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Epidemiology and Population Health

Third trimester cortisol is positively associated with gestational weight gain in pregnant women with class one obesity



Prevalence of pre-pregnancy obesity and excessive gestational weight gain (GWG) are higher among women of color with low SES. Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and its end-product, cortisol, during pregnancy is hypothesized to be associated with excessive GWG. However, past studies have produced inconsistent findings and often did not include health disparities populations. This study examined the association between pre-pregnancy body mass index (BMI), third trimester diurnal cortisol, and GWG in low-income, predominantly Hispanic women.


The MADRES study is an ongoing prospective cohort study of primarily Hispanic, low-income pregnant women and their children in Los Angeles, California. Data from 176 participants were included in this study. Total cortisol secretion (area under the curve, AUC) was quantified using four salivary cortisol samples (awakening, 30 min after awakening, afternoon, and bedtime) that were collected at home on one day during the third trimester of pregnancy. Moderation of the association between total cortisol and GWG by pre-pregnancy BMI was tested using multiple linear regression with a multiplicative interaction term.


There was no association between total cortisol secretion and GWG overall (p = 0.82), but the association between total cortisol and GWG was stronger for women with class 1 pre-pregnancy obesity compared to women with normal pre-pregnancy BMI (interaction term p = 0.04).


Results suggest that obesity status before pregnancy may be exacerbating the physiological impact of cortisol on GWG.

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Fig. 1: Consort diagram of included observations.
Fig. 2: Total gestational weight gain (GWG) by pre-pregnancy BMI.
Fig. 3: Diurnal Cortisol Patterns by Pre-Pregnancy BMI.
Fig. 4: Association of third trimester area under the curve and gestational weight gain by pre-pregnancy BMI.

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We want to thank the MADRES study families, nurses, midwives, doctors, and staff at each of our study sites and our MADRES study team without whom this study would not have been possible.


This work was supported by the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) Center (grant #s P50MD015705, P50ES026086, 83615801–0) funded by the National Institute of Environmental Health Sciences, the National Institute for Minority Health and Health Disparities and the Environmental Protection Agency; the Southern California Environmental Health Sciences Center (grant # P30ES007048) funded by the National Institute of Environmental Health Sciences; and the Lifecourse Approach to Developmental Repercussions of Environmental Agents on Metabolic and Respiratory health (LA DREAMERs) (grant #s UH3OD023287) funded by the National Institutes of Health Office of the Director ECHO Program. The first author was funded by the National Heart, Lung, and Blood Institute’s Predoctoral Training Fellowship [grant # F31HL154716]. The funding agencies had no role in the design of the study, the collection, analysis, or interpretation of data or in the writing of the paper.

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Conceptualization: CVB, TMB, CHN, GFD; Data curation: CHN, AKP, TC; Formal analysis: CHN; Funding acquisition; CVB, TMB, GFD; Investigation: CVB, TMB, GFD; Methodology: BHG, CVB, DL, SPE, NL, TMB, CMT-C, GFD; Project administration: CVB, TMB; Resources: CVB, TMB, GFD; Software: CHN, TC, AKP; Supervision: CVB, TMB, GFD; Validation: CHN, AKP; Visualization: CHN; Writing—original draft: CHN; Writing—review & editing: CVB, TMB, GFD, AKP, TC, CMT-C, SPE, BHG, DL, NL. All authors provided critical feedback and helped shape the research, analysis and paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Theresa M. Bastain.

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Naya, C.H., Toledo-Corral, C.M., Chavez, T. et al. Third trimester cortisol is positively associated with gestational weight gain in pregnant women with class one obesity. Int J Obes 46, 366–373 (2022).

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