Graduation Date

Fall 12-15-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Julia Houfek

Second Advisor

Jeffrey French

Third Advisor

Michael Rice

Abstract

The link between life course adversity and adverse health outcomes is well established, particularly early life adversity (ELA). There is also evidence that the physiologic adaptations associated with stress, depression and ELA can be transmitted intergenerationally via long-term set-point changes within the maternal hypothalamic-pituitary-adrenal axis (HPA). It is unknown how the type and timing of maternal stress and adversity influences HPA regulation during pregnancy and whether maternal coping attenuates this relationship. Manuscript 1 was an integrative review of studies examining the association between maternal ELA and HPA regulation during pregnancy. In manuscripts 2 and 3 the findings of the dissertation study are presented. The purpose of this dissertation was to further examine how the type and timing of maternal adversity is linked to physiologic HPA adaptations in pregnancy and whether psychosocial processes moderate the relationship between life adversity and HPA regulation. From a qualitative perspective, this study examined how situational factors in women’s lives influence their goals, motivations, and notions of health in pregnancy. The sample (N = 72) included women in the 2nd trimester of a singleton, uncomplicated pregnancy. The data collected included surveys, interviews, and salivary cortisol samples. Quantitative data were analyzed using correlation and general linear modeling. Lifetime stress was significantly correlated with higher cortisol during pregnancy. Childhood adversity accounted for cortisol elevations in the morning, while adult stress and depression accounted for elevated cortisol levels in the evening. Women’s willingness to seek social support significantly attenuated HPA reactivity. Neither stress nor cortisol were associated with birth outcomes. The qualitative study found that contextual and sociodemographic factors have a profound influence on the way that women prioritize life goals and health during pregnancy. Overall, women’s experience of adversity throughout the life course results in specific psychosocial and biobehavioral adaptive responses that shape the gestational environment and pregnancy experience.

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