Characterizing pregnancy cortisol in a diverse cohort: A role for neighborhood and family socioeconomic position

• In Event: Importance of multilevel perinatal research for advancing child development and family health equity

Abstract

The prenatal period is considered a window of biopsychosocial vulnerability and opportunity for parents and their offspring: alterations to biological processes such as the hypothalamic-pituitary-adrenocortical (HPA axis) during pregnancy have been associated with maternal mental health in the preparation for parenthood and neurobehavioral, neurocognitive, and physical development outcomes in their children (Bale et al., 2010; Tamashiro & Moran, 2010). Much research on the maternal social environment and the HPA-axis in pregnancy has focused on individual differences in stress exposures, focusing on ethnically homogenous and higher SES individuals (O'Connor et al., 2013; Tollenaar et al., 2011). However, neighborhood-level effects on health have increasingly become recognized as potentially important determinants of birth outcomes and health disparities (Messer, 2004).
In a study of 413 women followed longitudinally across pregnancy, we characterized diurnal cortisol trajectories across pregnancy in a racially-, ethnically-, and socioeconomically diverse cohort (34% Hispanic/Latina, 17% Black, 46% White; 39% with a household income <$20k/year) and examined longitudinal associations between diurnal salivary cortisol slope (DS; wake to bed) in pregnancy, individual SES (Hollingshead index, 1 = low socioeconomic position, 0 = higher socioeconomic), and their standardized, census-level neighborhood deprivation index (NDI; Messer, 2006). Using longitudinal latent class mixed modeling (controlling for wake time and recruitment wave), we found that DS became steeper with increasing gestational age (B=.001, p<.001), suggesting a blunting of the DS as pregnancy progresses. NDI was significantly and positively associated with DS across pregnancy, such that higher levels of neighborhood deprivation were associated with a blunter DS (B = .033, p=.006). Socioeconomic position was also independently associated with DS across pregnancy in the same direction as NDI such that lower socioeconomic position was associated with a blunter DS (B = .005, p<.001). The interaction of socioeconomic position and NDI was not statistically significant (p=.933). These results suggest that racially-, ethnically-, and socioeconomically-diverse pregnant women may not follow the diurnal cortisol rhythm patterns assumed to be “typical” in the current literature on pregnancy and HPA-axis functioning, suggesting that the current understanding of cortisol dynamics in pregnancy is an incomplete characterization of the population at large. These results also find that mothers located in neighborhoods characterized by high levels of deprivation are more at risk of developing a blunted DS across gestation, independent of the significant effects of family-level socioeconomic position. The neighborhoods where women live and work are likely sources of support and stress. These findings suggest that neighborhood influences represent aspects of community stratification, opportunity structures, and social conditions that may represent areas of opportunity for community- and policy-level intervention relevant to biopsychosocial vulnerability for new parents and their children.

Authors

• Laura R Stroud, Brown Medical School and The Miriam Hospital
  Presenting Author

• Brie M Reid, Brown University