1
|
Timmer-Murillo SC, Mowrer A, Wang AZ, Jazinski-Chambers K, Piña I, Rundell MR, Bennett JM, Wagner AJ, deRoon-Cassini TA. Examining emotion regulation and inflammation as predictors of maternal mental health after fetal anomaly diagnosis. Brain Behav Immun 2024; 122:1-8. [PMID: 39106938 DOI: 10.1016/j.bbi.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/09/2024] [Accepted: 08/01/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE Fetal anomalies occur in approximately 3% of pregnancies and receiving the diagnosis may be a potentially traumatic experience for families. The mental health of mothers receiving diagnoses and what predicts resilience or poor mental health is understudied. Emotion regulation is an important, modifiable, transdiagnostic factor of mental health, and may be protective post-diagnosis. Evaluating biomarkers of stress, including IL-6 and Allostatic Load (AL), can also serve as early indicators of risk, indicative of early intervention. This study assessed whether reappraisal, suppression, IL-6, and AL was associated with mental health outcomes and resilience in women after receiving a fetal anomaly diagnosis. METHODS Pregnant women (N=108) presenting to a fetal concerns clinic for initial consultation completed measures of emotion regulation (i.e., reappraisal and suppression), depression, anxiety, posttraumatic stress symptoms, and resilience between 2019-2022. A blood draw was used to assess IL-6 and create composite allostatic load measure including: IL-6, blood pressure, heart rate, glucose, cortisol, and body mass index. RESULTS Linear regressions controlling for age, gestational age, and perceived fetal diagnosis severity, demonstrated that IL-6 was negatively associated with resilience and positively associated with depression. Reappraisal was positively associated to resilience and negatively associated with depression, anxiety, and PTSD, whereas state insurance status was positively associated to anxiety and PTS symptoms. Suppression and allostatic load were not significant. CONCLUSIONS Women experiencing fetal anomaly diagnosis represent an understudied population with unaddressed mental health needs. Reappraisal serves as not only a protective factor, but one that can be enhanced to promote maternal resilience and mental health. Furthermore, elevated IL-6 may be a critical early indicator of potential intervention needs among women who are pregnant, to mitigate negative psychological states and enhance resilience.
Collapse
Affiliation(s)
- Sydney C Timmer-Murillo
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Alyssa Mowrer
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Amy Z Wang
- University of Wisconsin, Milwaukee, Department of Psychology, 2441 E. Hartford Ave. Milwaukee, WI 53211, USA.
| | - Kelley Jazinski-Chambers
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Isela Piña
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Maddie R Rundell
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeanette M Bennett
- UNC Charlotte, Department of Psychological Science, 9201 University City Blvd Charlotte, NC 28223, USA.
| | - Amy J Wagner
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Terri A deRoon-Cassini
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA; Comprehensive Injury Center, Division of Data Surveillance & Informatics, 10000 Innovation Dr. Milwaukee, WI 53226, USA.
| |
Collapse
|
2
|
Bergeron J, Avraam D, Calas L, Fraser W, Harris JR, Heude B, Mandhane P, Moraes TJ, Muckle G, Nader J, Séguin JR, Simons E, Subbarao P, Swertz MA, Tough S, Turvey SE, Fortier I, Rod NH, Andersen AMN. Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts. Eur J Epidemiol 2024; 39:773-783. [PMID: 38805076 PMCID: PMC11344005 DOI: 10.1007/s10654-024-01126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.
Collapse
Affiliation(s)
- Julie Bergeron
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Research Institute of the McGill University Health Center, Montreal, Canada.
| | - Demetris Avraam
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Lucinda Calas
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - William Fraser
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrook, Canada
| | - Jennifer R Harris
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Barbara Heude
- Centre for Research in Epidemiology and Statistics, INSERM, Paris, France
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Theo J Moraes
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Quebec, Canada
| | - Johanna Nader
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Jean R Séguin
- Department of Psychiatry and Addictology, Université de Montréal and CHU Ste-Justine Research Center, Montreal, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Morris A Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Tough
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
3
|
McPherson CB, O'Donnell L, Moes E, Edgar H. No relationship found between dental fluctuating asymmetry, birthweight, and birth term in two modern North American samples. Am J Hum Biol 2024:e24114. [PMID: 38842218 DOI: 10.1002/ajhb.24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Deciduous dental crowns primarily develop during gestation and early infancy and embody early life stress exposures. Composite measures of dental fluctuating asymmetry (DFA) generated from the deciduous teeth may therefore indicate cumulative gestational stress in developmental origins of health and disease (DOHaD) studies. This study examines whether higher composite measures of deciduous DFA are associated with low birthweight and prematurity, two aspects of birth phenotype consistently associated with increased morbidity and mortality risks in adulthood. SUBJECTS AND METHODS We evaluated associations between composite deciduous DFA, birthweight, and birth term in two contemporary North American samples: an autopsy sample from New Mexico (n = 94), and sample from a growth cohort study in Burlington, Ontario (n = 304). Dental metric data for each sample was collected from postmortem CT scans and dental casts, respectively. Composite DFA was estimated using buccolingual (BL) and mesiodistal (MD) crown diameters from paired deciduous teeth. RESULTS Contrary to expectations, the results of linear regression indicated no significant relationship between birthweight and DFA, or birth term and DFA, in either sample. CONCLUSIONS Deciduous DFA does not predict aspects of birth phenotype associated with gestational stress. Birthweight and birth term are plastic relative to the more developmentally stable deciduous dentition, which may only subtly embody early life stress. We suggest that deciduous DFA should be utilized with caution in DOHaD studies until its relationship with gestational stress is clarified.
Collapse
Affiliation(s)
- Cait B McPherson
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lexi O'Donnell
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily Moes
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Physician Assistant Studies, University of St. Francis, Albuquerque, New Mexico, USA
| | - Heather Edgar
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
- Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
4
|
Stookey JD, Guendelman S, McCallister B, Whittemore P, Abu-Amara D, Elsasser MA, Dahir F, Armstrong A, Jackson R. Conceptual framework for preterm birth review in San Francisco. Front Public Health 2024; 12:1332972. [PMID: 38751590 PMCID: PMC11094341 DOI: 10.3389/fpubh.2024.1332972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/29/2024] [Indexed: 05/18/2024] Open
Abstract
Preterm birth persists as a leading cause of infant mortality and morbidity despite decades of intervention effort. Intervention null effects may reflect failure to account for social determinants of health (SDH) or jointly acting risk factors. In some communities, persistent preterm birth trends and disparities have been consistently associated with SDH such as race/ethnicity, zip code, and housing conditions. Health authorities recommend conceptual frameworks for targeted action on SDH and precision public health approaches for preterm birth prevention. We document San Francisco, California's experience identifying the need, rationale, methods, and pilot work for developing a conceptual framework for preterm birth review (PTBR) in San Francisco. The PTBR conceptual framework is intended to enable essential public health services in San Francisco that prevent a range of preterm birth phenotypes by guiding plans for data collection, hypothesis testing, analytical methods, reports, and intervention strategy. Key elements of the PTBR conceptual framework are described including, 10 domains of SDH, 9 domains at the whole person level, such as lived experience and health behaviors, 8 domains at the within-person level, such as biomarkers and clinical measures, 18 preterm birth phenotypes, and the interconnections between domains. Assumptions for the PTBR conceptual framework were supported by a scoping review of literature on SDH effects on preterm birth, health authority consensus reports, and PTBR pilot data. Researcher and health authority interest in each of the domains warrants the framework to prompt systematic consideration of variables in each proposed domain. PTBR pilot data, illustrated in heatmaps, confirm the feasibility of data collection based on the framework, prevalence of co-occurring risk factors, potential for joint effects on specific preterm birth phenotypes, and opportunity for intervention to block SDH effects on preterm birth. The proposed PTBR conceptual framework has practical implications for specifying (1) population groups at risk, (2) grids or heatmap visualization of risk factors, (3) multi-level analyses, and (4) multi-component intervention design in terms of patterns of co-occurring risk factors. Lessons learned about PTBR data collection logistics, variable choice, and data management will be incorporated into future work to build PTBR infrastructure based on the PTBR conceptual framework.
