Early life adversity and depressive symptoms predict cortisol in pregnancy

  • Crystal Modde EpsteinEmail author
  • Julia F. Houfek
  • Michael J. Rice
  • Sandra J. Weiss
  • Jeffrey A. French
  • Kevin A. Kupzyk
  • Sharon J. Hammer
  • Carol H. Pullen
Original Article


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.


HPA Childhood trauma Stress Hardship Prenatal 



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.


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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board affiliated with the recruitment site and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.UCSF School of NursingSan FranciscoUSA
  2. 2.UNMC College of Nursing985330 Nebraska Medical CenterOmahaUSA
  3. 3.College of NursingUniversity of Colorado Anschutz Medical CampusAuroraUSA
  4. 4.Department of PsychologyUniversity of Nebraska at OmahaOmahaUSA
  5. 5.UNMC College of MedicineOmahaUSA

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