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Review
. 2021 May;50(3):242-255.
doi: 10.1016/j.jogn.2020.12.006. Epub 2021 Jan 29.

Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy

Crystal Modde Epstein, Julia F Houfek, Michael J Rice, Sandra J Weiss
Review

Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy

Crystal Modde Epstein et al. J Obstet Gynecol Neonatal Nurs. 2021 May.

Abstract

Objective: To synthesize published findings on the relationship between early life adversity and hypothalamic-pituitary-adrenal axis cortisol parameters in pregnant women.

Data sources: We searched PubMed, CINAHL, and PsycINFO databases using variants and combinations of the keywords early life adversity, pregnancy, hypothalamic-pituitary-adrenal axis, and cortisol.

Study selection: We selected articles that included pregnant participants, included measures of cortisol and early life adversity, were published in English in a peer-reviewed journal, and were of sufficient methodologic quality. Date of publication was unrestricted through May 2020.

Data extraction: Twenty-five articles met the inclusion criteria and were evaluated for quality and risk of bias. Sources of cortisol included saliva, hair, plasma, and amniotic fluid.

Data synthesis: We categorized findings according to four physiologically distinct cortisol output parameters: diurnal (daily pattern), phasic (in response to an acute stressor), tonic (baseline level), and pregnancy-related change. Preliminary evidence suggests that early adversity may be associated with elevated cortisol awakening response (diurnal) and blunted response to acute stressors (phasic), irrespective of other psychosocial symptoms or current stress. For women with high levels of current stress or psychological symptoms, early adversity was associated with higher baseline (tonic) cortisol levels.

Conclusion: Early life adversity in women is linked with alterations in cortisol regulation that are apparent during pregnancy. Researchers should examine how variations in each cortisol parameter differentially predict pregnancy health risk behaviors, maternal mental health, and neonatal health outcomes.

Keywords: abuse; adverse childhood experiences; hypothalamic–pituitary–adrenal axis; neuroendocrine; prenatal; toxic stress; trauma.

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Conflict of interest statement

Conflict of Interest The authors report no conflicts of interest or relevant financial relationships.

Figures

Figure 1.
Figure 1.
Search strategy for comprehensive literature review.
See this image and copyright information in PMC

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