Collapse
Affiliation(s)
- Jodi D. Stookey
- Maternal, Child, and Adolescent Health Division, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Sylvia Guendelman
- Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | | | | | - Deena Abu-Amara
- School of Community Health Sciences, University of Nevada, Reno, NV, United States
| | - Maria A. Elsasser
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
| | - Fardowsa Dahir
- Maternal, Child, and Adolescent Health Division, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Aline Armstrong
- Maternal, Child, and Adolescent Health Division, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Rebecca Jackson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
5
|
Leone T, Väisänen H, Witoelar F. Women's fertility and allostatic load in the post-reproductive years: An analysis of the Indonesian Family Life Survey. POPULATION STUDIES 2024; 78:127-149. [PMID: 36696949 DOI: 10.1080/00324728.2022.2160004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2022] [Indexed: 01/27/2023]
Abstract
We know little about the effects of the reproductive health burden in contexts where unsafe abortions, miscarriages, stillbirths, and low-quality maternal care are common. The aim of this study is to investigate the use of allostatic load to understand the impact of reproductive histories on later-life health. We applied path models to the Indonesian Family Life Survey with a sample of 2,001 women aged 40+. Although number of children was not associated with allostatic load, pregnancies not ending in live birth and parenthood before age 18 were both negatively associated with health. We also identified clear cohort and educational effects and a possible rural advantage. Our contribution is twofold: we highlight the importance of reproductive histories beyond live births on women's later-life health in a context of increasing population ageing, and we demonstrate the applicability of using allostatic load to measure health outside the Global North.
Collapse
Affiliation(s)
| | - Heini Väisänen
- Institut national d'etudes démographiques (INED)
- University of Southampton
| | | |
Collapse
|
6
|
Ormsby SM, Dahlen HG, Smith CA. Investigation of Hypothalamic Pituitary Adrenal Axis and Oxytocinergic System Changes in a Pragmatic Randomized Controlled Feasibility Trial of Acupuncture for Antenatal Depression. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:173-184. [PMID: 37566543 DOI: 10.1089/jicm.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Background: Antenatal depression is common and associated with detrimental impacts on women and their families. Disrupted neuroendocrine functioning is reported in women experiencing perinatal mental health disturbances. Preliminary randomized controlled trial (RCT) evidence suggests acupuncture may provide a safe and effective adjunct treatment; however, underlying mechanisms of effect are unclear. We conducted an RCT examination of acupuncture for the management of antenatal depressive symptomologies, which included oxytocinergic and hypothalamic pituitary adrenal (HPA) axis system evaluations. This article reports postintervention changes to cortisol: dehydroepiandrosterone (DHEA) ratios, and oxytocin (OT) hormone concentrations. Methods: Fifty-seven women with Edinburgh Postnatal Depression Scale (EPDS) scores ≥13 were randomized to receive individually tailored depressed specific acupuncture, progressive muscle relaxation (PMR) attention comparator, or treatment as usual (TAU). Weekly 1-h sessions were conducted for 8 weeks (24-31 of pregnancy). Preintervention and postintervention saliva samples were collected. Results: Postintervention mean cortisol: DHEA ratio differences were not significantly predicted by group allocation (n = 46, p = 0.065). Two-group comparisons demonstrated cortisol: DHEA ratios were significantly increased and predicted by group allocation when acupuncture was compared to TAU (p = 0.039); however, not between acupuncture and PMR (p = 0.179), or PMR and TAU (p = 0.421). Postintervention OT concentrations were not significantly predicted by group allocation. Limitations: Small sample size and posthoc analysis Conclusion: Findings suggest positive regulation of the HPA axis may be an underlying mechanism by which acupuncture provided the significant improvements to antenatal depression, stress, and distress observed in this cohort. Trial Registration: Registered on March 19, 2015, with the Australian New Zealand Clinical Trials Registry (ACTRN12615000250538).
Collapse
Affiliation(s)
- Simone M Ormsby
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| |
Collapse
|
7
|
Njoroge WFM, Tieu T, Eckardt D, Himes M, Alexandre C, Hall W, Wisniewski K, Popoola A, Holloway K, Rodriguez Y, Kornfield S, Momplaisir F, Wang X, Gur R, Waller R. The impact of the pandemic on mothers and children, with a focus on syndemic effects on black families: the "Prenatal to Preschool" study protocol. Front Psychiatry 2024; 14:1281666. [PMID: 38260788 PMCID: PMC10801187 DOI: 10.3389/fpsyt.2023.1281666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Racism, a known social determinant of health, affects the mental health and well-being of pregnant and postpartum women and their children. Convincing evidence highlights the urgent need to better identify the mechanisms and the ways in which young children's development and mental health are adversely impacted by their mothers' experiences of racism. With the additional stressor of the COVID-19 pandemic, the criticality of improving knowledge of these domains has never been starker. The proposed project will address these questions and move the field forward to create targeted, culturally informed preventative interventions, thus achieving mental health equity for all children and families. Methods This prospective research is a cohort study that will longitudinally observe the outcomes of a cohort of mothers and their children recruited during the initial phase of the COVID-19 pandemic. Data will be parent/caregiver questionnaires assessing mental health, racism, support, and resilience at multiple time points with the first beginning at 24 months, clinical interviews with mothers, electronic medical records of mothers, and videotaped dyadic interactions at child age 24 and 48 months. A subset of Black participants will be asked to participate in qualitative interviews at child age 36 months. Results Analyze will be performed within and across Black and Non-Latino/a/e/x white (NLW) groups, and comparing mothers and fathers/secondary caregivers. Descriptive and multivariate analyzes will be run to better characterize how young children's development and mental health may be adversely impacted by their caregiver's experiences of racism. Discussion This prospective longitudinal mixed-methods study evaluates the simultaneous effects of the COVID-19 pandemic and racism on mothers and their developing children to characterize cross-racial differences, providing insight into risk and resilience factors in early development and the peripartum period.
Collapse
Affiliation(s)
- Wanjikũ F. M. Njoroge
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tiffany Tieu
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Devlin Eckardt
- Clinical Research Support Office, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Megan Himes
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Alexandre
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Waynitra Hall
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kate Wisniewski
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ayomide Popoola
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kayla Holloway
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuheiry Rodriguez
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sara Kornfield
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Penn Center for Women’s Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Florence Momplaisir
- Perelman School of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Xi Wang
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Raquel Gur
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Waller
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
8
|
Faraji J, Bettenson D, Yong VW, Metz GAS. Early life stress aggravates disease pathogenesis in mice with experimental autoimmune encephalomyelitis: Support for a two-hit hypothesis of multiple sclerosis etiology. J Neuroimmunol 2023; 385:578240. [PMID: 37951203 DOI: 10.1016/j.jneuroim.2023.578240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 11/13/2023]
Abstract
Vision problems are one of the earliest diagnosed symptoms of multiple sclerosis (MS). The onset and progression of vision loss and the underlying pathogenesis in MS may be influenced by cumulative psychophysiological stress. Here, we used a two-hit model of stress in female mice to determine if early life stress (ELS, the first hit) influences the response to an immunization that induces experimental autoimmune encephalomyelitis (EAE, the second hit) later in life. We hypothesized that ELS caused by animal transportation from a vendor during early postnatal development represents a co-factor which can exacerbate the clinical severity of EAE. Indeed, adult EAE mice with a history of ELS displayed more severe clinical signs and delayed recovery compared to non-stressed EAE mice. ELS also diminished visual acuity measured by optokinetic responses, as well as locomotion and exploratory behaviours in EAE mice. Notably, ELS accelerated vision loss and caused earlier onset of visual impairments in EAE. Exacerbated functional impairments in stressed EAE mice were highly correlated with circulating corticosterone levels. The findings show that the progression of induced EAE in adulthood can be significantly impacted by adverse early life experiences. These observations emphasize the importance of comprehensive behavioural testing, including non-motor functions, to enhance the translational value of preclinical animal models of MS. Moreover, shipment stress of laboratory animals should be considered a necessary variable in preclinical MS research. The consideration of cumulative lifetime stresses provides a new perspective of MS pathogenesis within a personalized medicine framework.
Collapse
Affiliation(s)
- Jamshid Faraji
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
| | - Dennis Bettenson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada; Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
| |
Collapse
|
9
|
Namachivayam SP, Butt W, Brizard C, Millar J, Thompson J, Walker SP, Cheung MMH. Potential benefits of prenatal diagnosis of TGA in Australia may be outweighed by the adverse effects of earlier delivery: likely causation and potential solutions. Arch Dis Child 2023; 109:16-22. [PMID: 37751944 DOI: 10.1136/archdischild-2022-324861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Prenatal diagnosis of transposition of great arteries (TGA) is expected to improve postoperative outcomes after neonatal arterial switch operation (ASO); however, published reports give conflicting results. We aimed to determine the association between prenatal diagnosis and early postoperative outcomes after neonatal ASO. METHODS Cohort study involving 243 newborns who underwent ASO (70% prenatally diagnosed) between 2010 and 2019. Multivariable regression was used to determine the association between prenatal diagnosis and (a) birth characteristics and (b) postoperative outcomes. RESULTS Gestational age and birthweight centile were lower and small-for-gestational-age more common (11.8% vs 1.4%) in those diagnosed prenatally. Among births which followed labour induction or prelabour caesarean, prenatal diagnosis was associated with earlier gestation at birth (mean (SD), 38.5 (1.6) vs 39.2 (1.4), p=0.01). Among births which followed spontaneous labour, prenatal diagnosis was associated with earlier gestation at labour onset (38.2 (1.8) vs 39.2 (1.4), p=0.01). Prenatal diagnosis was associated with longer postoperative mechanical ventilation (incidence rate ratio 1.74, 95% CI 1.37 to 2.21), intensive care (1.70, 1.31 to 2.21) and hospital length of stay (1.37, 1.14 to 1.66) after ASO. Gestational age mediated up to 60% of the effect of prenatal diagnosis on postoperative outcomes. CONCLUSION Among newborns undergoing ASO for TGA, prenatal diagnosis is associated with poorer early postoperative outcomes. In addition to minimising iatrogenic factors (such as planned births) resulting in earlier births, evaluation of other dynamics following a prenatal diagnosis which may result in poor fetal growth and earlier onset of spontaneous labour is important.
