Abstract
Evidence suggests that exposure to early life adversity (ELA) programs the hypothalamic-pituitary-adrenal (HPA) axis to influence responses to later adversity and predisposes women to depression. However, few studies have examined whether ELA moderates the HPA cortisol response to adulthood adversity and depressive symptoms in pregnant women. The aims of this study were to determine (a) whether ELA, adulthood adversity, and depressive symptoms differentially predict patterns of cortisol and (b) whether ELA moderates the relationship of adulthood adversity or depressive symptoms to cortisol. This was a descriptive, cross-sectional study of pregnant women (N = 58, mean = 26.5 weeks gestation). Participants completed the Stress and Adversity Inventory and Edinburgh Depression Scale and collected salivary cortisol five times per day for 3 days to assess cortisol awakening response (CAR), diurnal cortisol slope, and cortisol area under the curve (AUC). ELA predicted a larger CAR, while depressive symptoms predicted a blunted CAR and higher cortisol AUC. Adulthood adversity predicted a blunted CAR and steeper diurnal slope, but only in women with high ELA. ELA also moderated the effect of depressive symptoms on diurnal slope. Early adversity and depressive symptoms appear to have significant effects on the HPA axis during pregnancy, with early adversity also moderating effects of depressive symptoms and adulthood adversity on cortisol regulation. Early adversity may be an important factor in identifying unique HPA phenotypes and risk for HPA axis dysregulation in pregnancy.
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References
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709. https://doi.org/10.1097/01.AOG.0000116689.75396.5f
Bergink V, Kooistra L, Lambregtse-van den Berg PM et al (2011) Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res 70:385–389. https://doi.org/10.1016/j.jpsychores.2010.07.008
Bleker LS, Roseboom TJ, Vrijkotte TG, Reynolds RM, de Rooij SR (2017) Determinants of cortisol during pregnancy—the ABCD cohort. Psychoneuroendocrinology 83:172–181. https://doi.org/10.1016/j.psyneuen.2017.05.026
Bublitz MH, Bourjeily G, Vergara-Lopez C, Stroud LR (2016) Momentary stress, cortisol, and gestational length among pregnant victims of childhood maltreatment: a pilot study. Obstet Med 9:73–77. https://doi.org/10.1177/1753495X16636264
Bublitz MH, Stroud LR (2012) Childhood sexual abuse is associated with cortisol awakening response over pregnancy: preliminary findings. Psychoneuroendocrinology 37:1425–1430. https://doi.org/10.1016/j.psyneuen.2012.01.009
Bublitz MH, Stroud LR (2013) Maternal history of child abuse moderates the association between daily stress and diurnal cortisol in pregnancy: a pilot study. Stress 16:706–710. https://doi.org/10.3109/10253890.2013.825768
Buss C, Entringer S, Reyes JF, Chicz-DeMet A, Sandman CA, Waffarn F, Wadhwa PD (2009) The maternal cortisol awakening response in human pregnancy is associated with the length of gestation. Am J Obstet Gynecol 201:398.e1–398.e8. https://doi.org/10.1016/j.ajog.2009.06.063
Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (2004) Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 82:217–225. https://doi.org/10.1016/j.jad.2003.12.013
Chida Y, Steptoe A (2009) Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 80:265–278
Clow A, Thorn L, Evans P, Hucklebridge F (2004) The awakening cortisol response: methodological issues and significance. Stress 7:29–37. https://doi.org/10.1080/10253890410001667205
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry J Ment Sci 150:782–786
Dedovic K, Ngiam J (2015) The cortisol awakening response and major depression: examining the evidence. Neuropsychiatr Dis Treat 11:1181–1189
Entringer S, Buss C, Shirtcliff EA, Cammack AL, Yim IS, Chicz-DeMet A, Sandman CA, Wadhwa PD (2010) Attenuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human pregnancy. Stress 13:258–268. https://doi.org/10.3109/10253890903349501
