Pregnancy anxiety and prenatal cortisol trajectories

• We examined the association between pregnancy anxiety and maternal prenatal cortisol.
• Higher pregnancy anxiety predicted steeper increases in cortisol trajectories relative to lower pregnancy anxiety.
• Cortisol trajectories significantly diverged between 30 and 31 weeks gestation.
• Results remained significant adjusting for state anxiety and perceived stress.
• Pregnancy anxiety may be linked to birth and infant outcomes via prenatal cortisol.

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 and 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy anxiety over gestation, nor pregnancy anxiety specific to only a particular time in pregnancy predicted cortisol. These findings provide support for one way in which pregnancy anxiety may influence maternal physiology and contribute to a growing literature on the complex biological pathways linking pregnancy anxiety to birth and infant outcomes.