Childhood sexual abuse is associated with cortisol awakening response over pregnancy: preliminary findings

Childhood maltreatment and inflammation among pregnant women with gestational diabetes mellitus: A pilot study

BACKGROUND

Women with childhood maltreatment histories are at increased risk for adverse birth outcomes. Mechanisms explaining this link are poorly understood. Past research is limited by sampling pregnant women at low risk for adverse maternal and neonatal outcomes.

METHODS

This pilot study was a secondary data analysis of 24 women with gestational diabetes mellitus; 17% of the sample also reported a maltreatment history. Women provided a blood sample to measure inflammatory cytokines and insulin resistance, and saliva samples to measure diurnal cortisol. Birth outcomes for past and current pregnancies were recorded.

RESULTS

Histories of maltreatment were associated with elevated interleukin-15 and a marginally greater incidence of preterm delivery in current and past pregnancies.

CONCLUSIONS

This pilot study was the first to demonstrate an association between childhood maltreatment history and inflammatory cytokine levels in pregnant women diagnosed with gestational diabetes mellitus.

Intergenerational Transmission of Maternal Childhood Maltreatment Exposure: Implications for Fetal Brain Development

OBJECTIVE

Growing evidence suggests the deleterious consequences of exposure to childhood maltreatment (CM) not only might endure over the exposed individual's lifespan but also might be transmitted across generations. The time windows, mechanisms, and targets of such intergenerational transmission are poorly understood. The prevailing paradigm posits that mother-to-child transmission of the effects of maternal CM likely occurs after her child's birth. The authors seek to extend this paradigm and advance a transdisciplinary framework that integrates the concepts of biological embedding of life experiences and fetal origins of health and disease risk.

METHOD

The authors posit that the period of embryonic and fetal life represents a particularly sensitive time for intergenerational transmission; that the developing brain represents a target of particular interest; and that stress-sensitive maternal-placental-fetal biological (endocrine, immune) pathways represent leading candidate mechanisms of interest.

RESULTS

The plausibility of this model is supported by theoretical considerations and empirical findings in humans and animals. The authors synthesize several research areas and identify important knowledge gaps that might warrant further study.

CONCLUSION

The scientific and public health relevance of this effort relates to achieving a better understanding of the "when," "what," and "how" of intergenerational transmission of CM, with implications for early identification of risk, prevention, and intervention.

Maltreatment and diurnal cortisol regulation: A meta-analysis

Childhood maltreatment leads to a host of negative physical and mental health outcomes, with cortisol dysregulation implicated as a possible mechanism. Given inconsistencies across in the literature regarding the direction and magnitude of the association between maltreatment and diurnal cortisol regulation, the current meta-analysis of 27 studies aimed to examine the association between maltreatment and at least one of 3 indicators of diurnal cortisol regulation: wake-up cortisol levels, the cortisol awakening response (CAR), and/or the diurnal cortisol slope. Effect sizes were calculated using Hedges' g formula and were pooled using a random effects model. For the association between maltreatment and wake-up cortisol level, the aggregate effect size was g=0.08, p=0.26. Notably, effect sizes between maltreatment and wake-up cortisol were significantly larger (Q_between=5.18, p=0.02) for studies of agency-referred samples, g=0.24, p=0.006, than studies for which maltreatment status was based on self-report, g=0.00, p=0.97, with maltreatment associated with reduced wake-up cortisol levels. For the association between maltreatment and the CAR and diurnal cortisol slope, the aggregate effect sizes were non-significant and none of the moderator variables were significant. Although results did not indicate a large and robust association between maltreatment and various indicators of diurnal cortisol, studies with more rigorous designs (i.e., agency-referred samples) showed a small, significant association between maltreatment and blunted wake-up cortisol levels, suggesting a pattern of hypocortisolism.

