Salivary cortisol reactivity to stress in pregnancy: A scoping review

Cortisol reactivity to acute experimental stressors indexes hypothalamic-pituitary-adrenal (HPA) axis responsivity under challenge, a dimension of stress physiology that is particularly consequential during pregnancy, when neuroendocrine adaptations alter how the stress system functions. No scoping review has characterized this literature. The present study mapped evidence on salivary cortisol reactivity to acute experimental stressors during pregnancy, with attention to experimental paradigms, mental health, psychological stress, gestational timing, and demographic characteristics.

A systematic search yielded 1234 records, of which 33 empirical studies representing 2418 pregnant participants met inclusion criteria. Data were extracted and charted using a standardized framework. Cortisol data were digitized from published figures where necessary for descriptive visualization.

Fewer than half of studies (39.4%) found significant cortisol responses to the administered stressor. Social stressors elicited significant responses more consistently than non-social stressors (47.4% vs. 33.3%). Associations between cortisol reactivity and depressive symptomatology were found in less than half of tests, with all significant associations in the positive direction. Substantial heterogeneity in sampling timing, pre-testing protocols, and operationalization of reactivity was observed across studies. There was limited ability to compare cortisol reactivity across racial and ethnic identity, socioeconomic variables, or gestational age.

This scoping review of salivary cortisol reactivity during pregnancy reveals a growing literature marked by substantial methodological heterogeneity that limits cross-study synthesis. Social-evaluative stressors are recommended to improve HPA axis activation in pregnancy. Future research should prioritize diverse populations, trimester-specific reporting, and standardized cortisol reporting (means, standard deviations, sampling times) at each time point relative to stressor onset.