Maternal Stress and Mental Health Before Pregnancy and Offspring Diurnal Cortisol in Early Childhood

• In Event: Preconception and Prenatal Pathways to Child Biobehavioral Outcomes

Abstract

Background: Do a mother’s mental health and perceived stress before pregnancy affect offspring physiology? A growing research literature provides evidence that maternal prenatal stress programs stress response systems in children, especially the hypothalamic-pituitary-adrenal (HPA) axis. Altered HPA axis functioning is one pathway through which stress processes influence health outcomes. However, only a few prior studies have considered whether maternal stress and mental health symptoms prior to conception shape the developing HPA axis in humans.
Purpose: The current study examines children's circadian regulation of cortisol production and associations with pre-pregnancy mental health symptoms and perceived stress. We assessed perceived stress and symptoms of depression and post-traumatic stress disorder during the pre-pregnancy period. We predicted that higher pre-pregnancy perceived stress and mental health symptoms would be associated with smaller awakening responses and flatter diurnal cortisol slopes in offspring.
Methods: Participants were drawn from a cohort of predominantly low-income women in three sites in Illinois, North Carolina, and Washington, DC. Mothers were recruited after the birth of a child and were studied in their homes at 6-month intervals during the postpartum period with extensive measures related to stress, mental health, and resilience. When mothers became pregnant again, home visits were conducted during and after that pregnancy. Thus, data collected during the postpartum period following the birth of one child served as prospective pre-pregnancy data predicting outcomes for a subsequent child. The present study examines diurnal cortisol production in these (subsequent) children. Children provided three saliva samples per day on three consecutive days at two timepoints in early childhood (M age=3.7 years, SD = .38; M age=5.04 years, SD = .43).
Results: Mothers’ PTSD symptoms prior to pregnancy were significantly associated with flatter child diurnal cortisol slopes at 4 and 5 years, but not with child CAR. Findings at age 4, but not 5, remained statistically significant after adjustment for maternal socioeconomic status, race/ethnicity, child age, and other covariates. In contrast, maternal pre-pregnancy depressive symptoms and perceived stress did not significantly predict cortisol slopes or CAR.
Conclusions: This study offered a unique opportunity to examine how multiple indicators of maternal stress and mental health before pregnancy influence a central marker of stress physiology in low- to middle-income young children. Results suggest that maternal pre-pregnancy PTSD symptoms may contribute to variation in early childhood physiology. This study extends earlier work demonstrating risk of adverse outcomes among children whose mothers experienced trauma but associations cannot be disentangled from effects of prenatal mental health of mothers on children’s early childhood. Findings are relevant to a lifespan approach to maternal-child health that emphasizes the importance of preconception and interpregnancy periods as critical moments to promote optimal individual and family health, with potential implications for screening and treatment in individuals prior to and during pregnancy.

Author

• Christine Guardino, Dickinson College
  Presenting Author