Oxytocin pathways in the intergenerational transmission of maternal early life stress

Severe stress in early life, such as childhood abuse and neglect, constitutes a major risk factor in the etiology of psychiatric disorders and somatic diseases. Importantly, these long-term effects may impact the next generation. The intergenerational transmission of maternal early life stress (ELS) may occur via pre-and postnatal pathways, such as alterations in maternal-fetal-placental stress physiology, maternal depression during pregnancy and postpartum, as well as impaired mother-offspring interactions. The neuropeptide oxytocin (OT) has gained considerable attention for its role in modulating all of these assumed transmission pathways. Moreover, central and peripheral OT signaling pathways are highly sensitive to environmental exposures and may be compromised by ELS with implications for these putative transmission mechanisms. Together, these data suggest that OT pathways play an important role in the intergenerational transmission of maternal ELS in humans. By integrating recent studies on gene-environment interactions and epigenetic modifications in OT pathway genes, the present review aims to develop a conceptual framework of intergenerational transmission of maternal ELS that emphasizes the role of OT.

Maternal Exposure to Childhood Trauma Is Associated During Pregnancy With Placental-Fetal Stress Physiology

BACKGROUND

The effects of exposure to childhood trauma (CT) may be transmitted across generations; however, the time period(s) and mechanism(s) have yet to be clarified. We address the hypothesis that intergenerational transmission may begin during intrauterine life via the effect of maternal CT exposure on placental-fetal stress physiology, specifically placental corticotropin-releasing hormone (pCRH).

METHODS

The study was conducted in a sociodemographically diverse cohort of 295 pregnant women. CT exposure was assessed using the Childhood Trauma Questionnaire. Placental CRH concentrations were quantified in maternal blood collected serially over the course of gestation. Linear mixed effects and Bayesian piece-wise linear models were employed to test hypothesized relationships.

RESULTS

Maternal CT exposure (CT+) was significantly associated with pCRH production. Compared with nonexposed women, CT+ was associated with an almost 25% increase in pCRH toward the end of gestation, and the pCRH trajectory of CT+ women exhibited an approximately twofold steeper increase after the pCRH inflection point at 19 weeks gestation.

CONCLUSIONS

To the best of our knowledge, this finding represents the first report linking maternal CT exposure with placental-fetal stress physiology, thus identifying a potential novel biological pathway of intergenerational transmission that may operate as early as during intrauterine life.

Dysregulation of 11beta-hydroxysteroid dehydrogenases: implications during pregnancy and beyond

Glucococorticoids play a critical role in the developmental programing and fetal growth. Key molecules mediating and regulating tissue-specific glucocorticoid actions are 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type 1 and 2 isozymes, both of which are expressed in the placenta and the fetal membranes. 11beta-HSD1 is implicated in the pathogenesis of metabolic syndrome and its dysregulation has been observed in pregnancy-related complications (pre-eclampsia, intrauterine growth restriction). Interestingly, preliminary clinical data have associated certain 11beta-HSD1 gene polymorphisms with hypertensive disorders in pregnancy, suggesting, if confirmed by further targeted studies, it's potential as a putative prognostic marker. Animal studies and observations in humans have confirmed that 11beta-HSD2 insufficiency is related with pregnancy adversity (pre-eclampsia, intrauterine growth restriction, preterm birth). Importantly, down-regulation or deficiency of placental 11beta-HSD2 is associated with significant restriction in fetal growth and low-birth weight, and unfavorable cardio-metabolic profile in adulthood. The potential association of 11beta-HSD1 tissue-specific dysregulation with gestational diabetes, as well as the plausible utility of 11beta-HSD2, as a biomarker of pregnancy adversity and later life morbidity, are emerging areas of intense scientific interest and future investigation.

Momentary stress, cortisol, and gestational length among pregnant victims of childhood maltreatment: a pilot study

BACKGROUND

Pregnant victims of childhood maltreatment are more likely to deliver preterm. The mechanisms explaining this relationship are unclear. The goal of the current pilot study was to investigate whether momentary stress and cortisol serve as mechanisms linking maltreatment history to gestational length.

METHODS

Seventeen women enrolled in the study (35% maltreated). Women completed two study sessions at 27 and 34 weeks gestation. Following each session, at four times/day over two days, women reported their momentary stress levels by text message and provided corresponding salivary cortisol samples. Gestational length was determined by medical chart review.

RESULTS

Higher reports of momentary stress were associated with shortened gestational length. High stress predicted lower cortisol concentrations for women with maltreatment histories but higher concentrations among women without maltreatment.