Felitti VJ, Anda RF, Nordenberg D et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med 14:245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Fischer S, Strawbridge R, Vives AH, Cleare AJ (2017) Cortisol as a predictor of psychological therapy response in depressive disorders: systematic review and meta-analysis. Br J Psychiatry 210:105–109. https://doi.org/10.1192/bjp.bp.115.180653
Gee DG, Casey BJ (2015) The impact of developmental timing for stress and recovery. Neurobiol Stress 1:184–194. https://doi.org/10.1016/j.ynstr.2015.02.001
Gillespie SL, Christian LM, Alston AD, Salsberry PJ (2017) Childhood stress and birth timing among African American women: cortisol as biological mediator. Psychoneuroendocrinology 84:32–41. https://doi.org/10.1016/j.psyneuen.2017.06.009
Heim CM, Newport DJ, Mletzko T, Miller AH, Nemeroff CB (2008) The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 33:693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008
Hsiao FH, Yang TT, Ho RTH, Jow GM, Ng SM, Chan CLW, Lai YM, Chen YT, Wang KC (2010) The self-perceived symptom distress and health-related conditions associated with morning to evening diurnal cortisol patterns in outpatients with major depressive disorder. Psychoneuroendocrinology 35:503–515. https://doi.org/10.1016/j.psyneuen.2009.08.019
Iliadis SI, Comasco E, Sylvén S, Hellgren C, Sundström Poromaa I, Skalkidou A (2015) Prenatal and postpartum evening salivary cortisol levels in association with peripartum depressive symptoms. PLoS One 10. https://doi.org/10.1371/journal.pone.0135471
Lu S, Gao W, Huang M, Li L, Xu Y (2016) In search of the HPA axis activity in unipolar depression patients with childhood trauma: combined cortisol awakening response and dexamethasone suppression test. J Psychiatr Res 78:24–30. https://doi.org/10.1016/j.jpsychires.2016.03.009
McDonnell CG, Valentino K (2016) Intergenerational effects of childhood trauma: evaluating pathways among maternal ACEs, perinatal depressive symptoms, and infant outcomes. Child Maltreat 21:317–326. https://doi.org/10.1177/1077559516659556
Miller GE, Culhane J, Grobman W, Simhan H, Williamson DE, Adam EK, Buss C, Entringer S, Kim KY, Felipe Garcia-Espana J, Keenan-Devlin L, McDade TW, Wadhwa PD, Borders A (2017) Mothers’ childhood hardship forecasts adverse pregnancy outcomes: role of inflammatory, lifestyle, and psychosocial pathways. Brain Behav Immun 65:11–19. https://doi.org/10.1016/j.bbi.2017.04.018
Nanni V, Uher R, Danese A (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry 169:141–151
Nelson J, Klumparendt A, Doebler P, Ehring T (2017) Childhood maltreatment and characteristics of adult depression: meta-analysis. Br J Psychiatry 210:96–104
O’Connor TG, Tang W, Gilchrist MA, Moynihan JA, Pressman EK, Blackmore ER (2014) Diurnal cortisol patterns and psychiatric symptoms in pregnancy: short-term longitudinal study. Biol Psychol 96:35–41. https://doi.org/10.1016/j.biopsycho.2013.11.002
Orta OR, Gelaye B, Bain PA, Williams MA (2018) The association between maternal cortisol and depression during pregnancy, a systematic review. Arch Womens Ment Health 21:43–53. https://doi.org/10.1007/s00737-017-0777-y
Pariante CM, Lightman SL (2008) The HPA axis in major depression: classical theories and new developments. Trends Neurosci 31:464–468. https://doi.org/10.1016/j.tins.2008.06.006
Peng H, Long Y, Li J, Guo Y, Wu H, Yang YL, Ding Y, He J, Ning Y (2014) Hypothalamic-pituitary-adrenal axis functioning and dysfunctional attitude in depressed patients with and without childhood neglect. BMC Psychiatry 14:45. https://doi.org/10.1186/1471-244X-14-45
Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH (2003) Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology 28:916–931. https://doi.org/10.1016/S0306-4530(02)00108-7
Records K, Rice MJ (2009) Lifetime physical and sexual abuse and the risk for depression symptoms in the first 8 months after birth. J Psychosom Obstet Gynecol 30:181–190. https://doi.org/10.1080/01674820903178121
Rice MJ, Records K (2006) Cardiac response rate variability in physically abused women of childbearing age. Biol Res Nurs 7:204–213. https://doi.org/10.1177/1099800405283567
Rice MJ, Records K (2008) Comparative analysis of physiological adaptation of neonates of abused and nonabused mothers. J Forensic Nurs 4:80–90. https://doi.org/10.1111/j.1939-3938.2008.00013 x [doi]
