Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It?

Figure 2

Models to assess stress. (a) An integrated model of stress. This layered model depicts the levels of organization, organic systems, and factors that might interact with one another within a multidimensional framework to sustain stress responses. In this context, if a handful of the elements depicted are acutely challenged (e.g., thirst stress response), the organism will only require a homeostatic response while keeping the set points of the parameters involved in such a response relatively unchanging. In contrast, if most body systems are acutely, subacutely, or chronically challenged (e.g., normal pregnancy), the organism would be forced to develop an allostatic response. This circumstance would provoke shifts in the set points of the parameters involved in such a response. Finally, if the entire body is acutely, subacutely, or chronically challenged (e.g., true gestational stress), the organism would be forced to mount a pantostatic stress response falling into a state of deregulation and disease. (b) Protocol to evaluate stress in the pregnant woman. This layered model of diagnosis, backed up by the model of stress, described above, aims to protocolize the psychological, clinical, and biochemical tests that must be used to effectively diagnose stress during pregnancy, assuming this as an allostatic challenge to the mother embedded into the multidimensional framework that sustains stress.

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