CONCLUSION

Results from this pilot study provide preliminary evidence for understanding mechanisms explaining increased risk for preterm birth among childhood maltreatment victims.

Effects of the Social Environment and Stress on Glucocorticoid Receptor Gene Methylation: A Systematic Review

The early-life social environment can induce stable changes that influence neurodevelopment and mental health. Research focused on early-life adversity revealed that early-life experiences have a persistent impact on gene expression and behavior through epigenetic mechanisms. The hypothalamus-pituitary-adrenal axis is sensitive to changes in the early-life environment that associate with DNA methylation of a neuron-specific exon 17 promoter of the glucocorticoid receptor (GR) (Nr3c1). Since initial findings were published in 2004, numerous reports have investigated GR gene methylation in relationship to early-life experience, parental stress, and psychopathology. We conducted a systematic review of this growing literature, which identified 40 articles (13 animal and 27 human studies) published since 2004. The majority of these examined the GR exon variant 1F in humans or the GR17 in rats, and 89% of human studies and 70% of animal studies of early-life adversity reported increased methylation at this exon variant. All the studies investigating exon 1F/17 methylation in conditions of parental stress (one animal study and seven human studies) also reported increased methylation. Studies examining psychosocial stress and psychopathology had less consistent results, with 67% of animal studies reporting increased exon 17 methylation and 17% of human studies reporting increased exon 1F methylation. We found great consistency among studies investigating early-life adversity and the effect of parental stress, even if the precise phenotype and measures of social environment adversity varied among studies. These results are encouraging and warrant further investigation to better understand correlates and characteristics of these associations.

When mothering goes awry: Challenges and opportunities for utilizing evidence across rodent, nonhuman primate and human studies to better define the biological consequences of negative early caregiving

This article is part of a Special Issue "Parental Care".Across mammalian species, mothers shape socio-emotional development and serve as essential external regulators of infant physiology, brain development, behavior patterns, and emotional regulation. Caregiving quality, consistency and predictability shape the infant's underlying neurobiological processes. Although the requirements for "optimal" caregiving differ across species, the negative long-term consequences of the absence of needed caregiving (e.g. neglect) or the presence of harmful/aversive caregiving (e.g. physical abuse), are translatable across species. Recognizing the significant potential of cross species comparisons in terms of defining underlying mechanisms, effective translation requires consideration of the evolutionary, ecological, and fundamental biological and developmental differences between and among species. This review provides both an overview of several success stories of cross-species translations in relation to negative caregiving and a template for future studies seeking to most effectively define the underlying biological processes and advance research dedicated to mitigating the lasting negative health consequences of child maltreatment.

Influence of the 5-HT3A Receptor Gene Polymorphism and Childhood Sexual Trauma on Central Serotonin Activity

Background

Gene-environment interactions are important for understanding alterations in human brain function. The loudness dependence of auditory evoked potential (LDAEP) is known to reflect central serotonergic activity. Single nucleotide polymorphisms (SNPs) in the 5-HT3A serotonin receptor gene are associated with psychiatric disorders. This study aimed to investigate the effect between 5-HT3A receptor gene polymorphisms and childhood sexual trauma on the LDAEP as an electrophysiological marker in healthy subjects.

Methods

A total of 206 healthy subjects were recruited and evaluated using the childhood trauma questionnaire (CTQ) and hospital anxiety and depression scale (HADS). Peak-to-peak N1/P2 was measured at five stimulus intensities, and the LDAEP was calculated as the linear-regression slope. In addition, the rs1062613 SNPs of 5-HT3A (CC, CT, and TT) were analyzed in healthy subjects.

Results

There was a significant interaction between scores on the CTQ-sexual abuse subscale and 5-HT3A genotype on the LDAEP. Subjects with the CC polymorphism had a significantly higher LDEAP than T carriers in the sexually abused group. In addition, CC genotype subjects in the sexually abused group showed a significantly higher LDAEP compared with CC genotype subjects in the non-sexually abused group.

Conclusions

Our findings suggest that people with the CC polymorphism of the 5-HT3A gene have a greater risk of developing mental health problems if they have experienced childhood sexual abuse, possibly due to low central serotonin activity. Conversely, the T polymorphism may be protective against any central serotonergic changes following childhood sexual trauma.

