A longitudinal study examining the associations between prenatal and postnatal maternal distress and toddler socioemotional developmental during the COVID-19 pandemic.

Elevated psychological distress, experienced by pregnant women and parents, has been well-documented during the COVID-19 pandemic. Most research focuses on the first 6-months postpartum, with single or limited repeated measures of perinatal distress. The present longitudinal study examined how perinatal distress, experienced over nearly 2 years of the COVID-19 pandemic, impacted toddler socioemotional development. A sample of 304 participants participated during pregnancy, 6-weeks, 6-months, and 15-months postpartum. Mothers reported their depressive, anxiety, and stress symptoms, at each timepoint. Mother-reported toddler socioemotional functioning (using the Brief Infant-Toddler Social and Emotional Assessment) was measured at 15-months. Results of structural equation mediation models indicated that (1) higher prenatal distress was associated with elevated postpartum distress, from 6-weeks to 15-months postpartum; (2) associations between prenatal distress and toddler socioemotional problems became nonsignificant after accounting for postpartum distress; and (3) higher prenatal distress was indirectly associated with greater socioemotional problems, and specifically elevated externalizing problems, through higher maternal distress at 6 weeks and 15 months postpartum. Findings suggest that the continued experience of distress during the postpartum period plays an important role in child socioemotional development during the COVID-19 pandemic.

Linking maternal disrupted interaction and infant limbic volumes: The role of infant cortisol output.

Despite a large animal literature documenting the role of low maternal nurturance and elevated glucocorticoid production on offspring limbic development, these pathways have not yet been assessed during human infancy. Informed by animal models, the present study examined whether 1) maternal disrupted interaction is related to infant cortisol levels, 2) infant cortisol levels are associated with infant limbic volumes, and 3) infant cortisol levels mediate associations between maternal disrupted interaction and infant limbic volumes. Participants included 57 mother-infant dyads. Infant saliva was measured at one time point before and two time points after the Still-Face Paradigm (SFP) at age 4 months. Five aspects of maternal disrupted interaction were coded during the SFP reunion episode. Between 4 and 25 months (M age = 11.74 months, SD = 6.12), under natural sleep, infants completed an MRI. Amygdala and hippocampal volumes were calculated via automated segmentation. Results indicated that 1) maternal disrupted interaction, and specifically disoriented interaction, with the infant was associated with higher infant salivary cortisol (AUCg) levels during the SFP, 2) higher infant AUCg was related to enlarged bilateral amygdala and hippocampal volumes, and 3) infant AUCg mediated the relation between maternal disrupted interaction and infant amygdala and hippocampal volumes. Findings are consistent with controlled animal studies and provide evidence of a link between increased cortisol levels and enlarged limbic volumes in human infants. Results further suggest that established interventions to decrease maternal disrupted interaction could impact both infant cortisol levels and infant limbic volumes.

Protocol for the COVID-19 Wellbeing and Stress Study: a longitudinal study of parent distress, biological stress and child biopsychosocial development during the pandemic and beyond.

INTRODUCTION: The COVID-19 pandemic has had a unique impact on the mental health and well-being of pregnant individuals and parents of young children. However, the impact of COVID-19-related stress during pregnancy on early child biopsychosocial development, remains unclear. The COVID-19 Wellbeing and Stress Study will: (1) investigate the impact of different forms of prenatal stress experienced during the pandemic (including objective hardship, perceived psychological distress and biological stress) on child stress biology, (2) examine the association between child stress biology and child developmental outcomes, (3) determine whether child stress biology acts as a mechanism linking prenatal stress to adverse child developmental outcomes and (4) assess whether gestational age at the onset of the COVID-19 pandemic or child sex, moderate these associations. METHODS AND ANALYSES: The COVID-19 Wellbeing and Stress Study is a prospective longitudinal study, consisting of six time points, spanning from pregnancy to 3 years postpartum. The study began in June 2020, consisting of 304 pregnant people from Ontario, Canada. This multimethod study is composed of questionnaires, biological samples, behavioural observations and developmental assessments ETHICS AND DISSEMINATION: This study was approved by the Hamilton Integrated Research Ethics Board (#11034) and the Mount Saint Vincent University Research Ethics Board (#2020-187, #2021-075, #2022-008). Findings will be disseminated through peer-reviewed presentations and publications, community presentations, and electronic forums (social media, newsletters and website postings).

