Pregnant Women With Dissociative Subtype of PTSD Have High Levels of Cortisol

Pregnant women with a dissociative subtype of posttraumatic stress disorder (PTSD-D) appear to have higher levels of the stress hormone cortisol than other pregnant women with a history of trauma, reported a study in the Journal of Obstetric, Gynecological, and Neonatal Nursing. An elevated cortisol level is a risk factor for preterm birth and other adverse health conditions in offspring, according to the study authors.

PTSD-D, which is characterized by altered perception of oneself and the world, is associated with a greater number of lifetime trauma exposures, including a history of childhood maltreatment.

“Exposure to early relational trauma that predisposes a person to dissociation and PTSD may affect that individual’s short- and long-term cortisol patterns,” wrote Julia S. Seng, Ph.D., of the University of Michigan and colleagues. The difference between cortisol levels in the women with PTSD-D and the other groups was most apparent in early pregnancy, which is a critical period for fetal development, noted the authors.

The study by Seng and colleagues involved 395 women expecting their first child who were divided into four groups: those without trauma, those with trauma but no PTSD, those with lifetime PTSD, and those with PTSD-D (presence of depersonalization and/or derealization consistent with the DSM-5 dissociative subtype definition).

The researchers analyzed saliva cortisol specimens collected from these women at three different times on a single day during the first half of their pregnancy. A subsample of 111 women, including women from each of the four cohorts, provided three salivary cortisol specimens per day, 12 times, from early pregnancy to six weeks postpartum. (This sample included 34 women without trauma, 38 with trauma but no PTSD, 31 with PTSD only, and eight with PTSD-D.)

In early pregnancy (gestational week 8), the cortisol levels of participants in the PTSD-D group were two times greater in the morning, eight times greater in the afternoon, and 10 times greater at bedtime than the cortisol levels of participants in the non-exposed control group. In late pregnancy (gestational week 32), participants in the PTSD-D group had cortisol levels that were less than two times greater in the morning and 1.5 times greater levels in the afternoon and at bedtime compared with participants in the non-exposed control group.

“We don’t know why this group had higher cortisol levels,” Seng told Psychiatric News. “Likely there are other stress-response systems that may be dysregulated by early childhood relational trauma that is often the index trauma for PTSD-D.”

These cortisol levels were so high that the researchers considered them “possibly toxic,” but Seng said it isn’t known at what level cortisol sets into motion adverse perinatal outcomes.

“Although some women with histories of childhood maltreatment are resilient or recovered by the time they become pregnant, these biological findings indicate that some are very adversely affected psychologically and very stressed during the childbearing year,” the authors wrote. “We can screen and apply a stepped approach to maternity care that includes case-finding and interventions for women with PTSD, posttraumatic depression, and PTSD-D.”

The study was funded by a National Institutes of Health grant. ■

An abstract of “Gestational and Postnatal Cortisol Profiles of Women With Posttraumatic Stress Disorder and the Dissociative Subtype” can be accessed here.