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Coronavirus Disease 2019 (COVID-19) and Pregnancy: Combating Isolation to Improve Outcomes. Obstet Gynecol 2020; 136:33-36. [PMID: 32384386 DOI: 10.1097/aog.0000000000003946] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the current global coronavirus disease 2019 (COVID-19) pandemic, new challenges arise as social distancing and isolation have become the standard for safety. Evidence supports the protective benefits of social connections and support during pregnancy and labor; there are increased maternal, fetal, and pregnancy risks when pregnant and laboring women lack support. As health care professionals take appropriate precautions to protect patients and themselves from infection, there must be a balance to ensure that we do not neglect the importance of social and emotional support during important milestones such as pregnancy and childbirth. Resources are available to help pregnant women, and technology represents an opportunity for innovation in providing care.
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102
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Surkan PJ, Hong X, Zhang B, Nawa N, Ji H, Tang WY, Ji Y, Kimmel MC, Wang G, Pearson C, Wang X. Can social support during pregnancy affect maternal DNA methylation? Findings from a cohort of African-Americans. Pediatr Res 2020; 88:131-138. [PMID: 31349361 PMCID: PMC6982603 DOI: 10.1038/s41390-019-0512-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND While stress and the absence of social support during pregnancy have been linked to poor health outcomes, the underlying biological mechanisms are unclear. METHODS We examined whether adverse experiences during pregnancy alter DNA methylation (DNAm) in maternal epigenomes. Analyses included 250 African-American mothers from the Boston Birth Cohort. Genome-wide DNAm profiling was performed in maternal blood collected after delivery, using the Infinium HumanMethylation450 Beadchip. Linear regression models, with adjustment of pertinent covariates, were applied. RESULTS While self-reported maternal psychosocial lifetime stress and stress during pregnancy was not associated with DNAm alterations, we found that absence of support from the baby's father was significantly associated with maternal DNAm changes in TOR3A, IQCB1, C7orf36, and MYH7B and that lack of support from family and friends was associated with maternal DNA hypermethylation on multiple genes, including PRDM16 and BANKL. CONCLUSIONS This study provides intriguing results suggesting biological embedding of social support during pregnancy on maternal DNAm, warranting additional investigation, and replication.
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Affiliation(s)
- Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Corresponding author: Pamela J. Surkan, Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E5523, Baltimore, MD, USA, 21205-2179. . Phone: 410-502-7396. Fax: 410-502-6733
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Boyang Zhang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nobutoshi Nawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hongkai Ji
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Wan-Yee Tang
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yuelong Ji
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary C. Kimmel
- Department of Psychiatry, University of North Carolina at Chapel Hill’s School of Medicine, Chapel Hill, North Carolina
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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103
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Eick SM, Goin DE, Izano MA, Cushing L, DeMicco E, Padula AM, Woodruff TJ, Morello-Frosch R. Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis. PLoS One 2020; 15:e0234579. [PMID: 32530956 PMCID: PMC7292353 DOI: 10.1371/journal.pone.0234579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022] Open
Abstract
Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Using path analysis, we examined associations between multiple self-reported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N = 510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI] = 1.60, 5.85) and 2.67 (95% CI = 1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β = 1.63, 95% CI = 0.29, 3.07; β = 1.48, 95% CI = 0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.
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Affiliation(s)
- Stephanie M. Eick
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail: (SME); (RM)
| | - Dana E. Goin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Monika A. Izano
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Lara Cushing
- Department of Health Education, San Francisco State University, San Francisco, California, United States of America
| | - Erin DeMicco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Tracey J. Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Rachel Morello-Frosch
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
- Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail: (SME); (RM)
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104
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Santos CL, Costa KMDM, Dourado JEC, Lima SBGD, Dotto LMG, Schirmer J. Maternal factors associated with prematurity in public maternity hospitals at the Brazilian Western Amazon. Midwifery 2020; 85:102670. [DOI: 10.1016/j.midw.2020.102670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 02/02/2020] [Accepted: 02/16/2020] [Indexed: 12/15/2022]
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105
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Ijabi J, Afrisham R, Moradi-Sardareh H, Roozehdar P, Seifi F, Ijabi R. The Correlation of SKA2 with Cortisol, IL-1β and Anxiety in Pregnant Women with the Risk of Preterm Delivery. Psychiatry Investig 2020; 17:387-394. [PMID: 32375462 PMCID: PMC7265031 DOI: 10.30773/pi.2019.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The association between preterm birth (PTB), Spindle and Kinetochore Associated Complex Subunit 2 gene (SKA2), cortisol and anxiety have been shown, but in this study, we aimed to clarify whether the expression of the SKA2 gene plays a role in interleukin1β (IL-1β) level since increasing level of IL-1β is linked with PTB. METHODS The case-control study was conducted on 49 and 51 women with preterm and term delivery, respectively. The score of anxiety was ranked according to the Spielberger state trait Anxiety Inventory. The concentration of cortisol and IL-1β was determined by the ELISA method. The expression of SKA2 gene was assessed by the quantitative real time real time polymerase chain reaction (qRT-PCR). The western blot analysis was also performed to confirm the expression of SKA2 at the levels of protein. RESULTS The results showed that the gene/protein expression of SKA2, the concentrations of cortisol and IL-1β were significantly higher in the preterm than the term group. In the preterm group, the expression of SKA2 was positively correlated to the other factors including cortisol, IL-1β, and the degree of anxiety. CONCLUSION Our findings suggest that the expression of SKA2 was correlated positively to the levels of cortisol, IL-1β and the rate of anxiety in women with PTB.
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Affiliation(s)
- Janat Ijabi
- Department of Hematology, School of Allied Health, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Afrisham
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hemen Moradi-Sardareh
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Roozehdar
- Department of Medical Veterinary, Azad University, Garmsar Branch, Garmsar, Iran
| | - Fatemeh Seifi
- Counseling and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghayeh Ijabi
- Counseling and Reproductive Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
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106
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Tanpradit K, Kaewkiattikun K. The Effect of Perceived Stress During Pregnancy on Preterm Birth. Int J Womens Health 2020; 12:287-293. [PMID: 32346315 PMCID: PMC7167275 DOI: 10.2147/ijwh.s239138] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Preterm birth is one of the most common problems in pregnancy globally, often leading to neonatal death. The rate of preterm birth is increasing every year. The etiology of preterm birth is multifactorial; preventable maternal psychosocial stress is one of the causes of preterm birth. There has not yet been a report of maternal psychosocial stress and preterm birth in Thailand. This study aimed to explore the relationship between maternal perceived stress and preterm birth. Objective To study the effects of maternal perceived stress on preterm birth. Patients and Methods An unmatched case–control study was conducted in postpartum women, between January 17, 2019, and September 30, 2019, at the Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital. A total of 200 participants were enrolled and divided into case and control groups in a 1:1 ratio. The case group consisted of postpartum women with preterm birth and the control group consisted of consecutive postpartum women with term birth. Perceived stress was measured by using the Thai Perceived Stress Scale-10 (T-PSS-10). Results Maternal perceived stress during pregnancy was significantly greater in preterm birth compared with term birth in both means score (19.43±4.48 vs 14.08±4.06, p<0.001) and moderate to high stress level (92 vs 51, p<0.001). Perceived stress score and stress level were significant predictive factors for preterm birth (AOR 1.31, 95% CI 1.20–1.44, P < 0.001 and AOR 8.66, 95% CI 3.64–20.63, P < 0.001, respectively). Conclusion Maternal perceived stress during pregnancy was statistically greater in preterm birth. Perceived stress score and stress level were significant predictive factors for preterm birth.
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Affiliation(s)
- Kittikhun Tanpradit
- Department of Obstetrics & Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kasemsis Kaewkiattikun
- Department of Obstetrics & Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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107
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Kim Y, Vohra-Gupta S, Margerison CE, Cubbin C. Neighborhood Racial/Ethnic Composition Trajectories and Black-White Differences in Preterm Birth among Women in Texas. J Urban Health 2020; 97:37-51. [PMID: 31898203 PMCID: PMC7010896 DOI: 10.1007/s11524-019-00411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The black-white disparity in preterm birth has been well documented in the USA. The racial/ethnic composition of a neighborhood, as a marker of segregation, has been considered as an underlying cause of the racial difference in preterm birth. However, past literature using cross-sectional measures of neighborhood racial/ethnic composition has shown mixed results. Neighborhoods with static racial/ethnic compositions over time may have different social, political, economic, and service environments compared to neighborhoods undergoing changing racial/ethnic compositions, which may affect maternal health. We extend the past work by examining the contribution of neighborhood racial/ethnic composition trajectories over 20 years to the black-white difference in preterm birth. We used natality files (N = 477,652) from birth certificates for all live singleton births to non-Hispanic black and non-Hispanic white women in Texas from 2009 to 2011 linked to the Neighborhood Change Database. We measured neighborhood racial/ethnic trajectories over 20 years. Hierarchical generalized linear models examined relationships between neighborhood racial/ethnic trajectories and preterm birth, overall and by mother's race. Findings showed that overall, living in neighborhoods with a steady high proportion non-Hispanic black was associated with higher odds of preterm birth, compared with neighborhoods with a steady low proportion non-Hispanic black. Furthermore, while black women's odds of preterm birth was relatively unaffected by neighborhood proportions of the Latinx or non-Hispanic white population, white women had the highest odds of preterm birth in neighborhoods characterized by a steady high proportion Latinx or a steady low proportion non-Hispanic white. Black-white differences were the highest in neighborhoods characterized by a steady high proportion white. Findings suggest that white women are most protected from preterm birth when living in neighborhoods with a steady high concentration of whites or in neighborhoods with a steady low concentration of Latinxs, whereas black women experience high rates of preterm birth regardless of proportion white or Latinx.
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Affiliation(s)
- Yeonwoo Kim
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Shetal Vohra-Gupta
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA. .,Population Research Center, The University of Texas at Austin, Austin, TX, USA.
