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Preterm birth and infant diurnal cortisol regulation
  1. David Q Stoye1,
  2. James P Boardman1,2,
  3. Clive Osmond3,
  4. Gemma Sullivan1,
  5. Gillian Lamb1,
  6. Gill S Black1,
  7. Natalie ZM Homer4,
  8. Nina Nelson5,6,
  9. Elvar Theodorsson7,
  10. Rebecca M Reynolds1,4,
  11. Evalotte Mörelius8
  1. 1 MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
  2. 2 Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
  3. 3 MRC Lifecourse Epidemiology Unit, Southampton, Southampton, UK
  4. 4 Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
  5. 5 Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
  6. 6 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
  7. 7 Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linkopings universitet, Linkoping, Sweden
  8. 8 School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
  1. Correspondence to Professor Rebecca M Reynolds, Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Edinburgh, UK; R.Reynolds{at}ed.ac.uk

Abstract

Background Hypothalamic-pituitary-adrenal (HPA) axis adaptation is a potential mechanism linking early life exposures with later adverse health. This study tested the hypothesis that preterm birth is associated with adaptation of diurnal cortisol regulation across infancy.

Methods A secondary analysis was conducted of saliva cortisol measured morning, midday and evening, monthly, across infancy, as part of a birth cohort conducted in Linköping, Sweden. Diurnal cortisol regulation of infants born extremely preterm (n=24), very preterm (n=27) and at term (n=130) were compared across infancy through random coefficients regression models.

Results Compared with infants born at term, infants born extremely preterm (−17.2%, 95% CI: −30.7 to −1.2), but not very preterm (1.7%, 95% CI: −14.1 to 20.4), had a flattened diurnal slope across infancy.

Conclusions Extremely preterm birth is associated with a flattened diurnal slope in infancy. This pattern of cortisol regulation could contribute to adverse metabolic and neurodevelopmental phenotypes observed in this population.

  • endocrinology
  • infant development

https://doi.org/10.1136/archdischild-2021-323296

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    Footnotes

    • RMR and EM are joint senior authors.

    • Twitter @EvalotteM

    • Contributors DQS conceptualised and carried out the secondary analysis presented in the manuscript, drafted the manuscript and reviewed and revised the manuscript. JPB, GS, GL, GSB and NZMH contributed to the interpretation of data for the work and revised the article critically for important intellectual content. RMR conceptualised the secondary analysis presented in the manuscript, contributed to the interpretation of data for the work, drafted the manuscript and reviewed and revised the manuscript. NN, ET and EM conceptualised and designed the initial cohort, contributed to the interpretation of data for the work and revised the article critically for important intellectual content.

    • Funding We are grateful to the families who consented to participate in the cohort. This study was funded by Theirworld (www.theirworld.org) and was undertaken in the MRC Centre for Reproductive Health, which is funded by MRC Centre Grant (MRC G1002033). RMR acknowledges the support of the British Heart Foundation (RE/18/5/34216). EM acknowledge Perth Children’s Hospital Foundation for supporting the professorial position.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    Linked Articles

    • Original research
      Saliva cortisol diurnal variation and stress responses in term and preterm infants
      David Q Stoye James P Boardman Clive Osmond Gemma Sullivan Gillian Lamb Gill S Black Natalie Z M Homer Nina Nelson Elvar Theodorsson Evalotte Mörelius Rebecca M Reynolds
      Archives of Disease in Childhood - Fetal and Neonatal Edition 2022; 107 558-564 Published Online First: 07 Mar 2022. doi: 10.1136/archdischild-2021-321593