Coordination of inflammatory and adrenocortical stress response during pregnancy and variation by mental health

Well-regulated coordination of a multi-system stress response is particularly consequential for intergenerational health during pregnancy, when maternal stress systems typically adapt to protect the fetus. However, little is known about patterns of combined immune/inflammatory mediator (IM) and hypothalamic-pituitary-adrenal (HPA) axis responding to acute stress in human pregnancy, let alone variations associated with maternal health risks. In this study we aimed to define normative perinatal stress response coordination and potential risk profiles by testing relations among pregnant women's salivary IM's and cortisol in response to psychosocial stress, as well as both concurrent affective distress symptomatology and lifetime diagnoses of affective disorders. A community sample of pregnant women (n = 158) participating in the first timepoint of a longitudinal study completed the Trier Social Stress Task and contributed five saliva samples assayed for cortisol; pro-inflammatory cytokines IL1β, IL6, TNFα; and CRP. They self-reported symptoms reflecting common (general distress) and distinct (anhedonic depression, anxious arousal) components of affective distress, and were interviewed about mental health history with a structured clinical interview. Multilevel modeling of IM and cortisol trajectories revealed IM and cortisol responses were positively coordinated on average, but varied across women. Greater affective distress predicted higher/increasing IM stress responses that diverged from cortisol recovery; history of mood disorder specifically related to increasing post-stress IM's, while current general distress related to non-coordination/divergence of IM from cortisol response. These findings highlight a novel stress response pathway characterizing both previous and current affective distress that may help efforts to ameliorate intergenerational impacts of perinatal stress.