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108
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Fassaie S, McAloon J. Maternal distress, HPA activity, and antenatal interventions: A systematic review. Psychoneuroendocrinology 2020; 112:104477. [PMID: 31753328 DOI: 10.1016/j.psyneuen.2019.104477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/05/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elevated antenatal distress has been associated with negative outcomes for both mothers and, as a result, their infants. One mechanism hypothesised to underlie these associations is the maternal hypothalamic pituitary adrenal (HPA) axis. Though research has examined whether biopsychosocial antenatal interventions can reduce maternal HPA activity, only one review has summarized the nature of findings to date. The present study examined randomised control trials (RCTs) specifically; our primary aim was to assess the effectiveness of antenatal interventions in reducing HPA activity in pregnant women, our secondary aim was to examine whether antenatal interventions reduced maternal self-report of depression and/or anxiety. METHODS This study systematically reviewed RCTs that evaluated biopsychosocial interventions that reported subjective and objective markers of maternal distress in pregnant women within the clinical population. RESULTS Eight studies met inclusion criteria and women were in their second or third trimester. HPA-activity was primarily assessed through salivary cortisol (n = 7) and self-reported maternal distress was assessed using a variety of validated screening measures. Included trials demonstrated significant methodological heterogeneity and small sample sizes, poor treatment adherence, and poor reliability in cortisol measurement indicated low methodological quality. CONCLUSIONS Due to the high heterogeneity across studies, small sample sizes, and unreliable sampling methods, firm conclusions about the efficacy and effectiveness of antenatal interventions cannot be drawn. Despite this, interventions which targeted pregnancy-specific influencers of maternal mood were more likely to result in reduced depression and anxiety symptomatology as reported by mothers.
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Affiliation(s)
- Soha Fassaie
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia
| | - John McAloon
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia.
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109
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Eick SM, Meeker JD, Swartzendruber A, Rios-McConnell R, Brown P, Vélez-Vega C, Shen Y, Alshawabkeh AN, Cordero JF, Ferguson KK. Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico. PLoS One 2020; 15:e0227976. [PMID: 31995596 PMCID: PMC6988967 DOI: 10.1371/journal.pone.0227976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022] Open
Abstract
Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population.
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Affiliation(s)
- Stephanie M. Eick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, San Francisco, CA, United States of America
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Rafael Rios-McConnell
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, United States of America
| | - Phil Brown
- Department of Sociology and Anthropology and Department of Health Sciences, Northeastern University, Boston, MA, United States of America
| | - Carmen Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, United States of America
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Akram N. Alshawabkeh
- College of Engineering, Northeastern University, Boston, MA, United States of America
| | - José F. Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
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110
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Stanhope KK, Hogue CJ. Stressful Life Events Among New Mothers in Georgia: Variation by Race, Ethnicity and Nativity. Matern Child Health J 2020; 24:447-455. [DOI: 10.1007/s10995-020-02886-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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111
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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112
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Moore TA, Case AJ, Mathews TL, Epstein CM, Kaiser KL, Zimmerman MC. Interleukin-17A and Chronic Stress in Pregnant Women at 24-28 Weeks Gestation. Nurs Res 2019; 68:167-173. [PMID: 30829924 PMCID: PMC6415538 DOI: 10.1097/nnr.0000000000000334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Allostatic load (AL) is a biopsychosocial model that suggests chronic psychosocial stress leads to physiological dysregulation and poor outcomes. The purpose of this study was to examine AL in pregnant women operationalized using proinflammatory cytokines and psychosocial indicators and perinatal outcomes. OBJECTIVES The aim of the study was to identify relationships between circulating cytokines/chemokines and the Prenatal Distress Questionnaire, the Maternal Antenatal Attachment Scale, the Emotional Quotient Inventory, the Life Experiences Scale, and demographics in pregnant women. METHODS A cross-sectional design was used to recruit pregnant women between 24 and 28 weeks of gestation. Blood and stress/emotional indicators were obtained after informed consent. Plasma was abstracted to simultaneously measure 29 cytokines/chemokines using a multiplex array. Cytokine/chemokine levels were compared with continuous variables using Spearman's rho and with categorical variables using Mann-Whitney U. RESULTS Twenty-five women with medically high-risk (n = 16) and low-risk (n = 9) pregnancies consented. Most women were White (68%) with a mean age of 29 years (SD = 5.9). Although several cytokines and chemokines showed significant correlations with the stress/emotional indicators, only interleukin-17A (IL-17A) was significantly associated with all of the indicators (Prenatal Distress Questionnaire: rs = .528, p = .012; Maternal Antenatal Attachment Scale: rs = -.439, p = .036; Emotional Quotient Inventory total: rs = -.545, p = .007), Life Experiences Scale (rs = .458, p = .032), birth weight (rs = -.499, p = .013), and race (p = .01). DISCUSSION Increased levels of IL-17A, a known cytokine associated with chronic stress and with poor perinatal outcomes, were associated with high prenatal distress, low maternal attachment, and lower emotional intelligence in pregnant women. Increased levels of IL-17A also were associated with lower birth weight and non-White race. Results support the model of AL in pregnant women and highlight IL-17A as a potential biomarker of AL during pregnancy.
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Affiliation(s)
- Tiffany A Moore
- Tiffany A. Moore, PhD, RN, is Assistant Professor, College of Nursing-Omaha Division, University of Nebraska Medical Center. Adam J. Case, PhD, is Assistant Professor, Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha. Therese L. Mathews, PhD, APRN-NP, BCBA-D, is Associate Professor, College of Nursing-Omaha Division, University of Nebraska Medical Center. Katherine Laux Kaiser, PhD, PHCNS, BC, is Professor Emeritus, College of Nursing-Omaha Division, University of Nebraska Medical Center. Matthew C. Zimmerman, PhD, is Associate Professor, Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, and Director, Free Radicals in Medicine Program, Omaha, Nebraska. Crystal Modde Epstein, PhD, APRN-NP, is a Post-Doctoral Scholar, School of Nursing, University of California, San Francisco
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113
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Arbuckle TE, MacPherson S, Barrett E, Muckle G, Séguin JR, Foster WG, Sathyanarayana S, Dodds L, Fisher M, Agarwal A, Monnier P, Walker M, Fraser WD. Do stressful life events during pregnancy modify associations between phthalates and anogenital distance in newborns? ENVIRONMENTAL RESEARCH 2019; 177:108593. [PMID: 31357157 DOI: 10.1016/j.envres.2019.108593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
Anogenital distance (AGD) has been used as a marker of fetal androgen action to identify endocrine disrupting chemicals. A US study (TIDES) has reported that the association between some phthalates and reduced AGD in males was only apparent in sons of mothers reporting no stressful life events (SLEs) during pregnancy. The objective of the current study was to examine the potential modifying effect of SLEs and their subjective impact on associations between prenatal phthalates and AGD. First trimester urines from the MIREC Study were analysed for phthalate metabolites and AGD was measured in neonates. Post-delivery, the women answered questions on SLEs during the pregnancy. Women reporting 1 or more SLEs during pregnancy were considered a "higher stressor" group, whereas women reporting no SLEs or who reported a SLE that was perceived as not at all stressful were considered a "lower stressor" group. Multivariable linear regression models were fit stratified by stressor group. Maternal stressor, AGD and phthalates results were available for 153 females and 147 males. A summary measure of androgen-disrupting phthalates (Σ AD) was associated with significantly longer AGDs in females from the higher stressor group. These effect sizes were increased when the perceived impact was restricted to moderately or very much stressful. In males, all phthalates were associated with longer anopenile distance (APD), regardless of stressor group; however, higher Σ AD was associated with significantly longer APD in the lower stressor group. In contrast to the TIDES study, we did not observe shorter AGDs in male infants prenatally exposed to di-(2-ethylhexyl) phthalates, regardless of maternal stressor level. In conclusion, we were unable to replicate the findings of the TIDES study, but did find some evidence that prenatal SLEs may modify associations between phthalates and female AGD. Further research with other populations and measures of prenatal stress may shed more light on whether prenatal stress is an important effect modifier of associations between phthalates (or other chemicals) and anogenital distance.
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Affiliation(s)
- Tye E Arbuckle
- Populations Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
| | - Susan MacPherson
- Populations Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Gina Muckle
- School of Psychology, Centre de Recherche du CHU de Québec, Laval University, Quebec City, QC, Canada
| | - Jean R Séguin
- Research Axis, Brain and Child Development, CHU Sainte-Justine Research Center, Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Warren G Foster
- Department of Obstetrics & Gynaecology and School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | | | - Linda Dodds
- Division of Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, NS, Canada
| | - Mandy Fisher
- Populations Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Amisha Agarwal
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Patricia Monnier
- Department of Obstetrics & Gynecology, McGill University, Montreal, QC, Canada and RI-MUHC, Montreal, QC, Canada
| | - Mark Walker
- Head, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - William D Fraser
- Department of Obstetrics & Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada
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114
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Liu B, Xu G, Sun Y, Du Y, Gao R, Snetselaar LG, Santillan MK, Bao W. Association between maternal pre-pregnancy obesity and preterm birth according to maternal age and race or ethnicity: a population-based study. Lancet Diabetes Endocrinol 2019; 7:707-714. [PMID: 31395506 PMCID: PMC6759835 DOI: 10.1016/s2213-8587(19)30193-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relation between maternal pre-pregnancy obesity and preterm birth is controversial and inconclusive. We aimed to clarify the association between pre-pregnancy obesity and preterm birth by maternal age and race or ethnicity in a large, multiracial, multiethnic, and diverse population in the USA. METHODS We did a population-based cohort study using nationwide birth certificate data from the US National Vital Statistics System for 2016 and 2017. We included all mothers who had a live singleton birth and who did not have pre-existing hypertension or diabetes. Pre-pregnancy obesity was defined as a pre-pregnancy BMI of at least 30 kg/m2. Preterm birth was defined as gestational age of less than 37 weeks. We used logistic regression models adjusted for maternal age, race or ethnicity, parity, education levels, smoking during pregnancy, previous history of preterm birth, marital status, infant sex, and timing of initiation of prenatal care to estimate the odds ratio (OR) of preterm birth. FINDINGS We included 7 141 630 singleton livebirths in our analysis, 527 637 (7·4%) of which were preterm births. 127 611 (7·5%) Hispanic mothers, 244 578 (6·6%) non-Hispanic white mothers, and 102 509 (10·4%) non-Hispanic black mothers had preterm births. In the overall population, maternal pre-pregnancy obesity was significantly associated with an increased risk of preterm birth compared with maternal pre-pregnancy healthy weight (ie, BMI of 18·5-24·9 kg/m2; adjusted OR 1·18 [95% CI 1·18-1·19]). In non-Hispanic white women, maternal obesity was inversely associated with preterm birth among those younger than 20 years (adjusted OR 0·92 [95% CI 0·88-0·97]), but positively associated with preterm birth among those aged 20 years or older (1·04 [1·01-1·06], 1·20 [1·18-1·23], 1·34 [1·31-1·37], 1·40 [1·36-1·43], and 1·39 [1·31-1·46] among those aged 20-24 years, 25-29 years, 30-34 years, 35-39 years, and ≥40 years, respectively). In Hispanic women, maternal obesity was not associated with preterm birth among those younger than 20 years (0·98 [0·93-1·04]), but positively associated with preterm birth among those aged 20 years or older (1·06 [1·03-1·09], 1·21 [1·17-1·24], 1·32 [1·28-1·36], 1·38 [1·33-1·43], and 1·30 [1·22-1·40] among those aged 20-24 years, 25-29 years, 30-34 years, 35-39 years, and ≥40 years, respectively). In non-Hispanic black women, maternal obesity was inversely associated with preterm birth among those younger than 30 years (0·76 [0·71-0·81] in those <20 years, 0·83 [0·80-0·86] in those aged 20-24 years, and 0·98 [0·95-1·01] among those aged 25-29 years), but positively associated with preterm birth among those aged 30 years or older (1·15 [1·11-1·19], 1·26 [1·20-1·32], and 1·29 [1·18-1·42] among those aged 30-34 years, 35-39 years, and ≥40 years, respectively). INTERPRETATION Maternal pre-pregnancy obesity is significantly associated with the risk of preterm birth in the general population, but the risk differs according to maternal age and race or ethnicity. Future investigation is warranted to understand the underlying mechanisms. FUNDING US National Institutes of Health.
