Impact of doula's continuous support on serotonin release in parturients: a pilot randomized clinical trial

Moraes, Eleonora de Deus Vieira de; Ribeiro, Mayara Segundo; Erbert, Cíntia; Prado, Caio Antonio de Campos; Moisés, Elaine Christine Dantas

doi:10.61622/rbgo/2024rbgo27

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 46 • 2024 • https://doi.org/10.61622/rbgo/2024rbgo27 copy

Impact of doula's continuous support on serotonin release in parturients: a pilot randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate whether the continuous support provided by doulas influences the endogenous release of serotonin in parturients.

Methods:

This pilot study included 24 primigravidae at term. Of these, 12 women received continuous doula support (Experimental Group), whereas the other 12 received the usual assistance without doula support (Control Group). Blood samples were collected from all the women at the active and expulsion stages of labor and at the fourth period of labor (Greenberg period) for evaluation of their serotonin levels using high-performance liquid chromatography.

Results:

The average serotonin concentrations in the control and experimental groups were respectively 159.33 and 150.02 ng/mL at the active stage, 179.13 and 162.65 ng/mL at the expulsion stage, and 198.94 and 221.21 ng/mL at the Greenberg period. There were no statistically significant differences in serotonin concentrations between the two groups at the active and expulsion stages of labor. By contrast, within the experimental group, a significant increase in serotonin concentration was observed in the Greenberg period compared with the levels in the active and expulsion stages (p < 0.05).

Conclusion:

The novelty of this study relies on the ability to correlate the influence of the continuous support offered by doulas with the release of serotonin in parturients, with the results suggesting that the assistance received during labor can modulate the levels of hormone release in the Greenberg period.

Brazilian Registry of Clinical Trials:

RBR-4zjjm4h

Keywords
Doulas; Serotonin; Humanized delivery; Labor; Pregnant women

Variables, mean (standard deviation)		Experimental Group n(%)	Control Group n(%)	p-value
Age (years)^\|\| \|\| Mean (standard deviation)		23.3(7.97)	21.33(5.05)	0.70^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples
Years of study (years)^\|\| \|\| Mean (standard deviation)		10.33(2.71)	10.67(1.92)	0.62^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples
GA^* * GA - gestational age; (weeks)^\|\| \|\| Mean (standard deviation)		38.92(1.31)	39.00(1.21)	0.92^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples
BMI^† † BMI - body mass index (kg/m²)^\|\| \|\| Mean (standard deviation)		30.86(4.91)	28.17(5.51)	0.14^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples
Prenatal care appointments^\|\| \|\| Mean (standard deviation)		9.08(2.61)	9,17(2.12)	0.88^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples
Marital status^¶ ¶ Number (percentage)	Married	5(41.67)	7(58.33)	0.69^§ § p-value according to the chi-square test
Marital status^¶ ¶ Number (percentage)	Single	7(58.33)	5(41.67)	0.69^§ § p-value according to the chi-square test
Ethnicity^¶ ¶ Number (percentage)	White	8(66.67)	5(41.67)	0.22^§ § p-value according to the chi-square test
Ethnicity^¶ ¶ Number (percentage)	Black	7(58.33)	4(33.33)	0.22^§ § p-value according to the chi-square test
Companion at birth^¶ ¶ Number (percentage)	Partner	7(58.33)	6(50.00)	0.91^§ § p-value according to the chi-square test
	Mother	4(33.33)	5(41.67)
	Mother-in-law	1(8.33)	1(8.33)
Course for pregnant women^¶ ¶ Number (percentage)	Yes	2(16.67)	1(8.33)	0.53^§ § p-value according to the chi-square test
Course for pregnant women^¶ ¶ Number (percentage)	No	10(83.33)	11(91.67)	0.53^§ § p-value according to the chi-square test

