Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants

Psychoneuroendocrinology. 2011 Nov;36(10):1480-94. doi: 10.1016/j.psyneuen.2011.04.002. Epub 2011 Jun 8.


Recent findings suggest that elevated stress levels during the pre- and postpartum period are related to poor maternal and infant health outcomes; yet, few studies have prospectively examined the efficacy of stress management interventions on regulating stress levels among mothers and their infants. The current study examined whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol (a biological marker of stress) and self-reported stress levels among mothers and their infants at six and 18 months postpartum, relative to two control groups. Our sample was comprised of predominantly Spanish-speaking, low-income women (80%; mean age=25±5 years) who were screened for depression during their second trimester of pregnancy (M=16±5 weeks of gestation). Women at high risk for depression [i.e., having either a past history of major depression or current elevated symptoms of depression (≥16 on CES-D)] were randomized to either a CBSM group (n=24) or a usual care (UC) group (n=33), while a low risk comparison (LRC) group (n=29) was comprised of women not meeting either depression criteria. ANCOVA analyses demonstrated that: (1) infants of women in the CBSM and LRC groups had significantly lower cortisol levels than infants of women in the UC group at six months postpartum (p<.001); and (2) women in the CBSM group had lower cortisol levels than women in the UC group at 18 months postpartum (p<.01). These results suggest that prenatal CBSM interventions may be efficacious in regulating biological markers of stress among mothers and their infants, thereby decreasing their risk for developing health complications over time.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Depressive Disorder, Major / metabolism
  • Depressive Disorder, Major / therapy
  • Female
  • Humans
  • Hydrocortisone / analysis
  • Hydrocortisone / metabolism*
  • Infant
  • Mothers / psychology
  • Mothers / statistics & numerical data
  • Poverty* / psychology
  • Poverty* / statistics & numerical data
  • Pregnancy
  • Prenatal Care / methods
  • Prenatal Exposure Delayed Effects / metabolism
  • Prenatal Exposure Delayed Effects / prevention & control*
  • Prenatal Exposure Delayed Effects / psychology
  • Saliva / chemistry
  • Saliva / metabolism*
  • Stress, Psychological / complications
  • Stress, Psychological / therapy*
  • Young Adult


  • Hydrocortisone