Associations of Maternal Cortisol, Inflammation, Hemoglobin, Iron Status, and BMI with Birth Outcomes in Pregnant Women in Ghana

Abstract

Cortisol, inflammation, hemoglobin, iron status and BMI have been linked with birth outcomes, but no study has examined all factors simultaneously. In a cohort of 1,320 Ghanaian women enrolled at 蠄 20 wk gestation in a randomized controlled nutrient supplementation trial (iLiNS‐DYAD), we measured morning salivary cortisol, hemoglobin, zinc protoporphyrin, plasma soluble transferrin receptor, CRP and AGP at 蠄 20 wk and 36 wk gestation. Birth data were available for 1,159 women. Controlling for intervention group and other factors, higher CRP, AGP, and cortisol were associated with a shorter duration of gestation, and women with high cortisol (> 80th percentile) at 蠄 20 wk gestation had a higher risk of preterm birth (RR: 2.0, 95% CI: 1.1, 3.3, p = 0.01), but this association was only evident in women with male fetuses. Higher CRP, AGP, and cortisol were also associated with lower infant weight (WAZ), length (LAZ) and head circumference (HCZ) z‐scores. Adjusted for duration of gestation, associations for cortisol and CRP were no longer significant, but remained for AGP. Higher BMI was associated with higher WAZ, LAZ, and HCZ, and higher hemoglobin at 蠄 20 wk (but not 36 wk) was associated with a longer duration of gestation. Iron status in early pregnancy was not associated with any birth outcome, yet poorer iron status in late pregnancy was associated with higher WAZ and LAZ.