The relationships between pregnancy-related worries, childhood maltreatment history and HPA-axis activity in pregnant women

Childhood maltreatment (CM) influences prenatal stress reactivity, such as the Hypothalamic-Pituitary-Adrenal (HPA)-axis, and maternal mood with other prenatal factors. Specifically, pregnancy-related worries (PRW) alter maternal mood and suggested be better predictors of maternal distress than general state anxiety (GSA). Present study investigates how CM is related to prenatal HPA-axis activity and whether this relationship is influenced by PRW. It is hypothesized that CM would predict prenatal HPA-axis activity through mediation by PRW, where CM increases PRW which alters HPA-axis; if not, PRW would moderate that relationship where CM predicts HPA-axis in relation to PRW. Participants were 77 pregnant women in their second-trimester (M = 31.80, (SD = 3.72) participating in the BABIP birth cohort from Istanbul, Turkey. CM, PRW, and GSA were assessed by Childhood Trauma Questionnaire, Cambridge Worry Scale, and State Anxiety Inventory-State Form, respectively. HPA-axis activity was measured from saliva as awakening cortisol, cortisol awakening response (CAR), and diurnal slope of cortisol (DS) across two days. Results showed that PRW did not mediate, but moderated the relationship between CM and HPA-axis. CM was associated with lower awakening cortisol, heightened CAR, and blunted DS in women with high PRW compared to women with low PRW. Unlike PRW, GSA did not moderate this relationship. These findings suggest PRW may have a more prominent role than GSA in exacerbating the impact of CM on prenatal HPA-axis. Future studies may focus on developing prevention and intervention programs towards PRW, particularly in at-risk groups like women with CM history to support maternal and infant health.