Negative versus withdrawn maternal behavior: Differential associations with infant gray and white matter during the first 2 years of life.

Distinct neural effects of threat versus deprivation emerge by childhood, but little data are available in infancy. Withdrawn versus negative parenting may represent dimensionalized indices of early deprivation versus early threat, but no studies have assessed neural correlates of withdrawn versus negative parenting in infancy. The objective of this study was to separately assess the links of maternal withdrawal and maternal negative/inappropriate interaction with infant gray matter volume (GMV), white matter volume (WMV), amygdala, and hippocampal volume. Participants included 57 mother-infant dyads. Withdrawn and negative/inappropriate aspects of maternal behavior were coded from the Still-Face Paradigm at four months infant age. Between 4 and 24 months (M age = 12.28 months, SD = 5.99), during natural sleep, infants completed an MRI using a 3.0 T Siemens scanner. GMV, WMV, amygdala, and hippocampal volumes were extracted via automated segmentation. Diffusion weighted imaging volumetric data were also generated for major white matter tracts. Maternal withdrawal was associated with lower infant GMV. Negative/inappropriate interaction was associated with lower overall WMV. Age did not moderate these effects. Maternal withdrawal was further associated with reduced right hippocampal volume at older ages. Exploratory analyses of white matter tracts found that negative/inappropriate maternal behavior was specifically associated with reduced volume in the ventral language network. Results suggest that quality of day-to-day parenting is related to infant brain volumes during the first two years of life, with distinct aspects of interaction associated with distinct neural effects.

Maternal Childhood Abuse Versus Neglect Associated with Differential Patterns of Infant Brain Development.

Severity of maternal childhood maltreatment has been associated with lower infant grey matter volume and amygdala volume during the first two years of life. A developing literature argues that effects of threat (abuse) and of deprivation (neglect) should be assessed separately because these distinct aspects of adversity may have different impacts on developmental outcomes. However, distinct effects of threat versus deprivation have not been assessed in relation to intergenerational effects of child maltreatment. The objective of this study was to separately assess the links of maternal childhood abuse and neglect with infant grey matter volume (GMV), white matter volume (WMV), amygdala and hippocampal volume. Participants included 57 mother-infant dyads. Mothers were assessed for childhood abuse and neglect using the Adverse Childhood Experiences (ACE) questionnaire in a sample enriched for childhood maltreatment. Between 4 and 24 months (M age = 12.28 months, SD = 5.99), under natural sleep, infants completed an MRI using a 3.0 T Siemens scanner. GMV, WMV, amygdala and hippocampal volumes were extracted via automated segmentation. Maternal history of neglect, but not abuse, was associated with lower infant GMV. Maternal history of abuse, but not neglect, interacted with age such that abuse was associated with smaller infant amygdala volume at older ages. Results are consistent with a threat versus deprivation framework, in which threat impacts limbic regions central to the stress response, whereas deprivation impacts areas more central to cognitive function. Further studies are needed to identify mechanisms contributing to these differential intergenerational associations of threat versus deprivation.

Trajectories of distress from pregnancy to 15-months post-partum during the COVID-19 pandemic.

Background: The COVID-19 pandemic has particularly burdened pregnant and postpartum women. It remains unclear how distress levels of pregnant and postpartum people have changed (or persisted) as the pandemic continues on and which factors may contribute to these trajectories of distress. Methods: This longitudinal study included 304 pregnant people, who were followed during pregnancy, 6-weeks, 6-months and 15-months postpartum. At each time point, a latent "distress" factor was estimated using self-reported depressive symptoms, anxiety symptoms, and stress. Reported negative impact of COVID-19 and social support were assessed during pregnancy as risk and protective factors related to distress. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time. Results: Mean distress was relatively stable from the pregnancy to 6-weeks postpartum and then declined from 6-weeks to 15-months postpartum. Higher education, greater social support, and lower negative impact of COVID-19 were associated with a lower distress during pregnancy. Unexpectedly, negative impact of COVID-19 was associated with a faster decrease in distress and more social support was associated with a greater increase in distress from pregnancy to 6-weeks postpartum. However, these effects became non-significant after controlling for distress during pregnancy. Conclusion: Findings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and the negative impact of the pandemic in pregnancy. Findings highlight the continued impact of COVID-19 on perinatal mental health and the need for support to limit the burden of this pandemic on pregnant people and families.

