Abstract
Background
Adolescents born preterm have altered hypothalamic-pituitary-adrenal axis function with a blunted cortisol stress response, however, the influences of intrauterine growth restriction and race are unclear.
Methods
We measured salivary cortisol before and 20 min after a maximal-exercise stress test and calculated the cortisol stress response. We used linear regression to compare cortisol stress responses between preterm and term groups, adjusting for birth weight z-score and maternal hypertension, and examined effect modification by race and sex.
Results
We evaluated 171 adolescents born preterm with very low birth weight and 50 born term. Adolescents born preterm had reduced cortisol stress response compared to term (0.03 vs. 0.08 μg/dL, p = 0.04). This difference was race dependent: non-Black adolescents born preterm had significantly reduced cortisol stress response compared to those born at term (adjusted β: −0.74; 95% CI −1.34, −0.15), while there was no difference in Black adolescents (0.53; −0.16, 1.22). Sex did not modify the relationship.
Conclusions
Adolescents born preterm exhibit a reduced salivary cortisol response to exercise stress, suggesting long-term alterations in the hypothalamic–pituitary–adrenal axis. This relationship was evident in non-Black but not in Black adolescents, suggesting that race may modify the influence of preterm birth on stress alterations of the hypothalamic–pituitary–adrenal axis.
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Acknowledgements
We thank the participants and their families; Patricia Brown, research nurse; and Alice Scott, study coordinator. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (PO1 HD047584; HD084227), the Clinical Research Unit of Wake Forest Baptist Medical Center (MCRR/NIH MO1-RR07122), and the Forsyth Medical Center and Wake Forest School of Medicine Department of Pediatrics research funds.
Author contributions
C.L.B. conceptualized and designed the study, analyzed and interpreted the data, drafted the article, and gave final approval of the version to be published. K.M., A.M.S., H.A.S., and E.T.J. conceptualized and designed the study, revised the article critically important intellectual content, and gave final approval of the version to be published. P.A.N. and L.K.W. conceptualized and designed the study, contributed to data acquisition, revised the article critically important intellectual content, and gave final approval of the version to be published.
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Brown, C.L., Myers, K., South, A.M. et al. Influence of race on the effect of premature birth on salivary cortisol response to stress in adolescents. Pediatr Res 87, 1100–1105 (2020). https://doi.org/10.1038/s41390-019-0682-3
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DOI: https://doi.org/10.1038/s41390-019-0682-3
