title: Prenatal Stress and the Cortisol Awakening Response in African-American and Caucasian Women in the Third Trimester of Pregnancy.
abstract: Objectives Prior studies have shown significant racial disparities in psychosocial stressors for pregnant women. One physiological mechanism by which prenatal stress is expressed is via the stress-sensitive hormone cortisol, which itself differs by race. In this study, we examine differences in cortisol awakening response (CAR) for African-American and Caucasian pregnant women during late pregnancy, particularly whether racial disparities are evident after accounting for measures of psychosocial stress. Methods During their third trimester of pregnancy (32-40 weeks of gestation), we asked women to self-collect salivary samples at home over 2 days. We then measured salivary cortisol across the day for 30 pregnant women (18 Caucasian; 12 African-American) to examine the CAR by race and by multiple measures of self-reported psychosocial stress, including perceived discrimination. Results Although the women in our sample showed normative cortisol diurnal rhythms (high on waking, peak 30 min post-waking, lowest at bedtime), we found that African-American women had blunted (smaller) awakening responses compared to Caucasian women (p < 0.05). The CAR was significantly larger in Caucasian women compared to African-American women even after accounting for covariates in a multivariate equation. However, when we added measures of psychosocial stress to the multivariate equation, higher levels of stress were significantly associated with a smaller CAR (p < 0.05), and the association between maternal race and CAR was no longer significant. Conclusions Our results add to a growing body of evidence that racial differences in the activity of the hypothalamic-pituitary-adrenal axis are associated with psychosocial stress during pregnancy.
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. clarissa.simon@northwestern.edu.
authors.forename: Clarissa D
authors.initials: CD
authors.lastname: Simon
authors.affiliation: Institute for Policy Research, Northwestern University School of Education and Social Policy, Evanston, IL, USA.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Adam
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
authors.affiliation: Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kaitlin A
authors.initials: KA
authors.lastname: Wolfe
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Chicago, IL, USA.|Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Ann E B
authors.initials: AE
authors.lastname: Borders
mesh_terms: D000328:Adult; D001741:Black or African American; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D007407:Interviews as Topic; D010913:Pituitary-Adrenal System / Q000502:physiology; D011247:Pregnancy / Q000378:metabolism*; D011263:Pregnancy Trimester, Third; D037841:Pregnant People / Q000208:ethnology / Q000523:psychology*; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000208:ethnology* / Q000503:physiopathology* / Q000523:psychology; D014481:United States; D044465:White People
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; Discrimination; Pregnancy; Racial disparities; Stress