Threat versus deprivation in mother's childhood: Differential relations to hair cortisol and psychopathology in pregnancy.

BACKGROUND: The negative effects of childhood maltreatment can be intergenerational, and the prenatal period may play an important role in this intergenerational transmission. Maternal hypothalamic-pituitary-adrenal (HPA) axis dysfunction and maternal psychopathology represent two mechanisms through which the effects of childhood maltreatment are hypothesized to be transmitted across generations. OBJECTIVE: This study first sought to extend prior research on pathways of intergenerational transmission by examining whether mothers' childhood experiences of abuse versus neglect differentially relate to maternal HPA activity and to maternal psychopathology during the prenatal period. Second, exploratory analyses examined the links between maternal variables and their State Protective Service involvement as a parent, as an indicator of maladaptive caregiving. METHODS: During the third trimester of pregnancy, 51 women reported on experiences of childhood maltreatment, on State Protective Service involvement as an adult parent, and on current depressive and post-traumatic stress symptoms, and provided a hair sample for cortisol assay. RESULTS: Regression analyses indicated that greater severity of abuse, but not neglect, in childhood was associated with higher maternal depressive symptoms (ß = 0.488, p = .020). In contrast, greater severity of neglect, but not abuse, in mothers' childhood was associated with lower maternal hair cortisol concentration (ß = -0.437, p = .031). Lower maternal hair cortisol concentration, but not maternal psychopathology or severity of childhood abuse or neglect, in turn, was associated with State Protective Service involvement (ß = -0.785, p < .001). CONCLUSIONS: Findings extend prior work by suggesting that childhood abuse and neglect may have different sequelae for mothers during pregnancy and that these sequelae may have different relations to parenting.

Latent profiles of maternal disrupted communication: Relations to affect and behaviour in early infancy.

Few studies have examined how mothering is organized in the first months of infancy, especially regarding risk-related interactions. Person-centred approaches, including latent profile analysis (LPA), add valuable insights about early parenting by identifying distinct profiles of interaction. First, this study aimed to identify profiles of disrupted maternal interaction during the Still-Face Paradigm among 181 mothers and their 3- to 8-month-old infants. Second, the study assessed how each maternal profile was related to infant affect and interactive behaviour. The LPA identified four profiles of maternal interaction: optimal, negative/intrusive, withdrawing and pervasively disrupted. The pervasively disrupted profile, in particular, has not been identified in past research. Each profile was associated with specific aspects of infant affect and behaviour. Recognition of disrupted behavioural profiles among at-risk mothers and infants in the early months could facilitate more precise tailoring of early interventions to the needs of mothers and infants with differing profiles of interactive risk.

Associations between psychological distress and hair cortisol during pregnancy and the early postpartum: A meta-analysis.

Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [- 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.

Maternal History of Child Maltreatment and Household Chaos: Examining the Mediating Role of Maternal and Child Psychopathology.

Caregiver history of childhood maltreatment can have pervasive effects on familial and household dynamics. Maternal history of child maltreatment (MCM) is linked to maternal depressive symptoms and offspring behavioural problems. Further, maternal and child mental health are associated with chaotic home environments. In this study, we examined the potential mediating roles of maternal depressive symptoms and child behavioural problems in the association between MCM and household chaos. A sample of 133 mother-child dyads participated in home visits during which mothers completed questionnaires measuring their history of child maltreatment, depressive symptoms, household chaos and child behaviour problems. Mothers also conducted videotaped home tours related to household chaos. Structural equation modelling results indicated that MCM was indirectly associated with higher household chaos via elevated maternal depressive symptoms and child externalizing, but not internalizing behaviour problems. Interventions aimed at mitigating the effects of MCM on maternal and child psychopathology may positively influence household dynamics.

Maternal Childhood Maltreatment Is Associated With Lower Infant Gray Matter Volume and Amygdala Volume During the First Two Years of Life.

