High maternal cortisol levels during pregnancy are associated with more psychiatric symptoms in offspring at age of nine – A prospective study from Nicaragua

• In a prospective study, children and mothers were followed from pregnancy up to 9 years.
• Maternal cortisol during pregnancy was related with child psychiatric symptoms.
• Maternal cortisol during pregnancy was not related with child cortisol.
• To conclude, exposure to prenatal stress increases risk of child psychopathology.
• Fetal programming of the HPA-axis does not seem to mediate this increased risk.

Maternal exposure to stress or adversity during pregnancy has been associated with negative health effects for the offspring including psychiatric symptoms. Programming of the hypothalamic–pituitary–adrenal (HPA) axis has been suggested as one mediating process. In order to investigate possible long term effects of stressors during pregnancy, we followed 70 children and their mothers from pregnancy up to nine years aiming to investigate if maternal cortisol levels and distress/exposure to partner violence were associated with child psychiatric symptoms and child cortisol levels at follow-up. Maternal distress was evaluated using The Self Reporting Questionnaire, exposure to partner violence by an instrument from WHO and child psychiatric symptoms with Child Behavior Checklist (CBCL). We adjusted the analyses for gestational week, gender, SES, perinatal data and maternal distress/exposure to partner violence at child age of nine years. Elevated maternal cortisol levels during pregnancy, as a possible marker of maternal stress load, were correlated with higher CBCL-ratings, especially concerning externalizing symptoms. Maternal cortisol levels during pregnancy were not associated with child cortisol levels at child age of nine years. Maternal distress and exposure to partner violence during pregnancy were neither associated with child psychiatric symptoms nor child cortisol levels. To conclude, intrauterine exposure to elevated cortisol levels was associated with higher ratings on offspring psychopathology at nine years of age. The lack of association between maternal cortisol levels during pregnancy and child cortisol levels does not support the hypothesis of fetal programming of the HPA-axis, but reliability problems may have contributed to this negative finding.