History of childhood sexual abuse and risk of prenatal and postpartum depression or depressive symptoms: an epidemiologic review

The objective of this review is to summarize the literature (and to the extent possible, report the magnitude and direction of the association) concerning history of childhood sexual abuse (CSA) and depression or depressive symptoms among pregnant and postpartum women. Publications were identified through literature searches of seven databases (PubMed, EMBASE, PyscINFO, CINAHL, Web of Science, BIOSIS, and Science Direct) using keywords including "child abuse," "depression," "pregnancy," "prenatal," "pregnancy," and "postpartum." The literature search yielded seven eligible studies on the prenatal period and another seven studies on the postpartum period. All but one prenatal study observed statistically significant positive associations of CSA with depression or depressive symptoms during pregnancy. Findings on the association of CSA with postpartum depression or depressive symptoms were inconsistent; pooled unadjusted and adjusted odds ratios were 1.82 (95 % confidence interval (CI) 0.92, 3.60) and 1.20 (95 % CI 0.81, 1.76). In sum, findings suggest a positive association of history of CSA with depression and depressive symptoms in the prenatal period. Findings on the postpartum period were inconsistent. Clinical and public health implications of evidence from the available literature are discussed, as are desirable study design characteristics of future research.

Childhood abuse is associated with increased hair cortisol levels among urban pregnant women

BACKGROUND

Hypothalamic-pituitary-adrenal (HPA) axis activity is known to be altered following events such as childhood abuse. However, despite potential adverse consequences for the offspring of women who have experienced abuse, very little is known about altered HPA axis activity during pregnancy.

METHODS

During pregnancy, 180 women from diverse racial/ethnic backgrounds reported on their exposure to emotional, physical and/or sexual abuse before the age of 11, and general post-traumatic stress symptoms (ie, not limited to childhood years or abuse experiences). Around delivery, they provided hair samples for the assessment of cortisol levels during pregnancy. Hair cortisol was assessed for each pregnancy trimester. The effect of childhood abuse on hair cortisol was assessed using mixed-effects analyses of covariance models allowing for within-subject correlated observations, and were first performed in the entire sample and subsequently stratified by race/ethnicity.

RESULTS

Controlling for post-traumatic stress symptoms, hair cortisol levels varied by history of child abuse, F(2,166)=3.66, p=0.028. Childhood physical and/or sexual abuse was associated with greater hair cortisol levels, t(166)=2.65, p=0.009, compared with no history of abuse. Because childhood rates of abuse and hair cortisol levels varied by race/ethnicity, analyses were stratified by race/ethnicity. The associations between history of abuse and cortisol levels were only significant among black women, F(2,23)=5.37, p=0.012.

CONCLUSIONS

Childhood abuse, especially physical and/or sexual abuse, is associated with differences in cortisol production during pregnancy, particularly among black women. Future research should investigate how these differences impact physical and mental health outcomes among offspring of affected women.

Stress During Pregnancy

High levels of stress during pregnancy are associated with a number of adverse psychological and physiological outcomes for mother and child. These effects seem to be transmitted in part by one of the major stress-responsive systems, namely the hypothalamic-pituitary-adrenal (HPA) axis, which includes the hormone cortisol. However, as inconsistent study results indicate, methodology poses a substantial challenge to the investigation of stress during pregnancy. For example, although measures of maternal psychological stress and stress hormones are independently related to adverse pregnancy outcome, they seldom have been found to correlate with one another directly. Repeated measurement of psychological and biological responses to acute standardized stress challenges appears to reveal stronger associations. This article reviews the literature on experienced stress and stress hormones in pregnant women and presents studies that used standardized stress challenges (e.g., the Trier Social Stress Test, the cortisol response to morning awakening) to examine maternal stress reactivity more systematically. This review also takes a look at the few studies that examined the protective effects of psychological and psychosocial resources or stress interventions on experienced stress and stress hormones in pregnant women. Overall, results indicate that baseline stress hormone levels advance incrementally during gestation, presumably to prepare mother and fetus for delivery, while responses to acute stress appear to be increasingly attenuated. Moreover, the acute maternal stress response seems to be predictive of neonatal birth outcome and maternal well-being postpartum. Preliminary findings also suggest that much can be done toward coping with stress during pregnancy. Further research and a closer collaboration between science and clinical practice are required.

