title: Posttraumatic stress disorder, smoking, and cortisol in a community sample of pregnant women.
abstract: BACKGROUND
  The prevalence of posttraumatic stress disorder (PTSD) in the United States is higher among pregnant women than women generally. PTSD is related to adverse birth outcomes via physiological and behavioral alterations, such as smoking.
  
  
  METHODS
  We utilize salivary cortisol measures to examine how traumatic stress, smoking and the hypothalamic-pituitary-adrenal axis interact. Pregnant women (n=395) gave cortisol specimens as part of a cohort study of PTSD and pregnancy at three health systems in the Midwestern United States. Women were divided into three groups: nonsmokers, quitters (who stopped smoking during pregnancy), and pregnancy smokers. Mean cortisol values at three points, sociodemographics, trauma history, and PTSD were compared across groups. We assessed the association of smoking group and PTSD with late afternoon cortisol levels.
  
  
  RESULTS
  Smokers, quitters, and nonsmokers differed on demographic risk factors and PTSD symptom load. Late afternoon and bedtime cortisol measures were significantly positively correlated with smoking in pregnancy, with smokers with PTSD presenting the highest cortisol levels. Regression analysis showed that smoking in pregnancy was associated with higher late afternoon cortisol in an additive manner with PTSD symptoms.
  
  
  CONCLUSIONS
  Smoking appears to have a different relationship with cortisol level for those with and without PTSD. This is the first study to show additive effects of smoking and PTSD on cortisol levels in pregnant women. Since high cortisol, smoking, and PTSD have been shown to adversely affect perinatal outcomes, and since those continuing to smoke in pregnancy had the highest PTSD symptom load, PTSD-specific smoking cessation programs in maternity settings are warranted.
authors.affiliation: University of Michigan School of Public Health, 415 Washington Heights, Ann Arbor, MI 48109, United States. Electronic address: wdlopez@umich.edu.
authors.forename: William D
authors.initials: WD
authors.lastname: Lopez
authors.affiliation: University of Michigan School of Nursing, 204 S. State Street, G120 Lange Hall, Ann Arbor, MI 48109, United States. Electronic address: jseng@umich.edu.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Seng
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D016014:Linear Models; D015999:Multivariate Analysis; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism* / Q000523:psychology; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000378:metabolism* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000378:metabolism* / Q000523:psychology
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; PTSD; Pregnancy; Tobacco use; Trauma