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Affiliation(s)
- Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Guifeng Xu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yang Du
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Rui Gao
- Shenzhen Birth Cohort Study Center, Nanshan Maternity and Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA; Obesity Research and Education Initiative, University of Iowa, Iowa City, IA, USA
| | - Mark K Santillan
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA; The Center for Hypertension Research, University of Iowa, Iowa City, IA, USA
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA; Obesity Research and Education Initiative, University of Iowa, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA.
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115
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Keiser AM, Salinas YD, DeWan AT, Hawley NL, Donohue PK, Strobino DM. Risks of preterm birth among non-Hispanic black and non-Hispanic white women: Effect modification by maternal age. Paediatr Perinat Epidemiol 2019; 33:346-356. [PMID: 31365156 PMCID: PMC6993282 DOI: 10.1111/ppe.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preterm birth (PTB) disproportionately affects African American compared with Caucasian women, although reasons for this disparity remain unclear. Some suggest that a differential effect of maternal age by race/ethnicity, especially at older maternal ages, may explain disparities. OBJECTIVE To determine whether the relationship between maternal age and preterm birth varies by race/ethnicity among primiparae non-Hispanic blacks (NHB) and non-Hispanic whites (NHW). METHODS A cross-sectional study of 367 081 singleton liveborn first births to NHB and NHW women in California from 2008 to 2012 was conducted. Rate ratios (RR) were estimated for PTB and its subtypes-spontaneous and clinician-initiated-after adjusting for confounders through Poisson regression. Universal age/race reference groups (NHW, 25-29 years) and race-specific reference groups (NHW or NHB, 25-29 years) were used for comparisons. RESULTS Among all women, RR of PTB was highest at the extremes of age (<15 and ≥40 years). Among NHBs, the risk of PTB was higher than among NHWs at all maternal ages (adjusted RR of PTB 1.38-2.93 vs 0.98-2.38). However, using race-specific reference groups, the risk of PTB for NHB women (RR 0.91-1.88) vs NHW women (RR 0.98-2.39) was nearly identical at all maternal ages, with overlapping confidence intervals. Analyses did not demonstrate substantial divergence of risk with advancing maternal age. PTB, spontaneous PTB, and clinician-initiated PTB demonstrated similar risk patterns at younger but not older maternal ages, where risk of clinician-initiated PTB increased sharply for all women. CONCLUSIONS Primiparae NHBs demonstrated increased risk of PTB, spontaneous PTB, and clinician-initiated PTB compared with NHWs at all maternal ages. However, RRs using race-specific reference groups converged across maternal ages, indicating a similar independent effect of maternal age on PTB by race/ethnicity. A differential effect of maternal age does not appear to explain disparities in preterm birth by race/ethnicity.
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Affiliation(s)
- Amaris M. Keiser
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yasmmyn D. Salinas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Andrew T. DeWan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Pamela K. Donohue
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Donna M. Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Gemmill A, Catalano R, Casey JA, Karasek D, Alcalá HE, Elser H, Torres JM. Association of Preterm Births Among US Latina Women With the 2016 Presidential Election. JAMA Netw Open 2019; 2:e197084. [PMID: 31322687 PMCID: PMC6647358 DOI: 10.1001/jamanetworkopen.2019.7084] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The circumstances surrounding the 2016 US presidential election have been proposed as a significant stressor in the lives of the US Latino population. Few studies to date, however, have evaluated the population health implications of the election for Latina mothers and their children. OBJECTIVE To determine whether preterm births (gestational age, <37 weeks) among US Latina women increased above expected levels after the 2016 US presidential election. DESIGN, SETTING, AND PARTICIPANTS In this national population-based study, an interrupted time series design, used to evaluate whether policies or other population-level changes interrupt a trend in an outcome, compared monthly counts of preterm births to Latina women after the 2016 presidential election with the number expected had the election not taken place. Women residing in the United States who had singleton births during the study period were included. Counts of singleton term and preterm births by month and race/ethnicity from January 1, 2009, through July 30, 2017 (32 860 727 live births), were obtained from the Centers for Disease Control and Prevention Wonder online database. These methods were applied separately to male and female births. Data were analyzed from November 8, 2018, through May 7, 2019. EXPOSURES Pregnancy in the 2016 US presidential election. MAIN OUTCOMES AND MEASURES The number of male and female preterm births based on the last menstrual period. RESULTS Among the 32 860 727 live births recorded during the study period, 11.0% of male and 9.6% of female births to Latina women were preterm compared with 10.2% and 9.3%, respectively, to other women. In the 9-month period beginning with November 2016, an additional 1342 male (95% CI, 795-1889) and 995 female (95% CI, 554-1436) preterm births to Latina women were found above the expected number of preterm births had the election not occurred. CONCLUSIONS AND RELEVANCE The 2016 US presidential election appears to have been associated with an increase in preterm births among US Latina women. Anti-immigration policies have been proposed and enforced in the aftermath of the 2016 presidential election; future research should evaluate the association of these actions with population health.
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Affiliation(s)
- Alison Gemmill
- Program in Public Health, Department of Family, Population and Prevention Medicine, Stony Brook University, Stony Brook, New York
- currently affiliated with Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Joan A. Casey
- School of Public Health, University of California, Berkeley
| | - Deborah Karasek
- Preterm Birth Initiative, University of California, San Francisco
| | - Héctor E. Alcalá
- Program in Public Health, Department of Family, Population and Prevention Medicine, Stony Brook University, Stony Brook, New York
| | - Holly Elser
- School of Public Health, University of California, Berkeley
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Saboory E, Mohammadi S, Dindarian S, Mohammadi H. Prenatal stress and elevated seizure susceptibility: Molecular inheritable changes. Epilepsy Behav 2019; 96:122-131. [PMID: 31132613 DOI: 10.1016/j.yebeh.2019.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/08/2023]
Abstract
Stressful episodes are common during early-life and may have a wide range of negative effects on both physical and mental status of the offspring. In addition to various neurobehavioral complications induced by prenatal stress (PS), seizure is a common complication with no fully explained cause. In this study, the association between PS and seizure susceptibility was reviewed focusing on sex differences and various underlying mechanisms. The role of drugs in the initiation of seizure and the effects of PS on the nervous system that prone the brain for seizure, especially the hypothalamic-pituitary-adrenal (HPA) axis, are also discussed in detail by reviewing the papers studying the effect of PS on glutamatergic, gamma-aminobutyric acid (GABA)ergic, and adrenergic systems in the context of seizure and epilepsy. Finally, epigenetic changes in epilepsy are described, and the underlying mechanisms of this change are expanded. As the effects of PS may be life-lasting, it is possible to prevent future psychiatric and behavioral disorders including epilepsy by preventing avoidable PS risk factors.
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Affiliation(s)
- Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sina Dindarian
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hozan Mohammadi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Gitsels-van der Wal JT, Gitsels LA, Hooker A, van Weert B, Martin L, Feijen-de Jong EI. Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study. BMC Pregnancy Childbirth 2019; 19:203. [PMID: 31208355 PMCID: PMC6580473 DOI: 10.1186/s12884-019-2316-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/25/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care. METHODS We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier. RESULTS The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)). CONCLUSION Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons. IMPLICATION FOR PRACTICE A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.
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Affiliation(s)
- Janneke T Gitsels-van der Wal
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Lisanne A Gitsels
- ESRC funded Business and Local Government Data Research Centre (BLG DRC), School of Computing Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, England, UK
| | - Angelo Hooker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands.,Department of Obstetrics and Gynecology, Zaans Medical Center, Koningin Julianaplein 58, Zaandam, Netherlands
| | - Britte van Weert
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Esther I Feijen-de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
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Schmeer KK, Guardino C, Irwin JL, Ramey S, Shalowitz M, Dunkel Schetter C. Maternal postpartum stress and toddler developmental delays: Results from a multisite study of racially diverse families. Dev Psychobiol 2019; 62:62-76. [PMID: 31172517 DOI: 10.1002/dev.21871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/02/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022]
Abstract
Maternal psychosocial stress during pregnancy can adversely influence child development, but few studies have investigated psychosocial stress during the postpartum period and its association with risk of toddler developmental delays. Moreover, given the expanding diversity of the U.S. population, and well-documented health and stress disparities for racial and ethnic minorities, research examining the effect of postpartum stress on risk of developmental delays in diverse populations is of critical importance. In this study, data from the Community Child Health Network provided the opportunity to test maternal postpartum stress as a predictor of toddler risk of developmental delay in a sample of African American, Latina and non-Hispanic White women and their toddlers (N = 1537) recruited in urban, suburban, and rural communities. Postpartum maternal stress over 1 year was operationalized as perceived stress, life events, and negative impact of life events. Regression results revealed higher risk of developmental delays in toddlers whose mothers experienced more negative life events, greater negative impact of events, and higher perceived stress over the year. Prenatal stress, pregnancy/birth complications, and postpartum depression did not explain these associations. Maternal postpartum stress may contribute to increased risk for developmental delays and is an important target for psychosocial intervention.