Collapse
Affiliation(s)
- Siva P Namachivayam
- Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Warwick Butt
- Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christian Brizard
- Department of Paediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Johnny Millar
- Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jenny Thompson
- Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Michael M H Cheung
- Department of Paediatrics, The University of Melbourne-Parkville Campus, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
10
|
BRAVEMAN PAULA. The Black-White Disparity in Preterm Birth: Race or Racism? Milbank Q 2023; 101:356-378. [PMID: 37096619 PMCID: PMC10126979 DOI: 10.1111/1468-0009.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/20/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.
Collapse
|
11
|
Severson E, Olson JK, Hyde A, Brémault-Phillips S, Spiers J, King S, Bick J, Lipschutz R, Verstraeten BSE, Olson DM. Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters. Matern Child Health J 2023; 27:944-953. [PMID: 36897470 DOI: 10.1007/s10995-023-03625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding. OBJECTIVE To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing? METHODS A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis. RESULTS For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness. CONCLUSION We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.
Collapse
Affiliation(s)
- Emily Severson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Joanne K Olson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ashley Hyde
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Suzanne King
- Douglas Hospital Research Centre & Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Rebecca Lipschutz
- Department of Clinical Psychology, University of Houston, Houston, TX, USA
| | | | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
12
|
Lueth AJ, Allshouse AA, Blue NM, Grobman WA, Levine LD, Simhan HN, Kim JK, Johnson J, Wilson FA, Murtaugh M, Silver RM. Allostatic Load and Adverse Pregnancy Outcomes. Obstet Gynecol 2022; 140:974-982. [PMID: 36357956 PMCID: PMC9712159 DOI: 10.1097/aog.0000000000004971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. METHODS This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes. RESULTS Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA. CONCLUSION High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
Collapse
Affiliation(s)
- Amir J. Lueth
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Amanda A. Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Nathan M. Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jin Kyung Kim
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, California
| | - Jasmine Johnson
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University
| | - Fernando A. Wilson
- Department of Population Health Sciences, University of Utah Health, Salt Lake City, Utah
| | - Maureen Murtaugh
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | | |
Collapse
|
13
|
Premji SS, Pana GS, Cuncannon A, Ronksley PE, Dosani A, Hayden KA, Lalani S, Musana JW, Shaikh K, Yim IS. Prenatal allostatic load and preterm birth: A systematic review. Front Psychol 2022; 13:1004073. [PMID: 36267082 PMCID: PMC9577361 DOI: 10.3389/fpsyg.2022.1004073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAllostatic load refers to cumulative neuroendocrine burden and has been postulated to mediate and moderate physiological and psychological stress-related responses. This may have important implications for the risk of preterm birth. This systematic review examines the evidence on the association between prenatal allostatic load and preterm birth.Data sourcesA comprehensive search of seven electronic databases was conducted from inception to August 23, 2022 to identify all English-language observational and mixed methods studies examining allostatic load and preterm birth with no year or geographic restrictions.Study eligibility criteriaStudies were included if they measured allostatic load, evaluated as the cumulative effect of any combination of more than one allostatic load biomarker, during pregnancy. Studies must have observed preterm birth, defined as < 37 weeks' gestational age, as a primary or secondary outcome of interest.Study appraisal and synthesis methodsThe Quality In Prognosis Studies tool was used to evaluate risk of bias within included studies. A narrative synthesis was conducted to explore potential associations between allostatic load and preterm birth, and sources of heterogeneity.ResultsThree prospective cohort studies were identified and revealed mixed evidence for an association between allostatic load and preterm birth. One study reported a statistically significant association while the other two studies reported little to no evidence for an association. Heterogeneity in when and how allostatic load was measured, limitations in study design and cohort socio-demographics may have contributed to the mixed evidence.ConclusionsThis review provides insight into key individual-, community-, and study-level characteristics that may influence the association between allostatic load and preterm birth. Knowledge gaps are identified as foci for future research, including heterogeneity in allostatic load biomarkers and allostatic load index algorithms as well as pregnancy-specific considerations for allostatic load measurement. Further investigation of the allostatic load framework in the context of perinatal mental health is needed to advance understandings of maternal, infant, and child health.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208990, PROSPERO, identifier: CRD42020208990.
Collapse
Affiliation(s)
- Shahirose Sadrudin Premji
- School of Nursing, Faculty of Health, York University, Toronto, ON, Canada
- *Correspondence: Shahirose Sadrudin Premji
| | - Gianella Santos Pana
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
| | | | - Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Aliyah Dosani
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - K. Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - Sharifa Lalani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Joseph Wangira Musana
- Department of Obstetrics and Gynecology, Aga Khan University Hospital, Nairobi, Kenya
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Ilona S. Yim
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | | |
Collapse
|
14
|
LE G, M P, MA M, KE B, MP V, JM R, C B, S E, PD W. Prospective association between maternal allostatic load during pregnancy and child mitochondrial content and bioenergetic capacity. Psychoneuroendocrinology 2022; 144:105868. [PMID: 35853381 PMCID: PMC9706402 DOI: 10.1016/j.psyneuen.2022.105868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/06/2022] [Accepted: 07/11/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mitochondria are multifunctional energy-producing and signaling organelles that support life and contribute to stress adaptation. There is a growing understanding of the dynamic relationship between stress exposure and mitochondrial biology; however, the influence of stress on key domains of mitochondrial biology during early-life, particularly the earliest phases of intra-uterine/prenatal period remains largely unknown. Thus, the goal of this study was to examine the impact of fetal exposure to stress (modeled as the biological construct allostatic load) upon mitochondrial biology in early childhood. METHODS In n = 30 children (range: 3.5-6 years, 53% male), we quantified mitochondrial content via citrate synthase (CS) activity and mtDNA copy number (mtDNAcn), and measured mitochondrial bioenergetic capacity via respiratory chain enzyme activities (complexes I (CI), II (CII), and IV (CIV)) in platelet-depleted peripheral blood mononuclear cells (PBMCs). In a cohort of healthy pregnant women, maternal allostatic load was operationalized as a latent variable (sum of z-scores) representing an aggregation of early-, mid- and late-gestation measures of neuroendocrine (cortisol), immune (interleukin-6, C-reactive protein), metabolic (homeostasis model assessment of insulin resistance, free fatty acids), and cardiovascular (aggregate systolic and diastolic blood pressure) systems, as well as an anthropometric indicator (pre-pregnancy body mass index [BMI]). RESULTS An interquartile increase in maternal allostatic load during pregnancy was associated with higher mitochondrial content (24% and 15% higher CS and mtDNAcn), and a higher mitochondrial bioenergetic capacity (16%, 23%, and 25% higher CI, CII and CIV enzymatic activities) in child leukocytes. The positive association between maternal allostatic load during pregnancy and child mitochondrial content and bioenergetic capacity remained significant after accounting for the effects of key pre- and post-natal maternal and child covariates (p's < 0.05, except CI p = 0.073). CONCLUSION We report evidence that prenatal biological stress exposure, modeled as allostatic load, was associated with elevated child mitochondrial content and bioenergetic capacity in early childhood. This higher mitochondrial content and bioenergetic capacity (per leukocyte) may reflect increased energetic demands at the immune or organism level, and thus contribute to wear-and-tear and pathophysiology, and/or programmed pro-inflammatory phenotypes. These findings provide potential mechanistic insight into the cellular processes underlying developmental programming, and support the potential role that changes in mitochondrial content and bioenergetic functional capacity may play in altering life-long susceptibility for health and disease.
