Association of maternal depression and home adversities with infant hypothalamic-pituitary-adrenal (HPA) axis biomarkers in rural Pakistan

Association of childhood adversity with HPA axis activity in children and adolescents: A systematic review and meta-analysis

Childhood adversity (CA) is associated with alteration of the hypothalamus-pituitary-adrenal (HPA) axis. We conducted a meta-analysis to synthesize existing evidence on the association between CA and HPA axis activity among children and adolescents and investigate four research questions: (1) Is CA associated with different aspects of the HPA axis (i.e., diurnal cortisol, acute stress response, chronic cortisol levels)?, (2) Does this association vary by the child's age?, (3) Are threat and deprivation dimensions of CA differentially associated with HPA axis activity?, and (4) Does this association depend on both the dimension and timing of CA? Meta-analyses were conducted with 129 studies reporting 506 effect sizes. Results showed significant associations between CA with higher afternoon cortisol levels (r = 0.053), a flatter diurnal slope (r = 0.048), more blunted reactivity (r = -0.043), and higher hair cortisol concentration (r = 0.098), but not other cortisol indicators (morning cortisol, cortisol awakening response, daily output, and cortisol recovery). Older children and adolescents had more pronounced blunted reactivity and steeper recovery with CA than younger children. Threat and deprivation did not differ in overall impact for any cortisol indicator; however, there are timing-dependent associations specific to threat or deprivation for some cortisol indicators. For instance, threat was associated with heightened reactivity when occurred before middle childhood, and with blunted reactivity when occurred after age 15 years; in contrast, deprivation was associated with blunted reactivity regardless of its timing. Findings could inform targeted interventions to reduce negative impacts of CA on development.

Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.

Transcriptomic Alteration in the Brain and Gut of Offspring Following Prenatal Exposure to Corticosterone

Maternal stress during pregnancy can profoundly affect offspring health, increasing the risk of psychiatric disorders, metabolic diseases, and gastrointestinal problems. In this study, the effects of high prenatal corticosterone exposure on gene expression in the brain and small intestine of rat offspring were investigated via RNA-sequencing analysis. Pregnant rats were divided into two groups: Corti.Moms were injected with corticosterone daily, while Nor.Moms were given saline injections. Their offspring were labeled as Corti.Pups and Nor.Pups, respectively. The brain tissue analysis of Corti.Pups showed that the expression levels of the genes linked to neurodegenerative conditions increased and enhanced mitochondrial biogenesis, possibly due to higher ATP demands. The genes associated with calcium signaling pathways, neuroactive ligand-receptor interactions, and IgA production were also upregulated in the small intestine of Corti.pups. Conversely, the genes related to protein digestion, absorption, and serotonergic and dopaminergic synaptic activities were downregulated. These findings revealed that gene expression patterns in both the brain and intestinal smooth muscle of offspring prenatally exposed to corticosterone were substantially altered. Thus, this study provided valuable insights into the effects of prenatal stress on neurodevelopment and gut function.

The determination of endogenous steroids in hair and fur: A systematic review of methodologies

BACKGROUND

Endogenous steroid hormone assessment is essential for clinical practice. These hormones are typically measured in blood. More recently, measurement of steroids in hair samples has been gaining in popularity, so we have reviewed the methodologies used for this to-date.

METHODS

Ovid Medline, CINAHL, Psychinfo, and EMBASE were searched to identify manuscripts that analysed cortisol, testosterone, androstenedione, 17-hydroxyprogesterone (17OHP), dehydroepiandrosterone sulphate (DHEAS), and/or 25-hydroxyvitamin D (25(OH)D), in hair or fur. Data related to sampling and measurement procedures were extracted and analysed.

RESULTS

The systematic review included a total of 180 papers, with 82 % published in the past 8 years; 67 % were human and 33 % animal studies. Cortisol was by far the most common analyte. Incomplete reporting on sample harvest, preparation, and measurement procedures was common. Typically, samples were collected from posterior vertex of humans or back/neck of animals, weighing between 11 and 50 mg (with a range of 1.25-1000 mg). Samples were usually stored at room temperature, often using aluminium foil. Isopropanol was the most common cleaning solution. Hair was normally powdered or segmented prior to extraction. Extraction was typically carried out over 18-24 hours using methanol. Validation and precision information was provided in 47 % of studies.

CONCLUSIONS

This systematic review highlights the lack of standardisation in the analysis of endogenous steroids in hair. Reporting was typically incomplete, and assay validations were partial or absent. Together, these limit the value of these exciting new methods and hold back transition to clinical use.

A Preliminary Investigation of Associations Between Traumatic Events Experienced During Pregnancy and Salivary Diurnal Cortisol Levels of Brazilian Adolescent Mothers and Infants

INTRODUCTION

Interpersonal violence against women is a major global health problem that may have intergenerational effects. This study investigated associations between maternal experiences of interpersonal violence and other traumatic events and maternal and infant salivary diurnal cortisol in a cohort of adolescent mothers in São Paulo, Brazil.

METHOD

Adolescent mothers (14-19 years) participating in a home-visiting intervention were interviewed retrospectively about lifetime and pregnancy violence and trauma exposure. Mothers collected saliva at waking and before bedtime from themselves (n = 23) and their infants (n = 32) at 12 months postpartum. Multivariable regression models were used to examine associations between trauma history variables and salivary diurnal cortisol.

RESULTS

Adjusting for the intervention group, infant sex, maternal age, non-supplement medication use, and sample collection time, we found that higher-than-average lifetime trauma exposure was associated with maternal evening cortisol (b = 0.472, p-value = 0.028). Lifetime assaultive violence exposure was also associated with maternal evening cortisol (b = 0.196, p-value = 0.02). Maternal exposure to traumatic events in pregnancy was positively associated with bedtime cortisol levels of infants (b = 0.21, p = 0.01). Trauma variables were not associated with maternal or infant morning cortisol levels.