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Affiliation(s)
- Kammi K Schmeer
- Department of Sociology, The Ohio State University, Columbus, Ohio
| | | | - Jessica L Irwin
- Department of Psychology, University of California, Los Angeles, California
| | - Sharon Ramey
- Department of Psychology, Virginia Tech Carilion Research Institute, Blacksburg, Virginia
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Chen HJ, Gur TL. Intrauterine Microbiota: Missing, or the Missing Link? Trends Neurosci 2019; 42:402-413. [PMID: 31053242 PMCID: PMC6604064 DOI: 10.1016/j.tins.2019.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
The intrauterine environment provides a key interface between the mother and the developing fetus during pregnancy, and is a target for investigating mechanisms of fetal programming. Studies have demonstrated an association between prenatal stress and neurodevelopmental disorders. The role of the intrauterine environment in mediating this effect is still being elucidated. In this review, we discuss emerging preclinical and clinical evidence suggesting the existence of microbial communities in utero. We also outline possible mechanisms of bacterial translocation to the intrauterine environment and immune responses to the presence of microbes or microbial components. Lastly, we overview the effects of intrauterine inflammation on neurodevelopment. We hypothesize that maternal gestational stress leads to disruptions in the maternal oral, gut, and vaginal microbiome that may lead to the translocation of bacteria to the intrauterine environment, eliciting an inflammatory response and resulting in deficits in neurodevelopment.
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Affiliation(s)
- Helen J Chen
- Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Tamar L Gur
- Department of Psychiatry and Behavioral Health, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA; Institute of Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
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121
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Adynski H, Zimmer C, Thorp J, Santos HP. Predictors of psychological distress in low-income mothers over the first postpartum year. Res Nurs Health 2019; 42:205-216. [PMID: 30888077 PMCID: PMC6472896 DOI: 10.1002/nur.21943] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/11/2019] [Accepted: 02/16/2019] [Indexed: 01/24/2023]
Abstract
Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10-item index of biologic measures of chronic stress, predict psychological distress in low-income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n = 842), depression ( n = 845), and anxiety ( n = 846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24-29 weeks, and T3: 50-65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low-income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.
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Affiliation(s)
- Harry Adynski
- School of Nursing, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Catherine Zimmer
- Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, North Carolina, United States
| | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, North Carolina, United States
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122
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Buskmiller C, Columbus C, Gavard JA. Maternity homes and social support: A cross-sectional survey stratifying outcomes. Proc (Bayl Univ Med Cent) 2019; 32:348-354. [PMID: 31384185 DOI: 10.1080/08998280.2019.1588838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022] Open
Abstract
Poor social support is associated with adverse obstetric outcomes. Maternity group homes (MGHs), residential programs for pregnant women, have been found to improve social support in small studies. The present study aimed to verify these previous studies, discover whether there is a group of women whom MGHs most benefit, identify what services offer that benefit, and identify how to predict who will most benefit from MGH admission. Forty-three US MGHs from 14 states were surveyed from August 2015 to February 2017. The primary outcome was self-reported social support before and during MGH admission. The secondary outcome was the perception that MGH admission would help current and future relationships. Among 95 respondents, 54% perceived better in-MGH support compared to pre-MGH support. Women with poor pre-MGH support reported improvement; the converse was true of high pre-MGH support (P < 0.001). A total of 77% to 82% of participants anticipated that MGH admission would help current and future relationships, including 91% to 92% of women with stable or increased in-MGH support (P = 0.07 current, P < 0.01 future). Participants with increased in-MGH support reported more services as helpful (P < 0.05). In summary, MGHs are associated with improved support and relationships for most residents. The support score may identify which women may benefit most from MGH admission.
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Affiliation(s)
- Cara Buskmiller
- Obstetrics, Gynecology, and Women's Health, St. Louis UniversitySt. LouisMissouri
| | - Cristie Columbus
- Division of Infectious Diseases, Baylor University Medical Center at DallasDallasTexas
| | - Jeffrey A Gavard
- Obstetrics, Gynecology, and Women's Health, St. Louis UniversitySt. LouisMissouri
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García-León MÁ, Caparrós-González RA, Romero-González B, González-Perez R, Peralta-Ramírez I. Resilience as a protective factor in pregnancy and puerperium: Its relationship with the psychological state, and with Hair Cortisol Concentrations. Midwifery 2019; 75:138-145. [PMID: 31102974 DOI: 10.1016/j.midw.2019.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/02/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Stress is considered an important risk factor for the physical and psychological health of pregnant women. Hence, it is very important to study those protective factors that attenuate the negative effects of stress, such as resilience. The objective of this study was to verify the role of resilience as a stress-reducing factor during pregnancy. METHODS A total of 151 pregnant women were assessed in this study: high resilience (n = 55) and low resilience (n = 96). Assessment consisted on perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing and Hair Cortisol Concentrations (HCC) during the third trimester of pregnancy and the puerperium, as well as postpartum depression. RESULTS The results show that there were statistically significant differences between women with high and low resilience in: perceived stress [F (1,150) = 8.40; p = .005)], HCC [F (1,150) = 9.70; p = .002], pregnancy-specific stress [F (1,150) = 9.62; p = .002], and various subscales of psychopathological symptoms. Specifically, women with high resilience had lower levels of perceived stress, pregnancy-specific stress, psychopathological symptoms, psychological wellbeing, and Hair Cortisol Concentrations during the third trimester. During the puerperium, women in the high resilience group showed higher psychological wellbeing, lower psychopathological symptoms, and lower postpartum depression scores. CONCLUSIONS These results highlight the protective role of resilience when pregnant women are confronted by the negative effects of stress, and therefore the potential utility of resilience to improve the health of pregnant women and their neonates.
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Affiliation(s)
- María Ángeles García-León
- School of Psychology, University of Granada, Granada, Spain; Research Center of Mind, Brain and Behavior, University of Granada, Granada, Spain.
| | - Rafael A Caparrós-González
- School of Psychology, University of Granada, Granada, Spain; Research Center of Mind, Brain and Behavior, University of Granada, Granada, Spain
| | - Borja Romero-González
- School of Psychology, University of Granada, Granada, Spain; Research Center of Mind, Brain and Behavior, University of Granada, Granada, Spain
| | | | - Isabel Peralta-Ramírez
- School of Psychology, University of Granada, Granada, Spain; Research Center of Mind, Brain and Behavior, University of Granada, Granada, Spain
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124
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Cao M, MacDonald JW, Liu HL, Weaver M, Cortes M, Durosier LD, Burns P, Fecteau G, Desrochers A, Schulkin J, Antonelli MC, Bernier RA, Dorschner M, Bammler TK, Frasch MG. α7 Nicotinic Acetylcholine Receptor Signaling Modulates Ovine Fetal Brain Astrocytes Transcriptome in Response to Endotoxin. Front Immunol 2019; 10:1063. [PMID: 31143190 PMCID: PMC6520997 DOI: 10.3389/fimmu.2019.01063] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
Neuroinflammation in utero may result in lifelong neurological disabilities. Astrocytes play a pivotal role in this process, but the mechanisms are poorly understood. No early postnatal treatment strategies exist to enhance neuroprotective potential of astrocytes. We hypothesized that agonism on α7 nicotinic acetylcholine receptor (α7nAChR) in fetal astrocytes will augment their neuroprotective transcriptome profile, while the inhibition of α7nAChR will achieve the opposite. Using an in vivo–in vitro model of developmental programming of neuroinflammation induced by lipopolysaccharide (LPS), we validated this hypothesis in primary fetal sheep astrocytes cultures re-exposed to LPS in the presence of a selective α7nAChR agonist or antagonist. Our RNAseq findings show that a pro-inflammatory astrocyte transcriptome phenotype acquired in vitro by LPS stimulation is reversed with α7nAChR agonistic stimulation. Conversely, α7nAChR inhibition potentiates the pro-inflammatory astrocytic transcriptome phenotype. Furthermore, we conducted a secondary transcriptome analysis against the identical α7nAChR experiments in fetal sheep primary microglia cultures. Similar to findings in fetal microglia, in fetal astrocytes we observed a memory effect of in vivo exposure to inflammation, expressed in a perturbation of the iron homeostasis signaling pathway (hemoxygenase 1, HMOX1), which persisted under pre-treatment with α7nAChR antagonist but was reversed with α7nAChR agonist. For both glia cell types, common pathways activated due to LPS included neuroinflammation signaling and NF-κB signaling in some, but not all comparisons. However, overall, the overlap on the level of signaling pathways was rather minimal. Astrocytes, not microglia—the primary immune cells of the brain, were characterized by unique inhibition patterns of STAT3 pathway due to agonistic stimulation of α7nAChR prior to LPS exposure. Lastly, we discuss the implications of our findings for fetal and postnatal brain development.
