Associations Between Maternal Awakening Salivary Cortisol Levels in Mid-Pregnancy and Adverse Birth Outcomes

Abstract Purpose Elevated levels of maternal cortisol have been hypothesized as the intermediate process between symptoms of depression and psychosocial stress during pregnancy and adverse birth outcomes. Therefore, we examined associations between cortisol levels in the second trimester of pregnancy and risks of three common birth outcomes in a nested case-control study. Methods This study was embedded in the PRIDE Study (n=3,019), from which we selected all cases with preterm birth (n=64), low birth weight (n=49), and small-for-gestational age (SGA; n=65), and 260 randomly selected controls, among the participants who provided a single awakening saliva sample in approximately gestational week 19 in 2012-2016. Multivariable linear and logistic regression was performed to assess the associations between continuous and categorized cortisol levels and the selected outcomes. Results We did not observe any associations between maternal cortisol levels and preterm birth and low birth weight. However, high cortisol levels (≥90th percentile) seemed to be associated with SGA (adjusted odds ratio 2.1, 95% confidence interval 0.9-4.8), in particular among girls (adjusted odds ratio 3.7, 95% confidence interval 1.1-11.9, based on 8 exposed cases) in an exploratory analysis. Conclusion The results of this study showed no suggestions of associations between maternal awakening cortisol levels in mid-pregnancy and adverse birth outcomes, except for an increased risk of SGA.