The effects of childhood sexual abuse on cortisol trajectories in pregnancy are moderated by current family functioning

The goal of this study was to understand the roles of maternal history of childhood sexual abuse (CSA) and current family functioning on the cortisol awakening response (CAR) in pregnancy. Participants were 185 pregnant women (ages 18-40) who completed items from the Adverse Childhood Experiences scale to measure child maltreatment history and the Family Assessment Device to measure current family functioning. Participants provided saliva samples at wake-up and 30min after wake-up at 25, 29, and 35 weeks gestation to measure CAR. A moderation effect was found such that participants with more severe CSA histories and poorer perceived family functioning had increasing CAR in pregnancy compared to participants with less severe CSA histories and better family functioning. These findings highlight the importance of considering stress in both childhood and current environments in predicting maternal cortisol in pregnancy.

Mechanisms linking in utero stress to altered offspring behaviour

Development in utero is recognised as a determinant of health in later life, a concept known as early life 'programming'. Several studies in humans have now shown a link between in utero stressors of maternal stress, anxiety and depression and adverse behavioural outcomes for the offspring including poorer cognitive function and behavioural and emotional problems. These behaviours are observed from the very early neonatal period and appear to persist through to adulthood. Underlying mechanisms are not known but overexposure of the developing foetus to glucocorticoids has been proposed. Dysregulation of the maternal and offspring hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a mechanism linking in utero stress with offspring behavioural outcomes. Studies suggest that altered circulating levels of maternal cortisol during pregnancy and/or changes in placental gene expression or methylation, which result in increased glucocorticoid transfer to the developing foetus, are linked to changes in offspring behaviour and in activity of the offspring HPA axis. Further understanding of the underlying pathways and identification of any gestation of vulnerability are needed to help design interventions to reduce in utero stress and improve behavioural outcomes in the offspring.

Maternal history of child abuse moderates the association between daily stress and diurnal cortisol in pregnancy: a pilot study

Previous research on the association between maternal daily stress and cortisol in pregnancy has yielded inconsistent findings. However, past studies have not considered whether stressful experiences in childhood impact maternal cortisol regulation in pregnancy. In this pilot study, we aimed to examine whether the association between maternal daily stress and cortisol differed according to maternal history of child abuse. Forty-one women provided salivary cortisol samples at wake-up, 30 min after wake-up, and bedtime for 3 days at three times over second and third trimesters of pregnancy. On each day of cortisol collection women reported their daily stress. Women reported child abuse experiences prior to age 18 years by completing 15 items from the Adverse Childhood Experiences Scale. Twenty-one percent (N = 9) of women reported a history of child sexual abuse (CSA), 44% (N = 18) reported a history of non-sexual child abuse and 34% (N = 14) reported no history of child abuse. Hierarchical Linear Modeling (HLM) analyses revealed that stress in the day prior was associated with increases in morning cortisol in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Increases in evening cortisol were associated with increases in daily stress in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Results reveal a dynamic association between daily stress and cortisol in pregnancy and suggest that patterns differ according to maternal child abuse history.

Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes

Overexposure of the developing fetus to glucocorticoids is hypothesised to be one of the key mechanisms linking early life development with later life disease. The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes dramatic changes during pregnancy and postpartum. Although cortisol levels rise threefold by the third trimester, the fetus is partially protected from high cortisol by activity of the enzyme 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2). Maternal HPA axis activity and activity of HSD11B2 may be modified by maternal stress and disease allowing greater transfer of glucocorticoids from mother to fetus. Here we review emerging data from human studies linking dysregulation of the maternal HPA axis to outcomes in both the mother and her offspring. For the offspring, greater glucocorticoid exposure is associated with lower birth weight and shorter gestation at delivery. In addition, evidence supports longer term consequences for the offspring including re-setting of the HPA axis and susceptibility to neurodevelopmental problems and cardiometabolic disease. For the mother, the changes in the HPA axis, particularly in the postpartum period, may increase vulnerability to mood disturbances. Further understanding of the changes in the HPA axis during pregnancy and the impact of these changes may ultimately allow early identification of those most at risk of future disease.