Collapse
Affiliation(s)
- Gyllenhammer LE
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, USA,Department of Pediatrics, University of California, School of Medicine, Irvine, CA, USA
| | - Picard M
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York, NY, USA,Department of Neurology, Merritt Center, Columbia Translational Neuroscience Initiative, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - McGill MA
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Boyle KE
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes Center, Aurora, Colorado, USA
| | - Vawter MP
- Department of Psychiatry and Human Behavior, University of California, School of Medicine, Irvine, CA, USA
| | - Rasmussen JM
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, USA,Department of Pediatrics, University of California, School of Medicine, Irvine, CA, USA
| | - Buss C
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, USA,Department of Pediatrics, University of California, School of Medicine, Irvine, CA, USA.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
| | - Entringer S
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, USA,Department of Pediatrics, University of California, School of Medicine, Irvine, CA, USA.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
| | - Wadhwa PD
- Development, Health and Disease Research Program, University of California, School of Medicine, Irvine, CA, USA,Department of Pediatrics, University of California, School of Medicine, Irvine, CA, USA.,Department of Psychiatry and Human Behavior, University of California, School of Medicine, Irvine, CA, USA,Department of Obstetrics and Gynecology, University of California, School of Medicine, Irvine, CA, USA,Department of Epidemiology, University of California, School of Medicine, Irvine, CA, USA
| |
Collapse
|
15
|
Larrabee Sonderlund A, Charifson M, Ortiz R, Khan M, Schoenthaler A, Williams NJ. A comprehensive framework for operationalizing structural racism in health research: The association between mass incarceration of Black people in the U.S. and adverse birth outcomes. SSM Popul Health 2022; 19:101225. [PMID: 36177482 PMCID: PMC9513165 DOI: 10.1016/j.ssmph.2022.101225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022] Open
Abstract
Structural racism represents a key determinant of the racial health disparities that has characterized the U.S. population throughout its existence. While this reality has recently begun to gain increasing acknowledgment and acceptance within the health sciences, there are still considerable challenges related to defining the concept of structural racism and operationalizing it in empirical study. In this paper, building on the existing evidence base, we propose a comprehensive framework that centers structural racism in terms of its historical roots and continued manifestation in most domains of society, and offer solutions for the study of this phenomenon and the pathways that connect it to population-level health disparities. We showcase our framework by applying it to the known link between spatial and racialized clustering of incarceration - a previously cited representation of structural racism - and disparities in adverse birth outcomes. Through this process we hypothesize pathways that focus on social cohesion and community-level chronic stress, community crime and police victimization, as well as infrastructural community disinvestment. First, we contextualize these mechanisms within the relevant extant literature. Then, we make recommendations for future empirical pathway analyses. Finally, we identify key areas for policy, community, and individual-level interventions that target the impact of concentrated incarceration on birth outcomes among Black people in the U.S.
Collapse
Affiliation(s)
- Anders Larrabee Sonderlund
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - Mia Charifson
- Department of Population Health, NYU Grossman School of Medicine, USA
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, USA
| | - Robin Ortiz
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
- Department of Pediatrics, NYU Grossman School of Medicine, USA
| | - Maria Khan
- Department of Population Health, NYU Grossman School of Medicine, USA
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, USA
| |
Collapse
|
16
|
Diao M, Zhou J, Tao Y, Hu Z, Lin X. Rac1 is involved in uterine myometrium contraction in the inflammation associated preterm birth. Reproduction 2022; 164:169-181. [PMID: 36018772 PMCID: PMC9513643 DOI: 10.1530/rep-21-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
Preterm birth (PTB) is a public health issue. The WHO has recommended the use of tocolytic treatment to inhibit preterm labour and improve pregnancy outcomes. Intrauterine inflammation is associated with preterm birth. Rac1 can modulate inflammation in different experimental settings. In the current study, we explored whether Rac1 can modulate spontaneous uterine myometrium contraction in a mouse model of lipopolysaccharide (LPS)-induced intrauterine inflammation. Subsequently, we recorded uterine myometrium contraction and examined uterine Rac1 expression in a mouse model of preterm birth and case in pregnant women by western blotting analysis. We also measured progesterone levels in the blood serum from mice. Murine myometrium was obtained 12 h post LPS treatment. Human myometrium was obtained at the time of caesarean section. We found that in the LPS-treated group of mice, uterine myometrium contraction was enhanced, protein levels and activation of Rac1 were increased and serum progesterone levels were decreased. The protein levels of Rac1 were also increased in preterm birth or case in pregnant women. NSC23766, a Rac1 inhibitor, attenuated uterine myometrium contraction and diminished Rac1 activation and COX-2 expression. Furthermore, silencing of Rac1 suppressed cell contraction and COX-2 expression in vitro. In conclusion, our results suggested that Rac1 may play an important role in modulating uterine myometrium contraction. Consequently, intervening with Rac1 represents a novel strategy for the treatment of preterm birth.
Collapse
Affiliation(s)
- Min Diao
- M Diao, Department of Anesthesiology,, Sichuan University West China Second University Hospital, Chengdu, China
| | - Jin Zhou
- J Zhou, Department of Anesthesiology, Sichuan University West China Second University Hospital, Chengdu, China
| | - Yunkai Tao
- Y Tao, Department of Anesthesiology, Sichuan University West China Second University Hospital, Chengdu, China
| | - Zhaoyang Hu
- Z Hu, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan University West China Hospital, Chengdu, China
| | - Xuemei Lin
- X Lin, Department of Anesthesiology,, Sichuan University West China Second University Hospital, Chengdu, China
| |
Collapse
|
17
|
van Daalen KR, Kaiser J, Kebede S, Cipriano G, Maimouni H, Olumese E, Chui A, Kuhn I, Oliver-Williams C. Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009227. [PMID: 35918071 PMCID: PMC9344988 DOI: 10.1136/bmjgh-2022-009227] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/21/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction Racial discrimination has been consistently linked to various health outcomes and health disparities, including studies associating racial discrimination with patterns of racial disparities in adverse pregnancy outcomes. To expand our knowledge, this systematic review and meta-analysis assesses all available evidence on the association between self-reported racial discrimination and adverse pregnancy outcomes. Methods Eight electronic databases were searched without language or time restrictions, through January 2022. Data were extracted using a pre-piloted extraction tool. Quality assessment was conducted using the Newcastle–Ottawa Scale (NOS), and across all included studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects meta-analyses were performed on preterm birth and small for gestational age. Heterogenicity was assessed using Cochran’s χ2 test and I2 statistic. Results Of 13 597 retrieved records, 24 articles were included. Studies included cohort, case–control and cross-sectional designs and were predominantly conducted in the USA (n=20). Across all outcomes, significant positive associations (between experiencing racial discrimination and an adverse pregnancy event) and non-significant associations (trending towards positive) were reported, with no studies reporting significant negative associations. The overall pooled odds ratio (OR) for preterm birth was 1.40 (95% CI 1.17 to 1.68; 13 studies) and for small for gestational age it was 1.23 (95% CI 0.76 to 1.99; 3 studies). When excluding low-quality studies, the preterm birth OR attenuated to 1.31 (95% CI 1.08 to 1.59; 10 studies). Similar results were obtained across sensitivity and subgroup analyses, indicating a significant positive association. Conclusion These results suggest that racial discrimination has adverse impacts on pregnancy outcomes. This is supported by the broader literature on racial discrimination as a risk factor for adverse health outcomes. To further explore this association and underlying mechanisms, including mediating and moderating factors, higher quality evidence from large ethnographically diverse cohorts is needed.
Collapse
Affiliation(s)
- Kim Robin van Daalen
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Jeenan Kaiser
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel Kebede
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York City, USA
| | | | | | | | - Anthea Chui
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Clare Oliver-Williams
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| |
Collapse
|
18
|
Auger N, Low N, Lee GE, Ayoub A, Luu TM. Pregnancy Outcomes of Women Hospitalized for Physical Assault, Sexual Assault, and Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11135. [PMID: 33535860 DOI: 10.1177/0886260520985496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23-1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19-1.71), stillbirth (RR 1.83, 95% CI 1.27-2.63), preterm birth (RR 1.70, 95% CI 1.54-1.87), and low birthweight (RR 1.78, 95% CI 1.58-2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.
Collapse
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Nancy Low
- McGill University, Montreal, Quebec, Canada
| | - Ga Eun Lee
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
19
|
Barry MC, Zimmer C, Halpern CT. Biomarkers of pre-pregnancy allostatic load and subsequent adverse birth outcomes. SSM Popul Health 2022; 18:101099. [PMID: 35698482 PMCID: PMC9187525 DOI: 10.1016/j.ssmph.2022.101099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
Racial disparities in birth outcomes are seemingly intractable. Using person-centered methods and drawing from the life course and Weathering Hypothesis literatures, we used data from the National Longitudinal Study of Adolescent to Adult Health to group non-Hispanic White and non-Hispanic Black women ages 24-34 into latent classes based on pre-pregnancy biomarkers of allostatic load. Stratified analyses yielded four latent classes among non-Hispanic White women, characterized by: 1) high blood pressure, 2) high body mass index and waist circumference, 3) high total cholesterol and triglycerides, and low high-density lipoprotein, and 4) low-risk, and two latent classes among non-Hispanic Black women, characterized by: 1) high body mass index and waist circumference, and moderate-risk blood pressure, hbA1c, and c-reactive protein, and 2) low-risk. Allostatic load class membership and other maternal- and infant-level covariates were then included simultaneously as predictors of three separate dichotomous outcomes: preterm birth, macrosomia, and low birth weight in multilevel logistic regression models. In a separate multilevel linear regression model, the same variables were simultaneously entered to predict continuously measured birthweight. In multilevel, multivariate models, White women in the high-risk body mass index and waist circumference class, as compared to the high-risk blood pressure class, had infants with higher birthweights. Other comparisons were not significant or not of meaningful magnitude. Prioritizing temporality so that allostatic load measurement preceded first birth likely biased the composition of the analytical sample. Additional research is needed to help medical providers and public health practitioners understand the complex biological and social mechanisms underlying inequities in birth outcomes and identify prevention strategies.
