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Objective: It is widely assumed that glucocorticoids represent a primary mechanism through which exposure to adversity and maternal psychological distress shape prenatal developmental trajectories of both mother and fetus. However, despite repeated investigations and the fact that prenatal cortisol has been reliably linked to developmental outcomes, the empirical evidence supporting an association between prenatal cortisol and maternal distress is scarce. In this study, a novel approach to assessing links between maternal prenatal psychological distress and gestational cortisol profiles, general growth mixture modeling (GGMM), was applied. Method: Measures of pregnancy anxiety, perceived stress, and state anxiety and depressive symptoms as well as plasma samples (for determination of cortisol) were collected from 250 women 4 times during pregnancy. Results: Using GGMM, 3 cortisol trajectory groups were identified, including a typical group (n = 199) that exhibited the expected steady increase in cortisol throughout gestation, a steep group (n = 31) displaying an accelerated increase in cortisol over the course of pregnancy relative to the typical group, and a flat group (n = 20) with relatively higher cortisol levels early in pregnancy that plateaued in midgestation. Women reporting the highest distress scores exhibited trajectories expected to be associated with the least optimal developmental outcomes (flatter trajectories characterized by relatively higher levels early in gestation and lower levels late in gestation). Conclusions: These findings suggest that psychological distress during pregnancy is associated with unique prenatal cortisol profiles and support further examination of this link, to enable continued evaluation of a plausible biological pathway by which maternal psychological distress programs fetal development.


This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Health Psychology, volume 39, issue 11, in 2020 following peer review. The definitive publisher-authenticated version is available online at

This article may not exactly replicate the final version published in the APA journal. It is not the copy of record.


American Psychological Association



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