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Affiliation(s)
- Mingju Cao
- Department of Obstetrics and Gynaecology and Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - James W MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Hai L Liu
- Department of Obstetrics and Gynaecology and Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Molly Weaver
- UW Medicine Center for Precision Diagnostics, University of Washington, Seattle, WA, United States
| | - Marina Cortes
- Animal Reproduction Research Centre (CRRA), Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lucien D Durosier
- Department of Obstetrics and Gynaecology and Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Patrick Burns
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada
| | - Gilles Fecteau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada
| | - André Desrochers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Marta C Antonelli
- Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Michael Dorschner
- UW Medicine Center for Precision Diagnostics, University of Washington, Seattle, WA, United States
| | - Theo K Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Martin G Frasch
- Department of Obstetrics and Gynaecology and Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Animal Reproduction Research Centre (CRRA), Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.,Center on Human Development and Disability, University of Washington, Seattle, WA, United States
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125
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Association of periodontal disease with depression and adverse birth outcomes: Results from the Perinatal database; Finger Lakes region, New York State. PLoS One 2019; 14:e0215440. [PMID: 30998794 PMCID: PMC6472778 DOI: 10.1371/journal.pone.0215440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Preterm and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems. Data from the Finger Lakes Perinatal Data System database on 316,956 deliveries occurring between 2004–2014 and pregnancy outcomes were analyzed to assess the association of periodontal (gum) disease with depression, other maternal factors and adverse birth outcomes. Adjusted effects of periodontal disease and depression on adverse birth outcomes were estimated using multiple logistic regression models and path analysis. Having preterm delivery was associated significantly with depression (OR = 1.177; 95% CI: [1.146, 1.208]), having adequate health care (OR = 1.638; 95% CI: [1.589, 1.689]), smoking during pregnancy (OR = 1.259; 95% CI: [1.220, 1.300]), and being less educated (OR = 1.214; 95% CI: [1.174, 1.256]). Having low birth weight was significantly associated with depression (OR = 1.206; 95% CI: [1.170, 1.208]), smoking during pregnancy (OR = 1.855; 95% CI: [1.793, 1.919]), and being less educated (OR = 1.322; 95% CI: [1.275, 1.370]). Periodontal disease was significantly associated with alcohol use during pregnancy (OR = 1.314; 95% CI: [1.227, 1.407]) and white race (OR = 1.192; 95% CI: [1.167, 1.217]). Depression was significantly associated with periodontal disease (OR = 1.762; 95% CI: [1.727, 1.797]) and alcohol use during pregnancy (OR = 1.470; 95% CI: [1.377, 1.570]). We concluded that a positive association existed between depression during pregnancy and adverse birth outcomes, and that depression served as a mediator in the association of periodontal disease with adverse birth outcomes.
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126
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Sealy-Jefferson S, Mustafaa FN, Misra DP. Early-life neighborhood context, perceived stress, and preterm birth in African American Women. SSM Popul Health 2019; 7:100362. [PMID: 30899773 PMCID: PMC6409403 DOI: 10.1016/j.ssmph.2019.100362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 12/05/2022] Open
Abstract
Stressors from multiple sources, across the life-course, may have independent and joint associations with preterm birth (PTB) risk in African American women. Using data from the Life-course Influences on Fetal Environments Study (LIFE; 2009-2011) of post-partum African American women from Metropolitan Detroit, Michigan (n=1365), we examined the association between perceived stress and PTB, and effect modification by perceptions of early-life neighborhood social control and disorder. We defined PTB as birth before 37 completed weeks of gestation. We used Cohen's Perceived Stress scale, and valid and reliable scales of early-life (age 10) neighborhood social control and social disorder to quantify exposures. We estimated prevalence ratios (PR) and 95% confidence intervals (CI) with log binomial regression models- with separate interaction terms for perceived stress and each early-life neighborhood scale. We considered p < 0.10 significant for interaction terms. PTB occurred in 16.4% (n=224) of the study participants. In the total sample, perceived stress was not associated with PTB rates. However, there was suggestive evidence of a joint association between perceived stress and early-life neighborhood social disorder (p for interaction = 0.06), such that among women who reported high early-life neighborhood social disorder (n=660), perceived stress was positively associated with PTB (adjusted PR: 1.31; 95% CI: 1.05, 1.63). There was no association between perceived stress and PTB for women in the low early-life neighborhood social disorder strata (n=651) (adjusted PR: 0.95, 95% CI: 0.75, 1.21). There was no evidence that early-life neighborhood social control modified the association between perceived stress and PTB. Our results suggest that early-life neighborhood stressors may magnify the association between current perceived stress and PTB rates, in African American women. More research to confirm and explicate the biologic and/or psychosocial mechanisms of the reported association is warranted.
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Affiliation(s)
- Shawnita Sealy-Jefferson
- The Ohio State University, College of Public Health, Division of Epidemiology, 300A Cunz Hall 1841 Neil Avenue, Columbus, OH 43210, USA
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Surkan PJ, Dong L, Ji Y, Hong X, Ji H, Kimmel M, Tang WY, Wang X. Paternal involvement and support and risk of preterm birth: findings from the Boston birth cohort. J Psychosom Obstet Gynaecol 2019; 40:48-56. [PMID: 29144191 PMCID: PMC6143424 DOI: 10.1080/0167482x.2017.1398725] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate to what extent paternal involvement and support during pregnancy were associated with preterm (PTB) and small-for-gestational age (SGA) births. METHODS Using data from the Boston Birth Cohort (n = 7047), multiple logistic regression models were performed to estimate the log odds of either PTB or SGA birth, with paternal involvement, paternal social support, and family and friend social support variables as the primary independent variables. RESULTS About 10% of participating mothers reported their husbands not being involved or supportive during their pregnancies. Lack of paternal involvement was associated with 21% higher risk of PTB (OR = 1.21, 95% CI: 1.01-1.45). Similarly, lack of paternal support was borderline associated with PTB (OR = 1.13, 95% CI: 0.94-1.35). Also marginally significant, lack of paternal involvement (OR = 1.18, 95% CI: 0.95-1.47) and father's support (OR = 1.19, 95% CI: 0.96-1.48) were associated with higher odds of SGA birth. No associations were found between familial and friend support during pregnancy and PTB or SGA. CONCLUSIONS Among predominantly low-income African Americans, lack of paternal involvement and lack of paternal support during pregnancy were associated with an increased risk of PTB, and suggestive of SGA birth. These findings, if confirmed in future research, underscore the important role a father can play in reducing PTB and/or SGA.
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Affiliation(s)
- Pamela J. Surkan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205, 410-502-7396,
| | - Liming Dong
- University of Michigan School of Public Health, Ann Arbor, MI, USA, 48109, 734-763-3645,
| | - Yuelong Ji
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205, 213-509-7601,
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA 21205, , 410-502-8919
| | - Hongkai Ji
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E3638, Baltimore, MD 21205, USA, 410-955-3517,
| | - Mary Kimmel
- University of North Carolina-Chapel Hill Department of Psychiatry, Campus Box #7160, Chapel Hill, NC USA 27599-7160, 919-445-0216,
| | - Wan-yee Tang
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E4132, Baltimore, MD, USA, 21205, 410-614-3910,
| | - Xiaobin Wang
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E4132, Baltimore, MD, USA, 21205, 410-955-5824,
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Miller ES, Sakowicz A, Roy A, Yang A, Sullivan JT, Grobman WA, Wisner KL. Plasma and cerebrospinal fluid inflammatory cytokines in perinatal depression. Am J Obstet Gynecol 2019; 220:271.e1-271.e10. [PMID: 30557551 DOI: 10.1016/j.ajog.2018.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 11/09/2018] [Accepted: 12/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND While perinatal depression is one of the most common complications of pregnancy, there is an insufficient understanding of the mechanistic underpinnings of disease. While an association between peripheral inflammatory cytokines and major depressive disorder has been demonstrated, cytokines cannot freely cross the blood-brain barrier, and thus, they give little insight into alternations in brain function. Because the brain is in direct communication with the cerebrospinal fluid, assessment of inflammation in the cerebrospinal fluid may be more directly related to the biologic markers of affective change. OBJECTIVE Our objectives were to examine the association between perinatal depression and inflammatory cytokines in plasma, the association between perinatal depression and inflammatory cytokines in cerebrospinal fluid, and the correlations between plasma and cerebrospinal fluid inflammatory cytokines. STUDY DESIGN This was a prospective, observational study of women with a singleton gestation at term undergoing a scheduled cesarean delivery. Women were screened for depression and those with depressive symptomatology preferentially enrolled. The Mini-International Neuropsychiatric Interview was administered to confirm the clinical diagnosis of depression. Maternal plasma and cerebrospinal fluid were collected preoperatively and cytokines measured via flow cytometry. Bivariable and multivariable analyses were used to determine the association between each cytokine and perinatal depression. Correlations were measured between the cytokines in plasma and cerebrospinal fluid. RESULTS Of the 117 women who met inclusion criteria, 76 (65%) screened positive for depression, 15 (20%) of whom met the clinical diagnostic criteria for depression. There were no significant associations between any of the plasma cytokines and perinatal depression in our sample. Conversely, in multivariable analyses, higher cerebrospinal fluid interleukin-1β (adjusted odds ratio, 232.7, 95% confidence interval, 5.9-9148.5), interleukin-23 (adjusted odds ratio, 22.1, 95% confidence interval, 1.7-294.5), and interleukin-33 (adjusted odds ratio, 1.7, 95% confidence interval, 1.1-2.6) concentrations were significantly associated with increased odds of perinatal depression. The plasma and cerebrospinal fluid cytokine concentrations were not strongly correlated. CONCLUSION Higher concentrations of cerebrospinal fluid cytokines were associated with perinatal depression. These cerebrospinal fluid cytokines were not strongly correlated with plasma cytokines, and accordingly, plasma cytokines were not significantly associated with perinatal depression. Central neuroinflammation, as opposed to peripheral inflammation, may represent a mechanistic pathway that contributes to perinatal depression.
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Andrews K, Gonzalez A. Contextual risk factors impacting the colonization and development of the intestinal microbiota: Implications for children in low- and middle-income countries. Dev Psychobiol 2019; 61:714-728. [PMID: 30663777 DOI: 10.1002/dev.21823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
Abstract
Early adversities, such as poverty, maternal stress, and malnutrition, can affect the structure and functioning of the developing brain with implications for biological systems such as the intestinal microbiota. To date, most studies examining the impact of these risk factors on the development and functioning of the intestinal microbiota have primarily been conducted in high-income countries. However, arguably, children in low- and middle-income countries may be at increased risk given cumulative biological and psychosocial adversities during their development. Accumulating evidence in low- and middle-income countries has linked dysbiosis of the intestinal microbiota to child health outcomes such as stunting, malnutrition, and diarrheal diseases characterized by reduced microbial diversity and elevated pathogenic bacteria, which has implications for psychosocial outcomes. This review summarizes empirical findings that highlight the association between risk factors prevalent in low- and middle-income countries and the intestinal microbiota of children. Additionally, we briefly survey the current evidence regarding the effect of nutritional interventions on the microbial composition of children in low- and middle-income countries. We conclude that these empirical studies have the capacity to inform future research investigating the influence of preventive interventions on biological systems by targeting the predominant risk factors faced by children in low- and middle-income countries.