Collapse
Affiliation(s)
- Megan C. Barry
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, 27599-7445, USA
- The Carolina Population Center, USA
| | - Catherine Zimmer
- HW Odum Institute for Research in Social Science, 231C WR Davis Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-3355, USA
| | - Carolyn T. Halpern
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, 27599-7445, USA
- The Carolina Population Center, USA
| |
Collapse
|
20
|
Njoroge WFM, White LK, Waller R, Forkpa M, Himes MM, Morgan K, Seidlitz J, Chaiyachati BH, Barzilay R, Kornfield SL, Parish-Morris J, Rodriguez Y, Riis V, Burris HH, Elovitz MA, Gur RE. Association of COVID-19 and Endemic Systemic Racism With Postpartum Anxiety and Depression Among Black Birthing Individuals. JAMA Psychiatry 2022; 79:600-609. [PMID: 35416928 PMCID: PMC9008565 DOI: 10.1001/jamapsychiatry.2022.0597] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE The intersection of endemic structural racism and the global health crisis secondary to the COVID-19 pandemic represents a syndemic, defined as the aggregation of 2 or more endemic and epidemic conditions leading to adverse repercussions for health. Long-standing inequities have placed Black individuals at disproportionate risk for negative postpartum mental health outcomes. Studies are urgently needed to understand how the COVID-19 pandemic has added to this risk (eg, syndemic associations). OBJECTIVE To examine the association between the syndemic and the postpartum mental health of Black birthing individuals. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort of Black birthing individuals were followed up from pregnancy (April 17 to July 8, 2020) through the early postpartum period (August 11, 2020, to March 2, 2021) from urban university medical center prenatal clinics. Pregnant Black participants were recruited via email and completed 2 online surveys. MAIN OUTCOMES AND MEASURES Composite variables capturing negative experiences of the COVID-19 pandemic and racism (structural racism [general], structural racism [neighborhood], and interpersonal racism) were created. Logistic regressions examined main and interactive associations between these variables and postpartum depression (Edinburgh Postnatal Depression Scale) and anxiety (Generalized Anxiety Disorder 7-item scale). RESULTS The mean (SD) age of 151 Black participants was 30.18 (5.65) years. The association between higher negative COVID-19 pandemic experiences and postpartum depression may be influenced by experiences of interpersonal racism and general systemic racism. Negative COVID-19 pandemic experiences were associated with greater likelihood of screening positive for depression only at higher levels of systemic racism (odds ratio, 2.52; 95% CI, 1.38-4.60) and interpersonal racism (odds ratio, 1.90; 95% CI, 1.04-3.48) but not at lower levels of systemic or interpersonal racism. Similarly, negative COVID-19 experiences were associated with anxiety only at higher levels of interpersonal racism (odds ratio, 1.85; 95% CI, 0.86-4.01) but not at lower levels of interpersonal racism. Overall, 44 (29%) met screening criteria for postpartum depression and 20 (13%) for postpartum anxiety. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study of Black birthing individuals, the experience of the syndemic was associated with negative postpartum mental health. Associations between interpersonal racism, structural racism, and negative COVID-19 pandemic experiences were associated with greater risk for postpartum depression and anxiety. Research is needed to address how systemic racism perturbs biobehavioral pathways to magnify associations between acute stressors and mental health. Such research can inform the creation of effective, culturally informed preventive interventions to improve the postpartum mental health of Black individuals.
Collapse
Affiliation(s)
- Wanjikũ F. M. Njoroge
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Lauren K. White
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca Waller
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia,Department of Psychology, University of Pennsylvania, Philadelphia
| | - Markolline Forkpa
- Dornsife School of Public Health Drexel University, Philadelphia, Pennsylvania
| | - Megan M. Himes
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | | | - Jakob Seidlitz
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Barbara H. Chaiyachati
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia,Center for Pediatric Clinical Effectiveness, Division General Pediatrics, Children’s Hospital Philadelphia, Philadelphia, Pennsylvania,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ran Barzilay
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Sara L. Kornfield
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Penn Center for Women’s Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Parish-Morris
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Valerie Riis
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather H. Burris
- Center for Pediatric Clinical Effectiveness, Division General Pediatrics, Children’s Hospital Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michal A. Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
21
|
Social Isolation Stress Modulates Pregnancy Outcomes and the Inflammatory Profile of Rat Uterus. Int J Mol Sci 2022; 23:ijms23116169. [PMID: 35682846 PMCID: PMC9181517 DOI: 10.3390/ijms23116169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022] Open
Abstract
Prenatal stressors have been linked to adverse pregnancy outcomes; including preterm birth (PTB). Recent work demonstrates that social isolation in mothers represents a silent stressor contributing to PTB risk. Here; we investigate the association of inflammatory and stress markers with PTB risk in Long–Evans rats exposed to social isolation stress (SIS) during preconception and pregnancy across four generations (F0-F3). Gestational length; blood glucose; corticosterone levels; and maternal and offspring weights were assessed in two SIS paradigms: transgenerational (TG) and multigenerational (MG) exposure. Maternal uterine tissues were collected 21 days after the dams gave birth. Exposure to SIS reduced pregnancy lengths in the parental generation and neonatal birth weights in the F1 and F2 generations. Interleukin (IL)-1β (Il1b) mRNA levels increased in F0 animals but decreased in the offspring of both stress lineages. Protein levels of IL-1β decreased in the TG lineage. Corticotrophin-releasing hormone receptor 1 (Crhr1) expression decreased in SIS-exposed F0 animals and increased in the TG-F2 and MG-F1 offspring. Expression of enzyme 11-β hydroxysteroid dehydrogenase-2 (11bHSD2) was enhanced in F1 animals. These findings suggest SIS has adverse consequences on the F0 mothers; but their F1–F3 progeny may adapt to this chronic stress; thus supporting the fetal programming hypothesis.
Collapse
|
22
|
Tsai MS, Newman C, Macdonald DW, Buesching CD. Adverse weather during in utero development is linked to higher rates of later-life herpesvirus reactivation in adult European badgers, Meles meles. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211749. [PMID: 35582658 PMCID: PMC9091846 DOI: 10.1098/rsos.211749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/12/2022] [Indexed: 05/03/2023]
Abstract
Maternal immune and/or metabolic conditions relating to stress or nutritional status can affect in utero development among offspring with subsequent implications for later-life responses to infections. We used free-ranging European badgers as a host-pathogen model to investigate how prenatal weather conditions affect later-life herpesvirus genital tract reactivation. We applied a sliding window analysis of weather conditions to 164 samples collected in 2018 from 95 individuals born between 2005-2016. We test if the monthly mean and variation in rainfall and temperature experienced by their mother during the 12 months of delayed implantation and gestation prior to parturition subsequently affected individual herpes reactivation rates among these offspring. We identified four influential prenatal seasonal weather windows that corresponded with previously identified critical climatic conditions affecting badger survival, fecundity and body condition. These all occurred during the pre-implantation rather than the post-implantation period. We conclude that environmental cues during the in utero period of delayed implantation may result in changes that affect an individual's developmental programming against infection or viral reactivation later in life. This illustrates how prenatal adversity caused by environmental factors, such as climate change, can impact wildlife health and population dynamics-an interaction largely overlooked in wildlife management and conservation programmes.