Background: Childhood maltreatment affects approximately 25% of the world's population. Importantly, the children of mothers who have been maltreated are at increased risk of behavioral problems. Thus, one important priority is to identify child neurobiological processes associated with maternal childhood maltreatment (MCM) that might contribute to such intergenerational transmission. This study assessed the impact of MCM on infant gray and white matter volumes and infant amygdala and hippocampal volumes during the first 2 years of life. Methods: Fifty-seven mothers with 4-month-old infants were assessed for MCM, using both the brief Adverse Childhood Experiences screening questionnaire and the more detailed Maltreatment and Abuse Chronology of Exposure scale. A total of 58% had experienced childhood maltreatment. Between 4 and 24 months (age in months: mean = 12.28, SD = 5.99), under natural sleep, infants completed a magnetic resonance imaging scan using a 3T Siemens scanner. Total brain volume, gray matter volume, white matter volume, and amygdala and hippocampal volumes were extracted via automated segmentation. Results: MCM on the Adverse Childhood Experiences and Maltreatment and Abuse Chronology of Exposure scales were associated with lower infant total brain volume and gray matter volume, with no moderation by infant age. However, infant age moderated the association between MCM and right amygdala volume, such that MCM was associated with lower volume at older ages. Conclusions: MCM is associated with alterations in infant brain volumes, calling for further identification of the prenatal and postnatal mechanisms contributing to such intergenerational transmission. Furthermore, the brief Adverse Childhood Experiences questionnaire predicted these alterations, suggesting the potential utility of early screening for infant risk.

Prenatal distress, access to services, and birth outcomes during the COVID-19 pandemic: Findings from a longitudinal study.

BACKGROUND/AIMS: During the COVID-19 pandemic, pregnant people have experienced disruptions to prenatal care, as well elevated rates of mental health problems and distress. The current longitudinal study aims to understand how different forms of prenatal distress (mental health problems, COVID-19 stressful experiences, and access to prenatal services) impact infant birth outcomes during the pandemic. METHODS: Participants were 265 pregnant individuals from Ontario, Canada. Maternal depression, pregnancy-related anxiety, COVID-related stressors (i.e., financial difficulties, social isolation), and disruptions to prenatal and health services were assessed during pregnancy. Delivery experiences and birth outcomes were assessed in the early postpartum period. Associations between pregnancy stressors and birth outcomes were assessed using path analyses. RESULTS: Participants reported experiencing substantial changes to their prenatal care due to COVID-19; 23.0 % had prenatal appointments cancelled, 47.9 % had difficulty accessing prenatal classes, and 60.8 % reported changes to their birth plans. Results of path analyses showed a unique effect of pregnancy-related anxiety during the pandemic on lower birth weight, younger gestational age at birth, and more infant birth problems. Further, multi-group path analysis revealed these effects were more pronounced in male infants. CONCLUSIONS: Findings demonstrate that pregnant individuals in Ontario, Canada have experienced considerable disruptions to services during pregnancy. In addition, pregnancy-related anxiety was uniquely linked to elevated risk for adverse birth outcomes, which more heavily impacted male infants. These findings underscore the need for additional mental health support and access to services for pregnant people and their infants, to reduce long-term adverse maternal and fetal health outcomes.

Examining the unique contributions of parental and youth maltreatment in association with youth mental health problems.

BACKGROUND: Extensive research seeks to understand the intergenerational impact of child maltreatment. However, it remains unclear how parent's history of child maltreatment (PCM) is associated with child mental health, after accounting for children's experiences of maltreatment and other proximal risk factors. OBJECTIVE: This study examines the associations between PCM and youth internalizing and externalizing problems, while accounting for youth experiences of maltreatment (YM), and parent mental health and positive parenting. PARTICIPANTS AND SETTING: Youth aged 14 to 17 years (N = 2266) participated in the 2014 Ontario Child Heath Study. METHODS: Parents and youth reported their experiences of child maltreatment. Parent-report and self-reports of youth internalizing and externalizing problems were also collected. Number of subtypes of maltreatment and specific subtypes of maltreatment were examined. Parents reported their own mental health problems and positive parenting practices. RESULTS: Regarding number of maltreatment subtypes, initially PCM was associated with parent-reported, but not self-reported, youth internalizing and externalizing problems. After accounting for YM, parent mental health problems and positive parenting, only YM remained significant. Regarding specific subtypes of maltreatment, both parent and youth emotional abuse were related to parent- and youth-reported internalizing and externalizing problems, after controlling for other maltreatment subtypes. However, the effects of parent emotional abuse became nonsignificant after accounting for YM and proximal risk factors. CONCLUSIONS: Findings indicate: 1) the unique associations between specific PCM and YM subtypes and youth mental health problems; 2) the role of proximal risk factors in explaining the association between PCM and youth mental health; and 3) the importance of multiple informants of youth mental health problems.