CONCLUSION

Results suggest that maternal trauma history influences both maternal and infant postnatal cortisol regulation as indexed by evening cortisol levels. These results are consistent with models of fetal programming; however, future studies should investigate potential postnatal psychobiological pathways. Lifetime trauma exposure may also become embedded in the maternal hypothalamic-adrenal-pituitary axis regulation. Future studies are needed to consider other biological pathways in the intergenerational transmission of trauma.

Toddler hair cortisol levels are associated with maternal prenatal depression

OBJECTIVES

Cortisol is an important metabolic hormone that regulates multiple physiologic systems. Cortisol metabolism is sensitive to early life environments, including that experienced prenatally. Limited research has evaluated factors that predict variation in maternal and offspring toddler hair cortisol, which is important since hair cortisol represents different dynamics of hypothalamic pituitary adrenal (HPA)-axis function than more common salivary or serum measures.

METHODS

To address this gap, we longitudinally evaluated whether maternal depression measured in pregnancy and 1 month postnatal was associated with maternal and offspring hair cortisol levels approximately 15 months after birth (n = 46 mothers, 40 toddlers; mean 15.6 months postnatal, SD = 2.9 months).

RESULTS

Mean depression symptoms were highest during the prenatal period. Prenatal, but not postnatal, maternal depression was associated with offspring hair cortisol levels (B = 0.095, p = .01). Maternal hair cortisol was not associated with depression measured at either time point.

CONCLUSIONS

These findings indicate that offspring hair cortisol more than a year after birth is associated with maternal prenatal depression, consistent with previous research in salivary cortisol, suggesting that long-term offspring stress physiology may be influenced by conditions experienced in utero. These findings highlight the potential for hair cortisol-a minimally invasive and easy-to-collect measure- to index toddler HPA-axis dynamics.

Adrenocortical deviations and adverse clinical outcomes in children and adolescents exposed to interparental intimate partner violence: A systematic review

Childhood exposure to interparental intimate partner violence (i-IPV) is a pervasive form of child maltreatment, posing major public health concerns and elevating risks for enduring adverse clinical and developmental consequences. However, assessing the full spectrum of clinical effects is challenging, potentially leading to inconsistent identification of children in need of early intervention. This systematic review aimed to identify hypothalamic-pituitary-adrenocortical axis dysfunction following i-IPV exposure, elucidating the underlying biopsychobehavioural mechanisms and predicting adverse outcomes. We searched Embase, MEDLINE, and PsycINFO for peer-reviewed studies from infancy through adolescence, screened reference lists and conducted forward searches. Analysis of 23 publications (N = 1848) revealed associations between i-IPV and altered adrenocortical function from early childhood, influenced by FKBP5 haplotype, parental caregiving and offspring emotional insecurity. Results showed that the adrenocortical stress response may predict internalising and externalising problems, childhood asthma, impaired executive function and poor academic performance. Nonetheless, inconsistencies in findings between studies suggest methodological heterogeneity and potential bias. Identifying biomarkers such as cortisol can enhance prediction and mechanism-based intervention efforts but long-term studies with a common theoretical and methodological framework are needed for comprehensive understanding. Integrating biological, emotional, and behavioural assessments could potentiate trauma services and research, ultimately improving outcomes for affected children.

Longitudinal pathways between maternal depression, parenting behaviors, and early childhood development: a mediation analysis

Maternal depression is a global public health concern with far-reaching impacts on child development, yet our understanding of mechanisms remains incomplete. This study examined whether parenting mediates the association between maternal depression and child outcomes. Participants included 841 rural Pakistani mother-child dyads (50% female). Maternal depression was measured at 12 months postpartum, parenting behaviors (warmth, stimulation, and harsh parenting) were measured at 24 months, and child outcomes (mental health, socioemotional development, and cognitive skills) were measured at 36 months. Maternal depression predicted increased harsh parenting, child mental health difficulties, and child socioemotional concerns; however, there was little evidence for parenting as a mediator between maternal depression and child outcomes. Sex-stratified results are discussed, and findings are situated in context.

The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India

Background: Early adversities negatively impact children's growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.

The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India

Background: Early adversities negatively impact children’s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.

Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study

OBJECTIVES

Adverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan.

DESIGN

This study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum.

SETTING

All participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers.

PARTICIPANTS

Data were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol.

PRIMARY AND SECONDARY OUTCOMES MEASURES

ACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables.

RESULTS

All models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production.

CONCLUSIONS

All four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.

Basal and reactive cortisol: A systematic literature review of offspring of parents with depressive and bipolar disorders

One of the most consistent biological findings in the study of affective disorders is that those with depression commonly show abnormal cortisol response, which suggests dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Children of parents with mood disorders offer the opportunity to explore the biological pathways that may confer risk for psychopathology. This review explores basal and reactive cortisol in the offspring of parents who are currently depressed or have had a history of a depressive or bipolar disorder. Using PRISMA guidelines, search terms yielded 2002 manuscripts. After screening, 87 of these manuscripts were included. Results from the literature suggest that while the degree and direction of dysregulation varies, offspring of a parent with depression tend to show elevations in both basal (particularly morning and evening) and reactive (tentatively for social stressors) cortisol levels. There were few studies focused on offspring of parents with bipolar disorder. This review also discusses implications and recommendations for future research regarding the HPA axis in the intergenerational transmission of depressive disorders.