A strongly psychosocially demanding situation in the life of a woman is the option of medically indicated abortion. Many studies, most of which have been retrospective, have identified an association between stressful life events, perceived stress, and abortion. The reports on the mental status of women exposed to abortion vary. Post-abortion depression, increased anxiety, and symptoms of posttraumatic stress disorder have been reported as results of termination (Brier, 2004).
Despite intensive research in the field of stress, an exact measurement of stress load is still not possible. Nevertheless, there are many stress markers which can be analysed by different methodologies using various biological fluids such as blood, saliva, and urine (Romanova et al., 2022). An interesting new approach is the analysis of cortisol in human hair which constitutes a promising method for the retrospective assessment of cumulative cortisol secretion over extended periods of time.
Here we present the design of a study aimed to examine the stressfulness of the life events related to a medically indicated abortion by measuring concentrations of cortisol in saliva and in hair. We are methodologically prepared to perform such type of research work. In our research group, we have not only validated the method, but we have even optimized the extraction procedure details (Balagova & Jezova, 2018).
The women undergoing medically indicated abortion will be recruited at the 1st Department of Obstetrics and Gynaecology, University Hospital, School of Medicine, Bratislava. The follow-up visit will be held at the Research Clinic in the Pavilion of Medical Sciences, Biomedical Research Center, Slovak Academy of Sciences, Bratislava two months after the abortion (Figure 1). The saliva and hair samples (2 cm proximally from the scalp) will be collected during each visit. Two centimetres long hair samples reflect two-month retrograde cumulative cortisol secretion. To avoid the influence of daily rhythm, the saliva samples will be collected in the afternoon between 13.00 and 16.00 hours. The examinations of mental state will be done within 24 hours before and two months after the abortion.
Concentrations of cortisol in saliva will be analysed as described previously (Izakova et al., 2021). Cortisol extraction from the hair will be performed according to the appropriate modification of the methodology (Balagova & Jezova, 2018) and analysed using an enzyme-linked immunosorbent assay (ELISA, IBL International, Hamburg, Germany). The samples of saliva will be stored at −20 °C, and the hair will be stored in a dark place at room temperature until analysed.
All data will be checked for normality of distribution with the Shapiro-Wilk’s test. The values of both salivary and hair cortisol concentrations before and after the abortion will be compared using the paired Student’s t-test. The results will be expressed as means ± SEM. The overall level of statistical significance is defined as p ≤ 0.05. Statistical analyses will be performed using Statistica 10 software (Statsoft Inc, Tulsa, OK 74104, USA).
The study will be conducted according to the guidelines specified in the Declaration of Helsinki, and all procedures were approved by the Ethics Committee of the University Hospital Bratislava, Slovakia. Written informed consent will be obtained from all participating women.
We have already obtained pilot data from the first group of eight women included in the study. The small number of participants prevents any statistical analysis. However, in the samples collected two months after the abortion compared to those collected one day before, the preliminary cortisol concentration values in the saliva were lower in most of the women. On the other hand, hair cortisol concentrations were higher two months after the abortion compared to those reflecting the two months before the medically indicated abortion in the half of the group while there were no changes in the second half.
It is well known that an adequate cortisol response is needed to overcome situations of acute stress (Jezova & Hlavacova, 2008). The concentration of cortisol measured in saliva reflects the actual response to a concrete, real-life stress situation. Thus, the high salivary cortisol concentrations measured one day before the medically indicated abortion can be interpreted as an expected and adequate response to severe real-life stressors.
Chronic stress situations, particularly those associated with depressive feelings and enhanced anxiety are accompanied by an increased release of glucocorticoids and other steroids produced in the adrenal cortex. Under chronic stress conditions, increased cortisol release is a part of insufficient coping with stress and its negative consequences (Koolhaas et al., 2011). This appears to be the case for the participants who are showing high cumulative cortisol concentrations two months after the medically indicated abortion according to the preliminary data.