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Affiliation(s)
- Krysta Andrews
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Hartman S, Sayler K, Belsky J. Prenatal stress enhances postnatal plasticity: The role of microbiota. Dev Psychobiol 2018; 61:729-738. [PMID: 30575950 DOI: 10.1002/dev.21816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/09/2018] [Accepted: 11/18/2018] [Indexed: 12/11/2022]
Abstract
Separate fields of inquiry indicate (a) that prenatal stress is associated with heightened behavioral and physiological reactivity and (b) that these postnatal phenotypes are themselves associated with increased susceptibility to both positive and negative environmental influences. Collectively, this work supports Pluess and Belsky's (Psychopathology, 2011, 23, 29) claim that prenatal stress fosters, promotes or "programs" postnatal developmental plasticity. Herein, we review animal and human evidence consistent with this hypothesis before advancing the novel idea that infant intestinal microbiota may be one candidate mechanism for instantiating developmental plasticity as a result of prenatal stress. We then review research indicating that prenatal stress predicts differences in infant intestinal microbiota; that infant intestinal microbiota is associated with behavioral and physiological reactivity phenotypes; and, thus, that prenatal stress may influence infant intestinal microbiota in a way that results in heightened physiological and behavioral reactivity and, thereby, postnatal developmental plasticity. Finally, we offer ideas for testing this claim and consider implications for intervention and use of probiotics during early infancy.
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Affiliation(s)
- Sarah Hartman
- Department of Human Development and Family Studies, University of California, Davis, California
| | - Kristina Sayler
- Department of Human Development and Family Studies, University of California, Davis, California
| | - Jay Belsky
- Department of Human Development and Family Studies, University of California, Davis, California
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Survey to Assess Interest in a Mindfulness Intervention at a Midwifery and Women's Health Clinic. Holist Nurs Pract 2018; 32:261-267. [PMID: 30113960 DOI: 10.1097/hnp.0000000000000286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a voluntary survey among ethnically and socioeconomically diverse women. About half of the respondents reported experiencing at least one health issue; over half were interested in attending a mindfulness class to reduce stress. Our study suggests interest in participating in a mindfulness intervention, primarily among those with more health issues.
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132
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Abstract
Two sets of evidence reviewed herein, one indicating that prenatal stress is associated with elevated behavioral and physiological dysregulation and the other that such phenotypic functioning is itself associated with heightened susceptibility to positive and negative environmental influences postnatally, raises the intriguing hypothesis first advanced by Pluess and Belsky (2011) that prenatal stress fosters, promotes, or "programs" postnatal developmental plasticity. Here we review further evidence consistent with this proposition, including new experimental research systematically manipulating both prenatal stress and postnatal rearing. Collectively this work would seem to explain why prenatal stress has so consistently been linked to problematic development: stresses encountered prenatally are likely to continue postnatally, thereby adversely affecting the development of children programmed (by prenatal stress) to be especially susceptible to environmental effects. Less investigated are the potential benefits prenatal stress may promote, due to increased plasticity, when the postnatal environment proves to be favorable. Future directions of research pertaining to potential mechanisms instantiating postnatal plasticity and moderators of such prenatal-programming effects are outlined.
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133
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Prenatal stress and the development of psychopathology: Lifestyle behaviors as a fundamental part of the puzzle. Dev Psychopathol 2018; 30:1129-1144. [PMID: 30068418 DOI: 10.1017/s0954579418000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal psychological stress, depression, and anxiety during pregnancy (prenatal stress; PNS) are thought to impact fetal development with long-term effects on offspring outcome. These effects would include physical and mental health, including psychopathology. Maternal sleep, diet, and exercise during pregnancy are lifestyle behaviors that are understudied and often solely included in PNS studies as confounders. However, there are indications that these lifestyle behaviors may actually constitute essential mediators between PNS and fetal programming processes. The goal of this theoretical review was to investigate this idea by looking at the evidence for associations between PNS and sleep, diet, and exercise, and by piecing together the information on potential underlying mechanisms and causal pathways through which these factors may affect the offspring. The analysis of the literature led to the conclusion that sleep, diet, and exercise during pregnancy, may have fundamental roles as mediators between PNS and maternal pregnancy physiology. By integrating these lifestyle behaviors into models of prenatal programming of development, a qualitatively higher and more comprehensive understanding of the prenatal origins of psychopathology can be obtained. The review finalizes by discussing some of the present challenges facing the field of PNS and offspring programming, and offering solutions for future research.
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Abstract
OBJECTIVE To assess the relationships between self-reported psychosocial stress and preterm birth, hypertensive disease of pregnancy, and small-for-gestational-age (SGA) birth and to assess the extent to which these relationships account for racial and ethnic disparities in these adverse outcomes. METHODS Self-reported measures of psychosocial stress (perceived stress, depression, racism, anxiety, resilience, and social support) were collected during pregnancy among a racially and ethnically diverse cohort of women enrolled in a prospective observational study of nulliparous women with singleton pregnancies, from eight clinical sites across the United States, between October 2010 and May 2014. The associations of preterm birth, hypertensive disease of pregnancy, and SGA birth with the self-reported measures of psychosocial stress as well as with race and ethnicity were evaluated. RESULTS The study included 9,470 women (60.4% non-Hispanic white, 13.8% non-Hispanic black, 16.7% Hispanic, 4.0% Asian, and 5.0% other). Non-Hispanic black women were significantly more likely to experience any preterm birth, hypertensive disease of pregnancy, and SGA birth than were non-Hispanic white women (12.2% vs 8.0%, 16.7% vs 13.4%, and 17.2% vs 8.6%, respectively; P<.05 for all). After adjusting for potentially confounding factors, including the six different psychosocial factors singly and in combination, non-Hispanic black women continued to be at greater risk of any preterm birth and SGA birth compared with non-Hispanic white women. CONCLUSION Among a large and geographically diverse cohort of nulliparous women with singleton gestations, non-Hispanic black women are most likely to experience preterm birth, hypertensive disease of pregnancy, and SGA birth. These disparities were not materially altered for preterm birth or SGA birth by adjustment for demographic differences and did not appear to be explained by differences in self-reported psychosocial factors.
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135
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Baker KK, Story WT, Walser-Kuntz E, Zimmerman MB. Impact of social capital, harassment of women and girls, and water and sanitation access on premature birth and low infant birth weight in India. PLoS One 2018; 13:e0205345. [PMID: 30296283 PMCID: PMC6175511 DOI: 10.1371/journal.pone.0205345] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child morbidity and mortality. Inadequate water and sanitation access (WASH) are risk factors for PTB and LBW in low-income countries. Physical stress from carrying water and psychosocial stress from addressing sanitation needs in the open may be mechanisms underlying these associations. If so, then living in a community with strong social capital should be able to buffer the adverse effects of WASH on birth outcomes. The objective of this study is to assess the relationships between WASH access and social conditions (including harassment and social capital) on PTB and LBW outcomes among Indian women, and to test whether social conditions modified the association between WASH and birth outcomes. METHODS AND FINDINGS This cohort study examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012 Waves of the India Human Development Survey. PTB and LBW occurred in 14.9% and 15.5% of women, respectively. After adjusting for maternal biological and socioeconomic conditions, PTB was associated with sharing a building/compound latrine (Odds Ratio (OR) = 1.55; 95% Confidence Interval (CI) = 1.01, 2.38) versus private latrine access, but suggested an effect in the opposite direction for sharing a community/public latrine (OR = 0.67; CI = 0.45, 1.01). Open defecation, type of drinking water source, minutes per day spent fetching water, and one-way time to a drinking water source were not associated with PTB. LBW was associated with spending more than two hours per day fetching water compared to less than two hours (OR = 1.33; CI = 1.05, 1.70) and suggested an association with open defecation (OR = 1.22; CI = 1.00, 1.48), but was not associated with other types of sanitation, type of drinking water source, or time to a drinking water source. Harassment of women and girls in the community was associated with both PTB (OR = 1.33; CI = 1.09, 1.62) and LBW (OR = 1.26; CI = 1.03, 1.54). The data also showed a possible association of local crime with LBW (OR = 1.30; CI = 1.00, 1.68). Statistically significant (p<0.05) evidence of effect modification was only found for collective efficacy on the association between type of sanitation access and PTB. In addition, stratified analyses identified differences in effect size for walking time to the primary drinking water source and PTB by crime, sanitation access and PTB by harassment, and total hours per day fetching water and LBW by collective efficacy. Limitations of this observational study include risk of bias, inability to confirm causality, reliance on self-reported outcomes, and limited sub-group sample sizes for testing effect modification. CONCLUSIONS The relationship between adverse birth outcomes and sanitation access, domestic water fetching, crime, and gender-based harassment suggests physical and psychosocial stress are possible mechanisms by which WASH access affects PTB and LBW among Indian women. Interventions that reduce domestic responsibilities related to water and sanitation and change social norms related to gender-based harassment may reduce rates of PTB and LBW in India.
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Affiliation(s)
- Kelly K. Baker
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, IA, United States of America
| | - William T. Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, IA, United States of America
| | - Evan Walser-Kuntz
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
| | - M. Bridget Zimmerman
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
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136
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Hartman S, Belsky J. Prenatal stress and enhanced developmental plasticity. J Neural Transm (Vienna) 2018; 125:1759-1779. [PMID: 30206701 DOI: 10.1007/s00702-018-1926-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/07/2018] [Indexed: 01/18/2023]
Abstract
Two separate lines of inquiry indicate (a) that prenatal stress is associated with heightened behavioral and physiological reactivity, and (b) that these postnatal phenotypes are associated with increased susceptibility to both positive and negative developmental experiences and environmental exposures. This research considered together raises the intriguing hypothesis first advanced by Pluess and Belsky (Dev Psychopathol 23:29-38, 2011) that prenatal-stress fosters, promotes or "programs" postnatal developmental plasticity. In this paper, we review further evidence consistent with this proposition, including a novel animal study which experimentally manipulated both prenatal stress and postnatal rearing. Directions for future work focused on mechanisms mediating the plasticity-inducing effects of prenatal stress and the moderators of such effects are outlined.