Patterns of Maternal Childhood Maltreatment and Disrupted Interaction Between Mothers and Their 4-Month-Old Infants.

Maternal childhood maltreatment (MCM) is associated with parenting disruptions which may contribute to the intergenerational transmission of negative health and social outcomes. Most prior work has used variable-centered approaches to assess MCM. Complementary person-centered approaches can identify groups of participants characterized by similar patterns of maltreatment. The current study assessed both types and patterns of MCM in relation to disrupted parenting among 179 mothers and their 4-month-olds. In variable-centered analyses, physical abuse was related to negative-intrusive maternal behavior and physical neglect to role-confused behavior. Person-centered analyses derived three classes of MCM, which differed in disrupted parenting. For example, mothers who experienced multiple types of maltreatment displayed more withdrawal than mothers in both other classes. Results document the differential effects of particular types and patterns of MCM on aspects of parenting and reveal that mother's history of maltreatment can affect the quality of mother-child interaction as early as 4 months of age.

Parental Mental Health and Hostility Are Associated With Longitudinal Increases in Child Internalizing and Externalizing Problems During COVID-19.

Children are at high risk for negative COVID-19 related outcomes. The present longitudinal study assessed (1) changes in child internalizing and externalizing problems from before to during the pandemic and (2) whether parent mental health (depression, anxiety, stress) or parenting behavior during COVID-19 were associated with changes in child mental health problems. Sixty eight mother-child dyads participated in this study. Children were approximately five years-old at the time of enrollment and were between the ages of 7-9 years old at the time of the follow-up survey. Parenting behavior, parental depression, anxiety, perceived stress and child internalizing and externalizing problems were measured using validated questionnaires. Children experienced greater internalizing (t = 6.46, p < 0.001) and externalizing (t = 6.13, p < 0.001) problems during the pandemic compared to before the pandemic. After taking into account child gender and COVID-related stressors, parental hostility was uniquely associated with greater changes in externalizing problems (ß = 0.355, SE = 0.178, p < 0.05), while maternal anxiety was associated with greater increases in internalizing problems (ß = 0.513, SE = 0.208, p < 0.05). Findings highlight the need for mental health supports for families to limit the impact of the COVID-19 pandemic on child and parent mental health.

Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy.

The COVID-19 pandemic has resulted in elevated mental health problems for pregnant women. Effective coping strategies likely reduce the impact of COVID-19 on mental health. This study aimed to (1) understand how COVID-19 stressors are related to different coping strategies and (2) identify whether coping strategies act as mechanisms accounting for the associations between COVID-19 stressful experiences and mental health problems in pregnancy. Participants were 304 pregnant women from Ontario, Canada. Depression, anxiety, insomnia, and perceived stress were assessed using validated measures. COVID-related stressors (i.e., financial difficulties, social isolation), subjective negative impact of COVID-19, and coping strategies used in response to COVID-19 were assessed by questionnaires. Results indicated that the subjective negative impact of COVID-19 was associated with more dysfunctional coping and less emotion-focused coping, whereas specific COVID-19 stressors, namely financial difficulties and social isolation, were associated with more dysfunctional coping and problem-focused coping. Dysfunctional coping was linked to elevated mental health problems and emotion-focused coping was linked to less mental health problems. Dysfunctional coping and emotion-focused coping partially mediated the effects of specific COVID-19 stressors on mental health outcomes. Findings indicate that coping is one pathway through which the COVID-19 pandemic impacts mental health in pregnancy. Supports and interventions for pregnant women during the pandemic should focus on bolstering coping skills, in order to minimize the mental health consequences of COVID-19.

