Early life adversity and depressive symptoms predict cortisol in pregnancy

Crystal Modde Epstein, Julia F. Houfek, Michael J. Rice, Sandra J. Weiss, Jeffrey A. French, Kevin A. Kupzyk, Sharon J. Hammer, Carol H. Pullen

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)379-389
Number of pages11
JournalArchives of Women's Mental Health
Issue number3
StatePublished - Jun 1 2020


  • Childhood trauma
  • HPA
  • Hardship
  • Prenatal
  • Stress

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health


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