Seng JS, Li Y, Yang JJ, King AP, Kane Low LM, Sperlich M, Rowe H, Lee H, Muzik M, Ford JD, Liberzon I (2018) Gestational and postnatal cortisol profiles of women with posttraumatic stress disorder and the dissociative subtype. J Obstet Gynecol Neonatal Nurs 47:12–22. https://doi.org/10.1016/j.jogn.2017.10.008
Seth S, Lewis AJ, Galbally M (2016) Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC Pregnancy Childbirth 16:124. https://doi.org/10.1186/s12884-016-0915-y
Shea A, Streiner DL, Fleming A et al (2007) The effect of depression, anxiety and early life trauma on the cortisol awakening response during pregnancy: preliminary results. Psychoneuroendocrinology 32:1013–1020
Slavich GM, Epel ES (2010) The Stress and Adversity Inventory (STRAIN): an automated system for assessing cumulative stress exposure
Slavich GM, Shields GS (2018) Assessing lifetime stress exposure using the Stress and Adversity Inventory for Adults (Adult STRAIN): an overview and initial validation. Psychosom Med 80:17–27. https://doi.org/10.1097/PSY.0000000000000534
Smith TE, French JA (1997) Psychosocial stress and urinary cortisol excretion in marmoset monkeys (Callithrix kuhli). Physiol Behav 62:225–232. https://doi.org/10.1016/S0031-9384(97)00103-0
Smith MV, Gotman N, Yonkers KA (2016) Early childhood adversity and pregnancy outcomes. Matern Child Health J 20:790–798. https://doi.org/10.1007/s10995-015-1909-5
Stetler C, Miller GE (2005) Blunted cortisol response to awakening in mild to moderate depression: regulatory influences of sleep patterns and social contacts. J Abnorm Psychol 114:697–705. https://doi.org/10.1037/0021-843X.114.4.697
Swales DA, Stout-Oswald SA, Glynn LM, Sandman C, Wing DA, Davis EP (2018) Exposure to traumatic events in childhood predicts cortisol production among high risk pregnant women. Biol Psychol 139:186–192. https://doi.org/10.1016/j.biopsycho.2018.10.006
Thayer ZM, Kuzawa CW (2014) Early origins of health disparities: material deprivation predicts maternal evening cortisol in pregnancy and offspring cortisol reactivity in the first few weeks of life. Am J Hum Biol 26:723–730. https://doi.org/10.1002/ajhb.22532
Thomas JC, Letourneau N, Campbell TS, Giesbrecht GF (2018a) Social buffering of the maternal and infant HPA axes: mediation and moderation in the intergenerational transmission of adverse childhood experiences. Dev Psychopathol In Press 30:921–939. https://doi.org/10.1017/S0954579418000512
Thomas JC, Magel C, Tomfohr-Madsen L, Madigan S, Letourneau N, Campbell TS, Giesbrecht GF (2018b) Adverse childhood experiences and HPA axis function in pregnant women. Horm Behav 102:10–22. https://doi.org/10.1016/j.yhbeh.2018.04.004
Vreeburg SA, Hoogendijk WJG, DeRijk RH et al (2013) Salivary cortisol levels and the 2-year course of depressive and anxiety disorders. Psychoneuroendocrinology 38:1494–1502. https://doi.org/10.1016/j.psyneuen.2012.12.017
Vreeburg SA, Hoogendijk WJG, van Pelt J, DeRijk RH, Verhagen JCM, van Dyck R, Smit JH, Zitman FG, Penninx BWJH (2009) Major depressive disorder and hypothalamic-pituitary-adrenal axis activity. Arch Gen Psychiatry 66:617–626. https://doi.org/10.1001/archgenpsychiatry.2009.50
Vrshek-Schallhorn S, Doane LD, Mineka S, Zinbarg RE, Craske MG, Adam EK (2013) The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history. Psychol Med 43:483–493. https://doi.org/10.1017/S0033291712001213
Acknowledgments
Thank you to the clinic staff who helped with recruitment and to all the women who participated in the study. Thank you to Taryn Derickson for her research assistance.
Funding
C. Modde Epstein was supported by the National Institute of Nursing Research of the National Institutes of Health (Award Numbers F31NR016176; T32NR016920) and a University of Nebraska Presidential Fellowship, University of Nebraska Medical Center, Omaha, NE.
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Epstein, C.M., Houfek, J.F., Rice, M.J. et al. Early life adversity and depressive symptoms predict cortisol in pregnancy. Arch Womens Ment Health 23, 379–389 (2020). https://doi.org/10.1007/s00737-019-00983-3
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DOI: https://doi.org/10.1007/s00737-019-00983-3