Collapse
Affiliation(s)
- Ming-shan Tsai
- Department of Zoology, Wildlife Conservation Research Unit, University of Oxford, Recanati-Kaplan Centre, Abingdon Road, Tubney House, Tubney, Oxfordshire OX13 5QL, UK
| | - Chris Newman
- Department of Zoology, Wildlife Conservation Research Unit, University of Oxford, Recanati-Kaplan Centre, Abingdon Road, Tubney House, Tubney, Oxfordshire OX13 5QL, UK
- Cook's Lake Farming Forestry and Wildlife Inc (Ecological Consultancy), Queens County, Nova Scotia, Canada
| | - David W. Macdonald
- Department of Zoology, Wildlife Conservation Research Unit, University of Oxford, Recanati-Kaplan Centre, Abingdon Road, Tubney House, Tubney, Oxfordshire OX13 5QL, UK
| | - Christina D. Buesching
- Cook's Lake Farming Forestry and Wildlife Inc (Ecological Consultancy), Queens County, Nova Scotia, Canada
- Department of Biology, Irving K. Barber Faculty of Science, The University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| |
Collapse
|
23
|
Abbott KM, Boyens BMS, Gubbels JAA. Intergenerational Talking Circles Exploring Psychosocial Stressors for Preterm Birth and Strategies for Resilience among American Indian Women. J Transcult Nurs 2022; 33:268-277. [PMID: 35240887 DOI: 10.1177/10436596221081269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study used phenomenological qualitative research design to understand the primary psychosocial stressors American Indian (AI) women face during pregnancy-factors that may be overlooked as contributing to the community's heightened preterm birth rate-and to identify mechanisms of resilience. METHOD Using Lakota talking circles (TCs) as the data collection method, researchers collected young mothers' and tribal elders' narratives about pregnancy and parenting. Themes were derived and verified from the transcripts. RESULTS During the TCs, the women identified transgenerational/historical trauma and instability in housing, childcare, and relationships as major contributors to pregnancy and parenting stress. DISCUSSION Having overcome obstacles while bearing and raising children, AI women exhibit resilience. Participants indicated that the TCs provided support and a cultural connection, thus serving as both a data collection method and an intervention. Future work will involve using TCs to support young mothers, transmit elder wisdom, and increase resilience among AI women.
Collapse
|
24
|
Hardcastle K, Ford K, Bellis MA. Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting. BMC Pregnancy Childbirth 2022; 22:129. [PMID: 35172776 PMCID: PMC8848970 DOI: 10.1186/s12884-022-04454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention. Methods Secondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers’ ACEs during routine contacts. Demographic data and information on mothers’ health were extracted from the Healthy Child Wales Programme. Results Half of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19–12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81–31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14–6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40–10.80, p = 0.009). Conclusions Findings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04454-z.
Collapse
Affiliation(s)
- Katie Hardcastle
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK.,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| |
Collapse
|
25
|
Eneanya ND, Boulware LE, Tsai J, Bruce MA, Ford CL, Harris C, Morales LS, Ryan MJ, Reese PP, Thorpe RJ, Morse M, Walker V, Arogundade FA, Lopes AA, Norris KC. Health inequities and the inappropriate use of race in nephrology. Nat Rev Nephrol 2022; 18:84-94. [PMID: 34750551 PMCID: PMC8574929 DOI: 10.1038/s41581-021-00501-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race - a socio-political construct that mediates the effect of structural racism - as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.
Collapse
Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leo S Morales
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Ryan
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Morse
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valencia Walker
- Department of Paediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Antonio A Lopes
- Clinical Epidemiology and Evidence-Based Medicine Unit of the Edgard Santos University Hospital and Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Keith C Norris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| |
Collapse
|
26
|
Shynlova O, Nadeem L, Dorogin A, Mesiano S, Lye SJ. The selective progesterone receptor modulator-promegestone-delays term parturition and prevents systemic inflammation-mediated preterm birth in mice. Am J Obstet Gynecol 2022; 226:249.e1-249.e21. [PMID: 34418351 DOI: 10.1016/j.ajog.2021.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Progesterone, acting via its nuclear receptors called progesterone receptors, promotes myometrial relaxation during pregnancy, and suspension of this activity triggers labor. We previously found that 20α-hydroxysteroid dehydrogenase causes a local withdrawal of progesterone in the term and preterm myometrium by converting the progesterone into an inactive form before it accesses the progesterone receptors. OBJECTIVE We hypothesized that a selective progesterone receptor modulator called promegestone, which is not metabolized by 20α-hydroxysteroid dehydrogenase, would sustain progesterone receptor signaling and prevent/delay term labor and preterm labor in mice. STUDY DESIGN In the term labor mouse model, promegestone (0.2 mg/dam) or a vehicle were administered subcutaneously in timed-pregnant CD-1 mice at gestational days 15, 16, and 17 (term gestational days, 19.5). In the inflammation preterm labor model, pregnant mice received promegestone or a vehicle on gestational days 15, 16, and 17, which was 24 hours before, immediately before, and 24 hours after systemic bacterial endotoxin (50 μg intraperitoneal; lipopolysaccharide group) or vehicle (saline) administration. The maternal and fetal tissues were collected on gestational day 16 6 hours after lipopolysaccharide±promegestone injection and at term gestational day 18.75. The protein levels of 10 cytokines were measured by multiplex immunoassay in maternal plasma and amniotic fluid. Myometrial, decidual, and placental messenger RNA levels of multiple cytokines and procontractile proteins were evaluated by real-time polymerase chain reaction and confirmed by immunoblotting. RESULTS Promegestone prevented term labor and maintained mice pregnancy postterm >24 hours. The litter size and fetal weights were not different from the controls. Promegestone prevented systemic bacterial-endotoxin-induced preterm labor in 100% of the mice, blocked uterine contractions, significantly inhibited all systemic inflammation-induced myometrial cytokines, and partially inhibited decidual and placental inflammation. Promegestone did not prevent bacterial-endotoxin-induced fetal toxicity. CONCLUSION Promegestone a selective progesterone receptor modulator that binds progesterone receptors with high affinity and is not metabolized by 20α-hydroxysteroid dehydrogenase could completely suppress term parturition and systemic bacterial-endotoxin-induced preterm birth in mice. We suggest that such selective progesterone receptor modulators may represent a potential therapeutic approach to the prevention of preterm labor in women at high risk of preterm birth.
Collapse
Affiliation(s)
- Oksana Shynlova
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
| | - Lubna Nadeem
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Dorogin
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH
| | - Stephen J Lye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Riddell CA, Goin DE, Morello-Frosch R, Apte JS, Glymour MM, Torres JM, Casey JA. Hyper-localized measures of air pollution and risk of preterm birth in Oakland and San Jose, California. Int J Epidemiol 2022; 50:1875-1885. [PMID: 34999861 PMCID: PMC8932296 DOI: 10.1093/ije/dyab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND US preterm-birth rates are 1.6 times higher for Black mothers than for White mothers. Although traffic-related air pollution (TRAP) may increase the risk of preterm birth, evaluating its effect on preterm birth and disparities has been challenging because TRAP is often measured inaccurately. This study sought to estimate the effect of TRAP exposure, measured at the street level, on the prevalence of preterm birth by race/ethnicity. METHODS We linked birth-registry data with TRAP measured at the street level for singleton births in sampled communities during 2013-2015 in Oakland and San Jose, California. Using logistic regression and marginal standardization, we estimated the effects of exposure to black carbon, nitrogen dioxide and ultrafine particles on preterm birth after confounder adjustment and stratification by race/ethnicity. RESULTS There were 8823 singleton births, of which 760 (8.6%) were preterm. Shifting black-carbon exposure from the 10th to the 90th percentile was associated with: 6.8%age point higher risk of preterm birth (95% confidence interval = 0.1 to 13.5) among Black women; 2.1%age point higher risk (95% confidence interval = -1.1 to 5.2) among Latinas; and inconclusive null findings among Asian and White women. For Latinas, there was evidence of a positive association between the other pollutants and risk of preterm birth, although effect sizes were attenuated in models that co-adjusted for other TRAP. CONCLUSIONS Exposure to TRAP, especially black carbon, may increase the risk of preterm birth for Latina and Black women but not for Asian and White women.
Collapse
Affiliation(s)
- Corinne A Riddell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Dana E Goin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, College of Natural Resources, Policy, & Management, University of California, Berkeley, Berkeley, USA
- Division of Community Health Sciences & Environmental Health Sciences Graduate Group, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Joshua S Apte
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
| |
Collapse
|
28
|
Faraji J, Metz GAS. Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why? Aging Dis 2021; 12:1624-1643. [PMID: 34631211 PMCID: PMC8460299 DOI: 10.14336/ad.2021.0319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.
Collapse
Affiliation(s)
- Jamshid Faraji
- 1Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada.,2Faculty of Nursing & Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gerlinde A S Metz
- 1Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| |
Collapse
|
29
|
Cumulative life stressors and stress response to threatened preterm labour as birth date predictors. Arch Gynecol Obstet 2021; 305:1421-1429. [PMID: 34549310 DOI: 10.1007/s00404-021-06251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Preterm birth represents one of the main causes of neonatal morbimortality and a risk factor for neurodevelopmental disorders. Appropriate predictive methods for preterm birth outcome, which consequently would facilitate prevention programs, are needed. We aim to predict birth date in women with a threatened preterm labour (TPL) based on stress response to TPL diagnosis, cumulative life stressors, and relevant obstetric variables. METHODS A prospective cohort of 157 pregnant women with TPL diagnosis between 24 and 31 weeks gestation formed the study sample. To estimate the stress response to TPL, maternal salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured. To determine cumulative life stressors, previous traumas, social support, and family functioning were registered. Then, linear regression models were used to examine the effect of potential predictors of birth date. RESULTS Lower family adaptation, higher Body Mass Index (BMI), higher cortisol levels and TPL diagnosis week were the main predictors of birth date. Gestational week at TPL diagnosis showed a non-linear interaction with cortisol levels: TPL women with middle- and high-cortisol levels before 29 weeks of gestation went into imminent labour. CONCLUSION A combination of stress response to TPL diagnosis (salivary cortisol) and cumulative life stressors (family adaptation) together with obstetric factors (TPL gestational week and BMI) was the best birth date predictor. Therefore, a psychosocial therapeutic intervention program aimed to increase family adaptation and decrease cortisol levels at TPL diagnosis as well as losing weight, may prevent preterm birth in symptomatic women.
