Mental Health
Predictors of hair cortisol concentrations in a North American preconception cohort study Lauren Wise* Lauren Wise Wise Wise Wise Boston University School of Public Health
Background: Hair cortisol concentrations (HCC) may reflect chronic stress, a determinant of adverse reproductive outcomes. Little is known about predictors of HCC during the preconception period.
Methods: We performed a cross-sectional analysis of baseline data from Pregnancy Study Online (PRESTO), a preconception cohort study of pregnancy planners enrolled during 2024-2025. Within 2-3 weeks of enrollment, 216 participants (199 females and 17 males) collected their hair samples via a mail-based kit. Participants were instructed by video and pamphlet to collect 10-20 mg of hair closest to the scalp from the posterior vertex region. We used ELISA to measure cortisol in hair samples, with 3 cm of hair reflecting average cortisol levels in the 3 months before enrollment. We fit mixed models to estimate the percent difference (β) in mean log-transformed HCC and 95% confidence intervals (CI) for associations with selected predictors including self-reported preconception measures of stress (Perceived Stress Scale-10), depressive symptoms (Major Depression Inventory), sleep duration, age, education, race, ethnicity, parenting history, body mass index, height, cigarette smoking, and cannabis use.
Results: Median HCC was 5.81 pg/mg (interquartile range: 4.18-11.66). The strongest predictors of higher HCC were sleep duration (<6 vs. 7-8 hours: β=141.0, 95% CI: -28.6, 713.5), age (5-year increase: β=21.5, 95% CI: 1.5, 39.2), depressive symptoms (10-unit increase in MDI score: β=12.5, 95% CI: -14.9, 48.6), and race and ethnicity (non-Hispanic Black: β=769.9, 95% CI: 257, 2020.1; Hispanic: β=37.3, 95% CI: -8.6, 106.2; and Non-Hispanic other race: β=37.5, 95% CI: -25.7, 154.4, vs. non-Hispanic White). Female participants had slightly lower HCC than male participants (β=-29.1, 95% CI: -60.8, 28.2). No appreciable associations were observed with other variables.
Conclusion: Selected socio-demographic and psychosocial variables were associated with HCC during the preconception period.