5 DISCUSSION
5.4 Methodological considerations
A recent study suggested that to achieve the highest laboratory to life generalizability different types of public speaking tasks should be used, the responses of which are then aggregated (Kamarck, Debski, & Manuck, 2000). Although a highly ecologically valid experiment among stress tests, the generalizability of TSST to real life environment is moderate at best. There are numerous ways to measure stress in the laboratory
environment, and there is constant debate whether such measurements are ecologically valid. There are multiple mental and physical challenges in our daily lives, and each of them has their own unique spectrum of physiological responses. TSST produces high responses of cortisol, moderately high sympathetic response and a high BP response that is more vascular than cardiac. Other stress tests and real life measurements with ambulatory devices are needed to both confirm and expand these findings. We also measured only parts of HPAA, CV system and ANS activity. It would therefore be interesting to measure more comprehensively both systems, their interactions to one another, or even the responses of other systems to psychosocial stress such as immune and central nervous system.
Additionally, size at birth is only a summary measure of prenatal adaptations. Babies born small may haveachieved their genetic growth potential and are in thelower tail of the birth weight distribution, whereas other babies with similar weight at birthmay have experienced a prenatal nutritional deficit, which has slowedtheir growth, and later on experience catch-up growth to gain their genetic growth potential. Therefore, further studies with improved surveillance and markers of prenatal environment are needed.
Finally, since prenatal stress may also contribute to our findings, future studies should investigate with sophisticated statistical models what exactly underlies with the associations between prenatal growth and later stress reactivity to psychosocial stress.
51 5.5 Conclusions
In summary, these studies provide support for the hypothesis that CV reactivity to and recovery from stress may be determined in utero and during the early postnatal period.
We suggest that in similar studies both the gender of the subjects and the peripheral and central components should be investigated separately. Second, it may also be that both hyper- and hypocortisolism is programmed during the fetal period. Third, our result highlights the role of gestational age at birth as a potential marker of intrauterine conditions in birth cohort studies.
Overall, these results reinforce previous suggestions that intrauterine programming of BP, sympathetic, and HPAA activity may be important contributors to the link between fetal and early growth and adult CV disease.
52
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