Collapse
|
30
|
Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
Collapse
Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | |
Collapse
|
31
|
Reno R, Burch J, Stookey J, Jackson R, Joudeh L, Guendelman S. Preterm birth and social support services for prenatal depression and social determinants. PLoS One 2021; 16:e0255810. [PMID: 34388192 PMCID: PMC8362957 DOI: 10.1371/journal.pone.0255810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022] Open
Abstract
Preterm birth (PTB; <37 weeks gestation), is a leading cause of infant mortality and morbidity. Among those born preterm, risk increases as gestational age at birth decreases. Psychosocial factors such as depression symptoms and social determinants of health (SDH) may increase risk for PTB. Research is needed to understand these risk factors and identify effective interventions. This retrospective cohort study recruited English- and Spanish-speaking women presenting symptoms of preterm labor or admitted for PTB from an urban county hospital in the San Francisco Bay Area (n = 47). We used an iterative analytic approach by which qualitative data informed an exploratory quantitative analysis. Key exposures were presence of self-reported depression symptoms during pregnancy, SDH along eight domains, and receipt of behavioral health services. The outcome was gestational age at birth. T-tests, Wilcoxon rank sum tests, and linear regression models were used to test associations between the exposures and gestational age. Most participants were Black (25.5%) or Latina (59.6%). After adjusting for covariates, participants with depression symptoms had an average gestational age 3.1 weeks shorter (95% CI: -5.02, -1.20) than women reporting no symptoms. After adjusting for covariates, high number of adverse social determinants (≥ 4) suggested an association with shorter gestational age (p = 0.07, 1.65 weeks, 95% CI: -3.44, 0.14). Receipt of behavioral health services was associated with a significantly later gestational age; the median difference was 5.5 weeks longer for depression symptoms, 3.5 weeks longer for high social determinants, and 6 weeks longer for depression symptoms and high social determinants. Among a cohort of high-risk pregnant women, both depression symptoms during pregnancy and co-occurring with exposure to high adverse SDH are associated with shorter gestational age at birth, after controlling for psychosocial factors. Receipt of behavioral health services may be an effective intervention to address disparities in PTB.
Collapse
Affiliation(s)
- Rebecca Reno
- Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Johanna Burch
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jodi Stookey
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Rebecca Jackson
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Layla Joudeh
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Sylvia Guendelman
- Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| |
Collapse
|
32
|
Ansari A, Bose S, You Y, Park S, Kim Y. Molecular Mechanism of Microbiota Metabolites in Preterm Birth: Pathological and Therapeutic Insights. Int J Mol Sci 2021; 22:8145. [PMID: 34360908 PMCID: PMC8347546 DOI: 10.3390/ijms22158145] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
Preterm birth (PTB) refers to the birth of infants before 37 weeks of gestation and is a challenging issue worldwide. Evidence reveals that PTB is a multifactorial dysregulation mediated by a complex molecular mechanism. Thus, a better understanding of the complex molecular mechanisms underlying PTB is a prerequisite to explore effective therapeutic approaches. During early pregnancy, various physiological and metabolic changes occur as a result of endocrine and immune metabolism. The microbiota controls the physiological and metabolic mechanism of the host homeostasis, and dysbiosis of maternal microbial homeostasis dysregulates the mechanistic of fetal developmental processes and directly affects the birth outcome. Accumulating evidence indicates that metabolic dysregulation in the maternal or fetal membranes stimulates the inflammatory cytokines, which may positively progress the PTB. Although labour is regarded as an inflammatory process, it is still unclear how microbial dysbiosis could regulate the molecular mechanism of PTB. In this review based on recent research, we focused on both the pathological and therapeutic contribution of microbiota-generated metabolites to PTB and the possible molecular mechanisms.
Collapse
Affiliation(s)
- AbuZar Ansari
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Shambhunath Bose
- Department of Bioscience, Sri Sathya Sai University for Human Excellence, Navanihal, Okali Post, Kamalapur, Kalaburagi, Karnataka 585313, India;
| | - Youngah You
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Sunwha Park
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Youngju Kim
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| |
Collapse
|
33
|
Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. J Pediatr Psychol 2021; 46:801-813. [PMID: 34304270 DOI: 10.1093/jpepsy/jsab027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/16/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. METHODS A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. RESULTS Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39). CONCLUSIONS The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.
Collapse
Affiliation(s)
| | - Karina M Shreffler
- Department of Human Development and Family Science, Oklahoma State University
| | - Stacy Tiemeyer
- Center for Integrative Research on Childhood Adversity, Oklahoma State University-Center for Health Sciences
| |
Collapse
|
34
|
Hyde A, Verstraeten BSE, Olson JK, King S, Brémault-Phillips S, Olson DM. The Fort McMurray Mommy Baby Study: A Protocol to Reduce Maternal Stress Due to the 2016 Fort McMurray Wood Buffalo, Alberta, Canada Wildfire. Front Public Health 2021; 9:601375. [PMID: 34222163 PMCID: PMC8249202 DOI: 10.3389/fpubh.2021.601375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study. Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted. Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.
Collapse
Affiliation(s)
- Ashley Hyde
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Joanne K Olson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
35
|
Jain D, Jain AK, Metz GAS, Ballanyi N, Sood A, Linder R, Olson DM. A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:673118. [PMID: 36304060 PMCID: PMC9580833 DOI: 10.3389/frph.2021.673118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population. Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA. Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.
Collapse
Affiliation(s)
- Divyanu Jain
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- *Correspondence: Divyanu Jain
| | - Ajay K. Jain
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
- IVF Center, Muzaffarnagar Medical College, Muzaffarnagar, India
| | - Gerlinde A. S. Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Nina Ballanyi
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Abha Sood
- Department of Obstetrics & Gynecology and In-vitro Fertilization Center, Jaipur Golden Hospital, New Delhi, India
| | - Rupert Linder
- Specialist for Gynecology, Obstetrics, Psychosomatics and Psychotherapy, Birkenfeld, Germany
| | - David M. Olson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
36
|
Mekonnen ZK, Oehlert JW, Eskenazi B, Shaw GM, Balmes JR, Padula AM. The relationship between air pollutants and maternal socioeconomic factors on preterm birth in California urban counties. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:503-513. [PMID: 33859340 PMCID: PMC8134052 DOI: 10.1038/s41370-021-00323-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Preterm birth is the leading cause of perinatal morbidity and mortality in the U.S. and disparities among racial and ethnic groups persist. While etiologies of preterm birth have not been fully elucidated, it is probable that environmental and social factors play a role. OBJECTIVE We hypothesized that there is an interactive association between exposure to fine particulate matter (PM2.5) or ozone (O3) and neighborhood socioeconomic factors that increase the risk of preterm birth. METHODS We conducted a retrospective study using geocoded birth certificate data between 2007 and 2011, daily ambient air quality data on PM2.5 and O3, and American Community Survey (2007-2011 5-year estimates) data to assess census tract-level socioeconomic factors in California urban counties. RESULTS Our study found a small positive association between maternal exposures to PM2.5 and O3 and preterm birth that varied by gestational exposure period. In mixed-effects models, we found an increase in the risk of preterm birth for a one-unit change in PM2.5 averaged across the entire pregnancy (AOR = 1.02, 95% CI: 1.01, 1.02) and O3 during 3-months pre-pregnancy (AOR = 1.03, 95% CI: 1.02, 1.04). Interaction between census tract-level factors and air pollutants showed an increase in the risk of preterm birth among mothers living in higher socioeconomic areas, though, a fixed cohort bias sensitivity analysis showed these associations were not significant. SIGNIFICANCE These findings substantiate previous studies that showed associations between air pollution and preterm birth, even as pollution levels have decreased. This study has important implications for policy decisions and may help inform research on potential mechanisms of preterm birth.