Maternal experiences of childhood maltreatment moderate patterns of mother-infant cortisol regulation under stress.

The relation between maternal and infant cortisol responses has been a subject of intense research over the past decade. Relatedly, it has been hypothesized that maternal history of childhood maltreatment (MCM) impacts stress regulation across generations. The current study employed four statistical approaches to determine how MCM influences the cortisol responses of 150 mothers and their 4-month-old infants during the Still-Face Paradigm. Results indicated that MCM moderated cortisol patterns in several ways. First, lower MCM mothers and infants had strong positive associations between cortisol levels measured at the same time point, whereas higher MCM mothers and infants did not show an association. Second, infants of higher MCM mothers had cortisol levels that were moderately high and remained elevated over the procedure, whereas infants of lower MCM mothers had decreasing cortisol levels over time. Third, higher MCM mothers and infants showed increasingly divergent cortisol levels over time, compared to lower MCM dyads. Finally, patterns of cross-lagged influence of infant cortisol on subsequent maternal cortisol were moderated by MCM, such that lower MCM mothers were influenced by their infants' cortisol levels at earlier time points than higher MCM mothers. These findings highlight MCM as one contributor to processes of stress regulation in the mother-infant dyad.

COVID-19 and mental health during pregnancy: The importance of cognitive appraisal and social support.

BACKGROUND: Pregnancy is a period of elevated risk for mental health difficulties, which are likely exacerbated by the COVID-19 pandemic. This study aims to understand the impact of COVID-19 on mental health and identify risk and protective factors during pregnancy. METHODS: Participants were 303 pregnant individuals from Ontario, Canada. Depression, anxiety and insomnia were measured using validated questionnaires. COVID-related experiences (i.e., financial difficulties, relationship conflict, social isolation) were assessed in relation to mental health. Social support and cognitive appraisal of the pandemic were examined as protective factors. RESULTS: 57% of the sample reported clinically elevated depression, >30% reported elevated worries, and 19% reported elevated insomnia. Depression (t = 25.14, p < .0001) and anxiety (t = 17.21, p < .0001) levels were higher than non-COVID pregnant samples. Social isolation, financial trouble, relationship difficulties and threat of COVID-19 were associated with mental health. Social support (rrange -.24 to -.38, p <.01) was associated with lower mental health problems and negative cognitive appraisal (rrange .20 to .33, p <.01) was linked to more mental health problems. Furthermore, social support and cognitive appraisal interacted (ß = -.92, SE = .41, p < .05), such that higher social support acted as a protective factor, particularly for those who appraise the impact of COVID-19 to be more negative. CONCLUSIONS: Findings underscore the need to address the high rates of mental health during pregnancy and outline potential targets (cognitive appraisal and social support) to protect pregnant people from experiencing mental health problems during the COVID-19 pandemic.

Integrated and diurnal indices of maternal pregnancy cortisol in relation to sex-specific parasympathetic responsivity to stress in infants.

Maternal hypothalamic-pituitary-adrenal axis activity may prenatally program sex-specific stress-response pathways. We investigated associations between maternal cortisol during pregnancy and infant parasympathetic responsivity to stress among 204 mother-infant pairs. Cortisol indices included 3rd trimester hair cortisol, as well as diurnal slope and area under the curve, derived from saliva samples collected during pregnancy. Mother-infant dyads participated in the Repeated Still-Face Paradigm (SFP-R) at age 6 months. We calculated respiration-adjusted respiratory sinus arrhythmia (RSAc ), an indicator of parasympathetic activation, from infant respiration and cardiac activity measured during the SFP-R. We used multivariable linear mixed models to examine each cortisol index in relation to infant RSAc and investigated sex differences using cross-product terms. Diurnal cortisol indices were not associated with RSAc . There was no association between hair cortisol and baseline RSAc . However, hair cortisol was associated with sex-specific changes in RSAc over the SFP-R such that, among girls, parasympathetic withdrawal was reduced with increasing prenatal exposure to cortisol. Consistently higher levels of prenatal cortisol exposure may lead to dampened parasympathetic responsivity to stress during infancy, particularly among girls. Maternal hair cortisol may be particularly valuable for studying the effects of prenatal cortisol exposure on infant autonomic reactivity.