Variables		Experimental Group n(%)	Control Group n(%)	p-value
Delivery route^* * Number (percentage);	Vaginal	10(83.33)	12(100)	0.14^† † p-value according to the chi-square test;
Delivery route^* * Number (percentage);	Cesarean	2(16.67)	0(0)	0.14^† † p-value according to the chi-square test;
Misoprostol^* * Number (percentage);	Yes	2(16.67)	2(16.67)	1.00^† † p-value according to the chi-square test;
Misoprostol^* * Number (percentage);	No	10(83.33)	10(83.33)	1.00^† † p-value according to the chi-square test;
Oxytocin^* * Number (percentage);	Yes	5(41.67)	4(33.33)	0.67^† † p-value according to the chi-square test;
Oxytocin^* * Number (percentage);	No	7(58.33)	8(66.67)	0.67^† † p-value according to the chi-square test;
Analgesia^* * Number (percentage);	Yes	8(66.67)	7(58.33)	0.67^† † p-value according to the chi-square test;
Analgesia^* * Number (percentage);	No	4(33.33)	5(41.67)	0.67^† † p-value according to the chi-square test;
Laceration^* * Number (percentage); ^§ § For vaginal deliveries	Yes	8(80.00)	10(83.33)	0.84^† † p-value according to the chi-square test;
	No	2(20.00)	2(16.67)	0.84^† † p-value according to the chi-square test;
Episiotomy^* * Number (percentage); ^§ § For vaginal deliveries	Yes	0(0.00)	1 8.33)	0.35^† † p-value according to the chi-square test;
	No	10(100.00)	11(91.67)	0.35^† † p-value according to the chi-square test;
Labor duration^\|\| \|\| Mean (standard deviation)		8.27(2.10)	6.64(2.66)	0.12^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples;
Expulsion duration^\|\| \|\| Mean (standard deviation)		0.81(0.44)	0.75(0.29)	0.49^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples;
Apgar 1st minute^\|\| \|\| Mean (standard deviation)		8.00(1.91)	7.83(1.27)	0.52^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples;
Apgar 5th minute^\|\| \|\| Mean (standard deviation)		9.33(0.98)	9.25(0.62)	0.47^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples;
Newborn weight (g)^\|\| \|\| Mean (standard deviation)		3,049.33(452.81)	3,235.92(422.74)	0.37^‡ ‡ p-value according to the Wilcoxon–Mann–Whitney test for independent samples;

Blood collection stages	Experimental Group (ng/mL)	Control Group (ng/mL)	p-value^* * p-value according to the Wilcoxon–Mann–Whitney test for independent samples;
Active stage (T1)	150.02 (66.57)^† † Mean (standard deviation)	159.33 (76.72)^† † Mean (standard deviation)	0.7102
Expulsion stage (T2)	162.65 (67.30)^† † Mean (standard deviation)	179.13 (42.17)^† † Mean (standard deviation)	0.5115
Greenberg period (T3)	221.21 (84.52)^† † Mean (standard deviation)	198.94 (58.88)^† † Mean (standard deviation)	0.3757

Comparisons	Estimate of difference between means	p-value^ p-value according to the Wilcoxon–Mann–Whitney test for independent samples, concentrations expressed in ng/mL;
(CG^* † EG - Experimental Group; – EG^† § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period); )^\|\| \|\| Comparisons between times within each group; T1	9.3167^¶ ¶ Estimated difference between means;	0.7102
(CG^* † EG - Experimental Group; – EG^† § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period); )^\|\| \|\| Comparisons between times within each group; T2	16.4750^¶ ¶ Estimated difference between means;	0.5115
(CG^* † EG - Experimental Group; – EG^† § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period); )^\|\| \|\| Comparisons between times within each group; T3	–22.2667^¶ ¶ Estimated difference between means;	0.3757
CG^* † EG - Experimental Group; (T1 – T2)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–19.7617^¶ ¶ Estimated difference between means;	0.4307
CG^* † EG - Experimental Group; (T1 – T3)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–39.6083^¶ ¶ Estimated difference between means;	0.1179
CG^* † EG - Experimental Group; (T2 – T3)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–19.8167^¶ ¶ Estimated difference between means;	0.4301
EG^† † EG - Experimental Group; (T1 – T2)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–12.6333^¶ ¶ Estimated difference between means;	0.6144
EG^† † EG - Experimental Group; (T1 – T3)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–71.1917^¶ ¶ Estimated difference between means;	0.0060^†† †† Significant p-value (p<0.05)
EG^† † EG - Experimental Group; (T2 – T3)^§ § Comparisons between groups at each time (T1, active stage; T2, expulsion stage; T3, Greenberg period);	–58.5583^¶ ¶ Estimated difference between means;	0.0225^†† †† Significant p-value (p<0.05)

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[1] Corresponding author Elaine Christine Dantas Moisés E-mail: elainemoises@fmrp.usp.br