortisol levels in pregnant women. Also, in the study
by Mirzaei et al. [12], significant relationship between cortisol
concentration plasma and anxiety levels were observed during
labor, these findings are consistent with the results of our study.
but in the study by Harville et al. [13] there was not a significant
relationship between perceived anxiety and stress in pregnancy.
Also, Rando et al. [14] reported that there was not a significant
relationship between salivary cortisol levels and overt anxiety in
pregnant women at 35 weeks of gestational age. Gerald et al. [15]
reported thar for each 1.0% increase in negative mood there was
a corresponding 1.9% increase in cortisol. This association was
unaffected by advancing gestational age. Researchers suggest
that cortisol is a plausible biological mechanism for transducing
the effects of maternal psychological distress during pregnancy
to fetal development. Explaining the findings of the study, it can
be said that CRH is secreted from the placenta into the mother’s
blood during pregnancy and plasma cortisol levels increase. This
can increase emotional distress such as anxiety and depression in
pregnant women. On the other hand, as mentioned, in pregnancy
the hypothalamic pituitary gland adrenal is underworked to protect
the pregnant women’s brain against the severe hormonal changes
that occur during this period. This can also increase anxiety and
depression during pregnancy and postpartum.
In conclusion, we found differences in pregnant women with stress and without stress regarding to salivary acid phosphatase levels. The results of this study are used as a guide for planners of pregnancy care clinics and infertility treatment centers to increase the importance of recognizing issues related to fear, frustration, stress and recognizing stressed pregnant women in the content of educational strategies. It is recommended that serum acid phosphatase levels be examined for future studies.
Ethical issues
The study was approved scientifically by research committee of Islamic Azad University Behabahan branch and ethically by the ethic committee of the university.
© 2021 Sareh Aberoumand. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.