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Affiliation(s)
- Sarah Hartman
- Department of Human Development and Family Studies, University of California, One Shields Avenue, 3321 Hart Hall, Davis, CA, 95616, USA.
| | - Jay Belsky
- Department of Human Development and Family Studies, University of California, One Shields Avenue, 3321 Hart Hall, Davis, CA, 95616, USA
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Shan D, Qiu PY, Wu YX, Chen Q, Li AL, Ramadoss S, Wang RR, Hu YY. Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China. Sci Rep 2018; 8:12239. [PMID: 30115949 PMCID: PMC6095911 DOI: 10.1038/s41598-018-29889-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/20/2018] [Indexed: 11/08/2022] Open
Abstract
This retrospective cohort study attempts to investigate pregnancy complications and adverse pregnancy outcomes in women of advanced maternal age (AMA). Data were extracted from electronic medical records system at West China Second University Hospital of Sichuan University from January 2013 to July 2016. The study cohort consisted 8 subgroups of women on 4 different age levels (20-29 years, 30-34 years, 35-39 years and ≥40 years) and 2 different parities (primiparity and multiparity). In the study period, 38811 women gave birth at our hospital, a randomized block was used to include 2800 women of singleton pregnancy >28 gestational weeks, with 350 patients in each subgroup. Maternal complications and fetal outcomes were collected and defined according to relevant guidelines. Confounding factors representing maternal demographic characteristics were identified from previous studies and analysed in multivariate analysis. There was an increasing trend for the risks of adverse pregnancy outcomes with increasing age, especially in AMA groups. Our study showed that AMA, primiparity, maternal overweight or obesity, lower educational level and residence in rural area increased pregnancy complications and adverse fetal outcomes. Increased professional care as well as public concern is warranted.
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Affiliation(s)
- Dan Shan
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Obstetrics and Gynaecology and Department of Molecular and Medical Pharmacology David Geffen School of Medicine at University of California at Los Angeles; Jonsson Comprehensive Cancer Centre, Los Angeles, CA, USA
| | - Pei-Yuan Qiu
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Yu-Xia Wu
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Chen
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ai-Lin Li
- Department of Ophthalmology, Chengde Medical University, Chengde, Hebei, China
| | - Sivakumar Ramadoss
- Department of Obstetrics and Gynaecology and Department of Molecular and Medical Pharmacology David Geffen School of Medicine at University of California at Los Angeles; Jonsson Comprehensive Cancer Centre, Los Angeles, CA, USA
| | - Ran-Ran Wang
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Yi Hu
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
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Wallingford MC, Benson C, Chavkin NW, Chin MT, Frasch MG. Placental Vascular Calcification and Cardiovascular Health: It Is Time to Determine How Much of Maternal and Offspring Health Is Written in Stone. Front Physiol 2018; 9:1044. [PMID: 30131710 PMCID: PMC6090024 DOI: 10.3389/fphys.2018.01044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022] Open
Abstract
Vascular calcification is the deposition of calcium phosphate minerals in vascular tissue. Vascular calcification occurs by both active and passive processes. Extent and tissue-specific patterns of vascular calcification are predictors of cardiovascular morbidity and mortality. The placenta is a highly vascularized organ with specialized vasculature that mediates communication between two circulatory systems. At delivery the placenta often contains calcified tissue and calcification can be considered a marker of viral infection, but the mechanisms, histoanatomical specificity, and pathophysiological significance of placental calcification are poorly understood. In this review, we outline the current understanding of vascular calcification mechanisms, biomedical consequences, and therapeutic interventions in the context of histoanatomical types. We summarize available placental calcification data and clinical grading systems for placental calcification. We report on studies that have examined the association between placental calcification and acute adverse maternal and fetal outcomes. We then review the intersection between placental dysfunction and long-term cardiovascular health, including subsequent occurrence of maternal vascular calcification. Possible maternal phenotypes and trigger mechanisms that may predispose for calcification and cardiovascular disease are discussed. We go on to highlight the potential diagnostic value of placental calcification. Finally, we suggest avenues of research to evaluate placental calcification as a research model for investigating the relationship between placental dysfunction and cardiovascular health, as well as a biomarker for placental dysfunction, adverse clinical outcomes, and increased risk of subsequent maternal and offspring cardiovascular events.
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Affiliation(s)
- Mary C Wallingford
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States.,Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Ciara Benson
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Nicholas W Chavkin
- Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT, United States.,School of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States
| | - Michael T Chin
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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139
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Gilles M, Otto H, Wolf IAC, Scharnholz B, Peus V, Schredl M, Sütterlin MW, Witt SH, Rietschel M, Laucht M, Deuschle M. Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant's anthropometric measures at birth. Psychoneuroendocrinology 2018; 94:152-161. [PMID: 29783163 DOI: 10.1016/j.psyneuen.2018.04.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal maternal stress might be a risk for the developing fetus and may have long-lasting effects on child and adult vulnerability to somatic and psychiatric disease. Over-exposure of the unborn to excess glucocorticoids and subsequent alteration of fetal development is hypothesized to be one of the key mechanisms linking prenatal stress with negative child outcome. METHODS In this prospective longitudinal study, mothers-to-be (n = 405) in late pregnancy (36.8 ± 1.9 weeks of gestational age) and their singleton neonates were studied. We investigated the impact of different prenatal stress indices derived from six stress variables (perceived stress, specific prenatal worries, negative life events, symptoms of depression, trait anxiety, neuroticism) and diurnal maternal saliva cortisol secretion on gestational age and anthropometric measures at birth. RESULTS Maternal prenatal distress during late gestation was associated with significant reduction in birth weight (-217 g; p = .005), birth length (-1.2 cm; p = .005) and head circumference (-0.8 cm; p = .001). Prenatal stress was modestly but significantly associated with altered diurnal cortisol pattern (flattened cortisol decline and higher evening cortisol), which in turn was significantly related to reduced length of gestation. No evidence for a profound interaction between maternal cortisol level in late pregnancy and infant's anthropometric measures at birth (i.e., birth weight, length, head circumference) was found. CONCLUSION Prenatal stress is associated with flattened circadian saliva cortisol profiles and reduced infant's anthropometric measures at birth. HPA system activity during pregnancy may be related to low gestational age. The effect of prenatal stress might be partly mediated by maternal-placental-fetal neuroendocrine mechanisms especially the dysregulation of diurnal cortisol profile.
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Affiliation(s)
- Maria Gilles
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Henrike Otto
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Isabell A C Wolf
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Barbara Scharnholz
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Verena Peus
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Michael Schredl
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marc W Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Manfred Laucht
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychology, University of Potsdam, Potsdam, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
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140
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Goosby BJ, Cheadle JE, Mitchell C. Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities. ANNUAL REVIEW OF SOCIOLOGY 2018; 44:319-340. [PMID: 38078066 PMCID: PMC10704394 DOI: 10.1146/annurev-soc-060116-053403] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research.
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Affiliation(s)
- Bridget J Goosby
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska 68588, USA
| | - Jacob E Cheadle
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska 68588, USA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48104, USA
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141
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Herbell K, Zauszniewski JA. Reducing Psychological Stress in Peripartum Women With Heart Rate Variability Biofeedback: A Systematic Review. J Holist Nurs 2018; 37:273-285. [PMID: 29944076 DOI: 10.1177/0898010118783030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Peripartum women are exposed to a variety of stressors that have adverse health consequences for the maternal-child dyad (e.g., impaired bonding). To combat these adverse health consequences, heart rate variability biofeedback (HRVBF) may be implemented by holistic nurses to aid peripartum women experiencing a high level of stress. A systematic review was completed using the guidelines established in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. To be included in the review, studies had to meet the following criteria: (a) published scientific articles, (b) studies published in English, (c) experimental, quasi-experimental, or case reports, (d) use of HRVBF as the main treatment, (e) use of psychological stress as a dependent variable, and (f) studies published until December 2017. The major findings of this review can be described as follows: (a) HRVBF and psychological stress in peripartum women are related concepts, (b) peripartum women who completed HRVBF report a reduction in stress compared with participants who did not receive HRVBF, and (c) there is currently no information on the effectiveness of HRVBF on psychological stress in the first and early second trimester of pregnancy. Overall, this systematic review of the literature provides objective evidence that HRVBF may be a potential beneficial adjuvant treatment for stress management in peripartum women.
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142
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McKee KS, Seplaki C, Fisher S, Groth SW, Fernandez ID. Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes. Matern Child Health J 2018; 21:147-155. [PMID: 27439420 DOI: 10.1007/s10995-016-2103-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N = 111). Results CPD scores ranged from 0 to 6, out of a total of 8 parameters (Mean 2.09; SD = 1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3397 g (SD = 522.89), and the mean gestational age was 39.64 weeks (SD = 1.08). CPD was not significantly associated with either birth weight or gestational age (p = 0.42 and p = 0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.
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Affiliation(s)
- Kimberly Schmitt McKee
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA. .,Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.
| | - Christopher Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Susan Fisher
- Temple Clinical Research Institute, Department of Clinical Sciences, Temple University School of Medicine, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.,Population Research, Fox Chase Cancer Center, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Susan W Groth
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd. Box SON, Rochester, NY, 14642, USA
| | - I Diana Fernandez
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
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143
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Li Y, Margerison-Zilko C, Strutz KL, Holzman C. Life Course Adversity and Prior Miscarriage in a Pregnancy Cohort. Womens Health Issues 2018. [PMID: 29530382 DOI: 10.1016/j.whi.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies indicate associations between preconception adversities and risk of miscarriage, but few have considered type (e.g., financial, substance use, abuse) or timing (e.g., childhood, adulthood) of adversities. We examined relationships between life course adversities in multiple domains and probability of miscarriage. METHODS Data came from women with at least one previous pregnancy in the Pregnancy Outcomes and Community Health (1998-2004) study (n = 2,106). Life course adversities in domains of abuse/witnessing violence, loss of someone close, economic hardship, and substance abuse were assessed via questionnaire and categorized as occurring during childhood only, adulthood only, both childhood and adulthood, or neither. We also calculated a cumulative adversity score. We used logistic regression models to estimate associations between life course adversity measures and the probability of miscarriage, and examined effect modification by race/ethnicity and maternal education. All models were adjusted for maternal age, race/ethnicity, education, and marital status. RESULTS The odds of miscarriage were higher among women experiencing legal adversities during both childhood and adulthood (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3-2.8) compared with women not experiencing legal adversities, and higher among women experiencing substance use adversities in childhood only (OR, 1.4; 95% CI, 1.1-1.7) compared with women not experiencing substance use adversities. Each additional adversity was marginally significantly associated with a 10% increase in odds of preterm birth (OR, 1.1; 95% CI, 1.0-1.1). Among women with only one prior miscarriage, no adversity measures were associated with miscarriage. CONCLUSIONS Exposure to adversity in certain domains and across the life course modestly increased the odds of miscarriage.
