Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy.
Crystal Modde Epstein, Julia F Houfek, Michael J Rice and 1 others
PMID 33524324WHAT IT FOUND
Pregnant women with early life adversity often had larger morning cortisol surges and blunted responses to momentary stress.
Baseline and long-term cortisol links were mixed. They often appeared only with current stress, low socioeconomic status, or among Black women.
Key findings
01Pregnant women with early life adversity had a larger cortisol awakening response in four of five unique studies.
02Three studies found blunted or delayed cortisol responses to acute or momentary stressors in pregnant women with early life adversity.
03Baseline and hair cortisol links were mixed, often appearing only with current stress, low socioeconomic status, or among Black women.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The reviewed studies were observational and correlational, so they cannot show that early life adversity caused cortisol changes or pregnancy problems. Studies used many different measures of early adversity and different cortisol samples, including saliva, hair, plasma, and amniotic fluid, so results are hard to combine. Some studies had small samples, with sample sizes as low as 17 or 19 participants. The review did not examine fetal or offspring outcomes or the mechanisms linking cortisol changes to health. Most samples were from the United States, Canada, Germany, Denmark, or Peru, so findings may not apply to all populations.
Declared interests
The article is listed as supported by NIH extramural research. The authors reported no conflicts of interest or relevant financial relationships.
The easy way to misread this
Do not conclude that early life adversity causes abnormal cortisol or that cortisol testing should guide pregnancy care. The review synthesised observational studies with different measures, and it did not test a nursing intervention or show that these cortisol patterns caused adverse pregnancy outcomes.