The Mind, Body & Baby (MBB) Lab studies how stress during pregnancy relates to maternal physiology, fetal growth, and birth outcomes. We combine laboratory stress tasks with prospective designs that follow women through pregnancy, and in some cases their children for years after. Much of this work is done in close collaboration with Dr. Anna Strahm at Sanford Research.
Why stress and pregnancy
There is considerable evidence linking psychosocial stress (e.g., stressful life events, anxiety, emotional distress, daily hassles) to pregnancy outcomes, including lower birthweight and shorter length of gestation (see reviews by Dunkel Schetter, Gurung, Lobel, & Wadhwa, 2001; Stanton, Lobel, Sears, & DeLuca, 2002). Stress is thought to contribute to poor outcomes through wear and tear on physiological systems and dysregulation of the body’s stress responses (McEwen & Stellar, 1993). Still, it is not clear which systems are involved, what dysregulation looks like, or how these stress and physiology links contribute to disparities in pregnancy outcomes. For example, African American women give birth preterm and to low birthweight infants about twice as often as non-Hispanic White and Latina women, and researchers have been unable to fully account for this difference.
Current research
Midwest Birth Outcomes and Indigenous American Pregnancy (now enrolling). Led by the Strahm Lab at Sanford Research in partnership with our lab, this study examines perinatal health disparities among Indigenous American women in the Midwest, who experience infant mortality (8.8 per 1,000 live births) and preterm birth (12.8%) at rates well above the Healthy People 2030 targets of 5.0 per 1,000 and 9.6%. Standard risk factors do not fully explain these gaps, so the study looks at culturally relevant factors, including historical trauma, childhood and recent stress, and wellness behaviors, and at how the body responds to stress during pregnancy. Participants complete surveys and one laboratory visit in mid pregnancy, at Sanford Research in Sioux Falls or with our lab at NDSU in Fargo. The study is registered at ClinicalTrials.gov as NCT06008561 and runs through December 2027. Interested in taking part? Start here.
GLOW: Glucose Levels and Outcomes in Women, Mid Pregnancy (now enrolling). In this collaboration between the Strahm Lab at Sanford Research and our lab, we are studying how stress, body image, and eating behaviors during pregnancy relate to blood sugar levels, and whether these factors are associated with pregnancy health. Participants complete surveys and wear a continuous glucose monitor, giving us a window into the daily experiences of pregnant women. We are recruiting people who are 18 or older and between 14 and 27 weeks of a healthy single pregnancy; participants may receive up to $350. The study is registered at ClinicalTrials.gov as NCT07598149. To learn more or see if you are eligible, call (605) 312-6457 or email strahmlab@sanfordhealth.org.
Physiological responses in pregnancy. Pregnant participants complete a laboratory session in mid pregnancy while we measure blood pressure, heart rate variability, and cortisol. We are learning how patterns of physiological response, including blunted blood pressure responses, relate to the length of gestation and fetal growth.
Mood, metabolism, and fetal growth. We examine how depressive symptoms, perceived stress, and blood sugar regulation interact with physiology during pregnancy. For example, heart rate variability changes how strongly depressive symptoms relate to fetal growth (Byron et al., 2025). Newer work asks whether the season of conception shapes these links.
Culture, discrimination, and disparities. We study how social and cultural experiences, such as lifetime racism and being U.S.-born or foreign-born, relate to blood pressure during pregnancy and to birth weight (Hilmert et al., 2014; Strahm et al., 2025).
Disaster and long-term outcomes. The Red River Flood Pregnancy Study followed women who were pregnant during the 2009 flood. A nine-year follow-up linked prenatal traumatic stress to their children’s hair cortisol (Strahm et al., 2020).
Interested in joining the lab? Contact us.
Selected publications
Byron, G. S.,* Hilmert, C. J., & Strahm, A. M. (2025). Heart rate variability during pregnancy moderates the impact of depressive symptoms on fetal growth. Journal of Affective Disorders, 370, 381-384. doi:10.1016/j.jad.2024.11.008
Strahm, A. M., Hilmert, C. J., Campos, B., Dvorak, R., & Schenker, M. (2025). Maternal blood pressure and birth weight associations in U.S.-born and foreign-born Latinas. Cultural Diversity and Ethnic Minority Psychology, 31(3), 414-420. doi:10.1037/cdp0000649
Strahm, A. M.,* Bagne, A. G.,* Rued, H. A.,* Larson, K. J., Roemmich, J. N., & Hilmert, C. J. (2020). Prenatal traumatic stress and offspring hair cortisol concentration: A nine year follow up to the Red River flood pregnancy study. Psychoneuroendocrinology, 113, 104579. doi:10.1016/j.psyneuen.2019.104579
Hilmert, C. J., Kvasnicka-Gates, L. R.,* Teoh, A. N.,* Bresin, K.,* & Fiebiger, S. (2016). Major flood related strains and pregnancy outcomes. Health Psychology, 35(11), 1189-1196. doi:10.1037/hea0000386
Hilmert, C. J., Dominguez, T. P., Dunkel Schetter, C., Srinivas, S. K., Glynn, L. M., Hobel, C. J., & Sandman, C. A. (2014). Lifetime racism and blood pressure changes during pregnancy: Implications for fetal growth. Health Psychology, 33(1), 43-51. doi:10.1037/a0031160
Abdou, C. M., Dunkel Schetter, C., Campos, B., Hilmert, C. J., Dominguez, T. P., Hobel, C. J., Glynn, L. M., & Sandman, C. A. (2010). Communalism predicts maternal affect, stress, and physiology better than ethnicity and SES. Cultural Diversity and Ethnic Minority Psychology, 16(3), 395-403.
Hilmert, C. J., Dunkel Schetter, C., Dominguez, T. P., Abdou, C., Hobel, C. J., Glynn, L., & Sandman, C. (2008). Blood pressure and stress during pregnancy: Racial differences and associations with birthweight. Psychosomatic Medicine, 70, 57-64.
* Graduate student author