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Affiliation(s)
- Yu Li
- Department of Epidemiology, Brown University, Providence, Rhode Island.
| | - Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
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Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth 2018; 45:7-18. [PMID: 29057487 DOI: 10.1111/birt.12316] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB. METHODS Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies. RESULTS Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours). CONCLUSIONS Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Department of Nursing, University of Iceland, Reykjavík, Iceland
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Island Medical Program, Victoria, Canada
| | - Elizabeth Nethery
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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145
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Amabebe E, Anumba DOC. Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health. Front Endocrinol (Lausanne) 2018; 9:568. [PMID: 30319548 PMCID: PMC6165882 DOI: 10.3389/fendo.2018.00568] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023] Open
Abstract
Stress stimuli are ubiquitous and women do not enjoy any exemptions. The physiologic "fight-or-flight" response may be deleterious to the female lower genital tract microbiome if the stress stimuli persist for longer than necessary. Persistent exposure to psychosocial stress and stimulation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes, and associated hormones are risk factors for several infections including genitourinary tract infections. Though this could be due to a dysregulated immune response, a cortisol-induced inhibition of vaginal glycogen deposition may be involved especially in the instance of vaginal infection. The estrogen-related increased vaginal glycogen and epithelial maturation are required for the maintenance of a healthy vaginal ecosystem (eubiosis). The ability of cortisol to disrupt this process as indicated in animal models is important in the pathogenesis of vaginal dysbiosis and the subsequent development of infection and inflammation. This phenomenon may be more crucial in pregnancy where a healthy Lactobacillus-dominated vaginal microbiota is sacrosanct, and there is local production of more corticotropin-releasing hormone (CRH) from the decidua, fetal membranes and placenta. To highlight the relationship between the stress hormone cortisol and the vaginal microbiomial architecture and function, the potential role of cortisol in the maintenance of vaginal health is examined.
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Frasch MG, Baier CJ, Antonelli MC, Metz GAS. Perinatal Psychoneuroimmunology: Protocols for the Study of Prenatal Stress and Its Effects on Fetal and Postnatal Brain Development. Methods Mol Biol 2018; 1781:353-376. [PMID: 29705857 DOI: 10.1007/978-1-4939-7828-1_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Prenatal stress (PS) impacts early behavioral, neuroimmune, and cognitive development. Pregnant rat models have been very valuable in examining the mechanisms of such fetal programming. A newer pregnant sheep model of maternal stress offers the unique advantages of chronic in utero monitoring and manipulation. This chapter presents the techniques used to model single and multigenerational stress exposures and their pleiotropic effects on the offspring.
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Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
| | - Carlos J Baier
- Departamento de Biología, Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bioquímica y Farmacia (DBByF), Universidad Nacional del Sur (UNS), Bahía Blanca, Argentina
| | - Marta C Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gerlinde A S Metz
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
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147
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Ncube CN, Enquobahrie DA, Gavin AR. Racial Differences in the Association Between Maternal Antenatal Depression and Preterm Birth Risk: A Prospective Cohort Study. J Womens Health (Larchmt) 2017; 26:1312-1318. [PMID: 28622475 PMCID: PMC5733649 DOI: 10.1089/jwh.2016.6198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the United States, racial/ethnic disparities in preterm birth (PTB) are well documented, but explanations for why the disparity persists remain to be fully explored. We examined racial/ethnic differences in the association of maternal antenatal depression with PTB (<37 completed weeks of gestation) risk. METHODS In a prospective cohort study, participants (n = 2073) included non-Hispanic (NH) black, NH white, Asian, and Hispanic women who received prenatal care at a university obstetric clinic January 2004-March 2010, and delivered at the university's hospital. We obtained data from self-reported questionnaires and electronic medical records. We assessed antenatal depression using the Patient Health Questionnaire-9 and self-reported antenatal antidepressant medication use. Poisson regression models were used to estimate the association between antenatal depression and PTB risk, within strata of race/ethnicity. RESULTS NH black (risk ratio [RR] = 1.89; 95% confidence interval [CI]: 0.94, 3.80), NH white (RR = 1.58, 95% CI: 1.04, 2.39), and Asian (RR = 2.06; 95% CI: 0.69, 6.13) women with antenatal depression were at increased risk for delivering preterm infants, compared with women without antenatal depression, although the associations were statistically significant only among NH white women. There was no evidence of an association between antenatal depression and risk of PTB among Hispanic women (RR = 0.96; 95% CI: 0.28, 3.25); p-value for interaction = 0.81. CONCLUSION Our findings suggest race-specific associations of antenatal depression with an increased risk of delivering a preterm infant, supporting the importance of considering race/ethnicity when examining risk factors for health outcomes.
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Affiliation(s)
- Collette N. Ncube
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Amelia R. Gavin
- School of Social Work, University of Washington, Seattle, Washington
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148
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Yamamoto S, Premji S. The Role of Body, Mind, and Environment in Preterm Birth: Mind the Gap. J Midwifery Womens Health 2017; 62:696-705. [PMID: 29135075 DOI: 10.1111/jmwh.12658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/20/2022]
Abstract
Preterm birth continues to be a problem affecting low-, middle-, and high-income countries, with rates increasing in some areas despite ongoing efforts to reduce the incidence. This emphasizes the need for more effective interventions, particularly if we aim to achieve the broad health targets of the Sustainable Development Goals (SDGs) by 2030. The current focus on medically-oriented interventions such as reducing nonmedically-indicated induction of labor, cesarean birth, and multiple embryo transfers associated with assisted reproductive technologies, as well as the application of cervical cerclage and use of progesterone therapy, though important, are likely only partial solutions to the complex phenomenon of preterm birth. Preterm birth has multiple etiologies. The biologic mechanisms involved in preterm labor and how it may be triggered are not well understood. There is growing evidence to suggest some of these triggers may also be related to stress and environmental conditions. In this review, we focus on evidence concerning psychosocial (mind) and environmental factors (environment) as well as briefly review the evidence related to maternal and fetal factors (body) associated with the risk of preterm birth, with reference to some of the SDGs. We also assess emerging evidence regarding the interaction of the body, mind, and environment in relation to preterm birth, currently a gap in our knowledge, and how these interactions could impact clinical practice. Findings suggest that multidisciplinary expertise and approaches will be needed to develop effective interventions to address the complex etiologies of preterm birth, as opposed to single-risk-factor mitigation. Clinicians and researchers will play key roles in identifying many of these risk factors and shaping interventions that address this complex issue. Addressing the interlinkages between body, mind, and environment through the integration of research and clinical practice is critical to reducing the risk of preterm birth and contributing to the achievement of the SDGs.
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149
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Togher KL, Treacy E, O'Keeffe GW, Kenny LC. Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling. Psychiatry Res 2017; 255:17-26. [PMID: 28511050 DOI: 10.1016/j.psychres.2017.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 12/18/2022]
Abstract
The experience of maternal distress in pregnancy is often linked with poorer obstetric outcomes for women as well as adverse outcomes for offspring. Alterations in placental glucocorticoid signalling and subsequent increased fetal exposure to cortisol have been suggested to underlie this relationship. In the current study, 121 pregnant women completed the Perceived Stress Scale, State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale in the third trimester of pregnancy. Placental samples were collected after delivery. Maternal history of psychiatric illness and miscarriage were significant predictors of poorer mental health in pregnancy. Higher anxiety was associated with an increase in women delivering via elective Caesarean Section, and an increase in bottle-feeding. Birth temperature was mildly reduced among infants of women with high levels of depressive symptomology. Babies of mothers who scored high in all stress (cumulative distress) measures had reduced 5-min Apgar scores. High cumulative distress reduced the expression of placental HSD11B2 mRNA and increased the expression of placental NR3C1 mRNA. These data support a role for prenatal distress as a risk factor for altered obstetric outcomes. The alterations in placental gene expression support a role for altered placental glucocorticoid signalling in the relationship between maternal prenatal distress and adverse outcomes.
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Affiliation(s)
- Katie L Togher
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Eimear Treacy
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translation Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
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150
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Zijlmans MAC, Beijers R, Riksen-Walraven MJ, de Weerth C. Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study. Stress 2017; 20:495-504. [PMID: 28691638 DOI: 10.1080/10253890.2017.1348497] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Maternal prenatal anxiety and stress (PNS) have been positively associated to physical health prob lems in offspring in the first year of life. Whether these associations are transient, persistent, or even progressive over time, is as yet unknown. The goal of this study is to investigate associations between late pregnancy PNS and child health from 18 months to age 6. METHODS Mothers were recruited in late pregnancy, and had uncomplicated, singleton pregnancies without physical health problems. Around week 37 of pregnancy, mothers reported on their PNS by means of questionnaires, and provided saliva for determination of circadian cortisol concentrations. Children's illnesses in the preceding year were assessed using maternal reports at 30, 48, 60, and 72 months. Antibiotic use was obtained from medical records between one and six years. Multilevel models (N¼174) showed a positive relation between maternal prenatal general and pregnancy-specific anxiety during late pregnancy and offspring respiratory illnesses and symptoms. Interaction effects with time indicated that more PNS was related to more respiratory illnesses until toddlerhood, but not later in life. Furthermore, maternal prenatal cortisol concentrations were related to child digestive illnesses. A steeper maternal cortisol decline over the day was related to more child digestive illnesses, until around three years of age. Finally, children of mothers who suffered more from daily hassles during pregnancy received more antibiotics between one and six years of age. PNS was not related to general and skin illnesses. CONCLUSION Summarizing, this study showed that late pregnancy anxiety and cortisol was associated with children's respiratory and digestive illnesses till the age of 3.0-3.5 years. Additionally, more daily hassles were related to more prescribed antibiotics between one and six years. These findings point in the direction of possible effects of PNS persisting beyond the first year of life and into toddlerhood, but disappearing at older ages.
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Affiliation(s)
- Maartje A C Zijlmans
- a Department of Developmental Psychology , Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Roseriet Beijers
- a Department of Developmental Psychology , Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Marianne J Riksen-Walraven
- a Department of Developmental Psychology , Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Carolina de Weerth
- a Department of Developmental Psychology , Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands
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