Background: Despite decades of nutrition interventions, Guatemala still has one of the highest
rates of child stunting in the world, with the indigenous populations being disproportionately
affected. Impaired linear growth may be a consequence of maternal stresses associated not only
with malnutrition and infection but also with psychosocial factors, the effects of which may be
mediated by maternal cortisol. Objective: In 8 historically marginalized rural Mam-Mayan
communities in the Western Highlands of Guatemala, our objectives were to (1) characterize
women’s exposure to nutrition, infection and psychosocial stressors vs. resilience factors, (2)
describe the maternal diurnal salivary cortisol rhythm in pregnancy and postpartum (PP) and
explore its association with psychosocial variables, (3) assess the cumulative impact of
maternal-level factors (nutritional, infectious, psychosocial), social factors (autonomy, social
support, domestic violence), and household factors (socioeconomic status, food security) on
early infant growth, and (4) evaluate whether maternal cortisol may be a mediator in the vertical
transmission of stress.