TY - JOUR
T1 - Pregnancy-specific anxiety and gestational length
T2 - The mediating role of diurnal cortisol indices
AU - Ross, Kharah M.
AU - Mander, Harmeen
AU - Rinne, Gabrielle
AU - Okun, Michele
AU - Hobel, Calvin
AU - Coussons-Read, Mary
AU - Dunkel Schetter, Christine
N1 - Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/7
Y1 - 2023/7
N2 - Background: Preterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length. Methods: A sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS. Results: There was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= −0.102(0.057), .95CI [− 0.227,− 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= −0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length. Conclusion: Lower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.
AB - Background: Preterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length. Methods: A sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS. Results: There was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= −0.102(0.057), .95CI [− 0.227,− 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= −0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length. Conclusion: Lower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.
KW - Cortisol variability
KW - Diurnal cortisol indices
KW - Gestational length
KW - Pregnancy
KW - Pregnancy-specific anxiety
KW - Preterm birth
UR - http://www.scopus.com/inward/record.url?scp=85152947992&partnerID=8YFLogxK
U2 - 10.1016/j.psyneuen.2023.106114
DO - 10.1016/j.psyneuen.2023.106114
M3 - Journal Article
C2 - 37084672
AN - SCOPUS:85152947992
SN - 0306-4530
VL - 153
JO - Psychoneuroendocrinology
JF - Psychoneuroendocrinology
M1 - 106114
ER -