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Childhood abuse is associated with increased hair cortisol levels among urban pregnant women
  1. Hannah M C Schreier1,
  2. Michelle Bosquet Enlow2,3,
  3. Thomas Ritz4,
  4. Chris Gennings5,6,
  5. Rosalind J Wright6
  1. 1Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
  3. 3Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Psychology, Southern Methodist University, Dallas, Texas, USA
  5. 5Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  6. 6Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Hannah M C Schreier, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA; hannah.schreier{at}


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.

  • Lifecourse / Childhood Circumstances

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