Collapse
Affiliation(s)
- Zesemayat K Mekonnen
- University of California Berkeley-University of California San Francisco Joint Medical Program, Berkeley, CA, USA
| | - John W Oehlert
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA, USA
| | - Brenda Eskenazi
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA, USA
| | - John R Balmes
- University of California Berkeley-University of California San Francisco Joint Medical Program, Berkeley, CA, USA
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
37
|
Shamblaw AL, Sommer JL, Reynolds K, Mota N, Afifi TO, El-Gabalawy R. Pregnancy and obstetric complications in women with a history of childhood maltreatment: Results from a nationally representative sample. Gen Hosp Psychiatry 2021; 70:109-115. [PMID: 33799106 DOI: 10.1016/j.genhosppsych.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION A history of childhood maltreatment is associated with increased risk of perinatal complications, with research primarily focused on childhood sexual abuse. Limited research has examined the relationship between different types of childhood maltreatment on perinatal complications, particularly in population-based samples. METHODS This study examined the association between childhood maltreatment and self-reported perinatal complications in a sample of pregnant and postpartum women (n = 1279) drawn from the 2012-2013 NESARC-III, a nationally representative survey of United States adults. RESULTS Nearly half (45%) of pregnant or postpartum women reported at least one form of childhood maltreatment and a quarter (24.6%) of these women experienced a perinatal complication compared to 13.5% of women without a history of childhood maltreatment. Exposure to any childhood maltreatment, childhood sexual abuse and intimate partner violence (IPV) during childhood were significantly associated with increased odds of perinatal complications after adjusting for sociodemographic characteristics and lifetime psychiatric disorders (AOR ranged from 1.87 to 2.09). Experiencing two or more types of childhood maltreatment (compared to none) was also associated with increased odds of perinatal complications (AOR 2.18 [99% CI = 1.22, 3.90]). CONCLUSIONS This association may be explained by vulnerability to physical diseases/complications due to persistent changes in biological stress systems, physical injuries from abuse, or as a result of traumatic memories triggered by pregnancy and childbirth. Findings highlight one of many negative sequelae of childhood maltreatment and the importance of promoting healthcare provider awareness of this association so they can provide appropriate interventions when needed.
Collapse
Affiliation(s)
- Amanda L Shamblaw
- Department of Clinical Health Psychology, University of Manitoba, Canada; Department of Psychology, University of Toronto Scarborough, Canada
| | - Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Canada; Department of Psychology, University of Manitoba, Canada
| | | | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Canada; Department of Psychiatry, University of Manitoba, Canada
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Canada; Department of Psychology, University of Manitoba, Canada; Department of Psychiatry, University of Manitoba, Canada.
| |
Collapse
|
38
|
Berry OO, Londoño Tobón A, Njoroge WFM. Social Determinants of Health: the Impact of Racism on Early Childhood Mental Health. Curr Psychiatry Rep 2021; 23:23. [PMID: 33712922 DOI: 10.1007/s11920-021-01240-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Despite increased literature on the impact of racism in the past decades, relatively few studies have focused on the effects of racism on younger children. This article reviews research from the past 5 years focusing on the impact of racism on infant and early childhood mental health and socioemotional development. RECENT FINDINGS Longitudinal studies provide evidence that very young children are highly influenced by exposure to multiple and interconnecting levels of racism and discrimination. These forms of exposure (structural and personally mediated, which can be further divided into direct and indirect exposure) are particularly nefarious to young children's socioemotional development and have implications for adolescent and adult mental health with lasting sequelae. Furthermore, the effects of racism on parenting practices and maternal/caregiver mental health appear to indicate mechanisms through which racism affects young children. Although more studies are needed in this area, recent literature indicates that racism is a social determinant of health that adversely impacts infant and early childhood socioemotional, and behavioral development. Future studies should focus on understanding the mechanisms through which racism impacts early childhood development and health, and interventions to prevent and mitigate the effects of racism.
Collapse
Affiliation(s)
- Obianuju O Berry
- Department of Child Psychiatry, New York University, New York, NY, USA. .,Office of Behavioral Health, New York Health + Hospital, New York, NY, USA.
| | - Amalia Londoño Tobón
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wanjikũ F M Njoroge
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
39
|
Larrabee Sonderlund A, Schoenthaler A, Thilsing T. The Association between Maternal Experiences of Interpersonal Discrimination and Adverse Birth Outcomes: A Systematic Review of the Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041465. [PMID: 33557227 PMCID: PMC7913961 DOI: 10.3390/ijerph18041465] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
In the present systematic review, we argue that maternal experiences of interpersonal discrimination at least partially account for the disproportionate rates of adverse birth outcomes in minority populations. Since the 1990s, research in this area has slowly, but steadily increased, shedding more light on the insidious nature of interpersonal discrimination and its toxic health effects. With the aim of bringing this topic to the fore in academic as well as clinical settings, this paper provides a state-of-the-art review of the empirical knowledge on the relationship between maternal experiences of discrimination and birth outcomes. Of 5901 articles retained in the literature search, 28 met the predefined inclusion criteria. Accounting for a range of health and behavioral factors, the vast majority of these studies support the notion that maternal experiences of interpersonal discrimination predict a range of adverse birth outcomes, including preterm birth, low birth weight, and various physiological markers of stress (allostatic load) in both mother and child pre- and postpartum. Several moderators and mediators of this relationship were also identified. These related primarily to the type (first-hand and vicarious), timing (childhood, adolescence, and adulthood), frequency, and pervasiveness of discrimination experienced, as well as to maternal mental health and coping. More research into these factors, however, is required to definitively determine their significance. We discuss these findings as they relate to the general health repercussions of interpersonal discrimination, as well as in terms of applied prenatal care and interventions. Ultimately, we argue that assessing maternal experiences of interpersonal discrimination in prenatal care may represent a considerable asset for mitigating existing majority-minority disparities in adverse birth outcomes.
Collapse
Affiliation(s)
| | | | - Trine Thilsing
- Department of Public Health, University of Southern Denmark, 5230 Odense, Denmark;
| |
Collapse
|
40
|
Racial/ethnic differences in maternal resilience and associations with low birthweight. J Perinatol 2021; 41:196-203. [PMID: 33028937 PMCID: PMC7889645 DOI: 10.1038/s41372-020-00837-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Evaluate racial/ethnic differences in maternal resilience and its associations with low birthweight (LBW). STUDY DESIGN Retrospective cohort study of 3244 women surveyed in the Longitudinal Study of Adolescent to Adult Health. The Add Health Resilience Instrument assessed resilience. Logistic regression models explored associations between women's resilience and risk of LBW. RESULT Resilience scores were lowest in American Indian women. Women with the lowest resilience scores were more likely to deliver a LBW infant than highly resilient women, after adjusting for demographic and health-related factors (aOR 1.58 95% CI 1.05-2.38). The risk-adjusted rate of LBW among highly resilient Black women (15.6%) was significantly higher than the risk-adjusted rate of LBW among highly resilient white women (9.1%, p = 0.01) and highly resilient Hispanic women (8.6%, p = 0.04). CONCLUSION Resilience scores differ significantly among women of different race and ethnicity but do not appear to entirely account for racial/ethnic disparities in LBW.
Collapse
|
41
|
Riggan KA, Gilbert A, Allyse MA. Acknowledging and Addressing Allostatic Load in Pregnancy Care. J Racial Ethn Health Disparities 2021; 8:69-79. [PMID: 32383045 PMCID: PMC7647942 DOI: 10.1007/s40615-020-00757-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.
Collapse
Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Anna Gilbert
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
42
|
Fryer KE, Vines AI, Stuebe AM. A Multisite Examination of Everyday Discrimination and the Prevalence of Spontaneous Preterm Birth in African American and Latina Women in the United States. Am J Perinatol 2020; 37:1340-1350. [PMID: 31365929 DOI: 10.1055/s-0039-1693696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE African American women have a higher risk of spontaneous preterm birth than White and Latina women. Although Latina women are exposed to similar social determinants of health, they have lower rates of spontaneous preterm birth. One theory for this difference is the maternal stress biological pathway, whereby lifetime stressors, such as racial discrimination, lead to a premature activation of parturition. We investigated the prevalence of self-reported discrimination and its association with the prevalence of spontaneous preterm birth. STUDY DESIGN Using data from the Community Child Health Research Network Study, a multisite cohort study from 2008 to 2012, we conducted a cross-sectional analysis of 1,154 African American women and 578 Latina women. RESULTS Adjusting for multiple risk factors, African American and Latina women who experienced the highest tertile of discrimination had a higher prevalence of preterm birth compared with those who experienced discrimination less than once per year, adjusted hazard ratio (aHR) = 1.5 (0.7-3.1) and 3.6 (0.9-14.4), respectively. CONCLUSION In our cohort, we found a statistically significant association only in the medium discrimination group in Latina women, but we did not find a statistically significant association in African American women. Reduction in experienced discrimination may be an important intervention for reducing adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Kimberly E Fryer
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
43
|
Jack-Roberts C, Maples P, Kalkan B, Edwards K, Gilboa E, Djuraev I, Zou S, Hoepner L, Fordjour L, Lee WC, Kral J, Dalloul M, Jiang X. Gestational diabetes status and dietary intake modify maternal and cord blood allostatic load markers. BMJ Open Diabetes Res Care 2020; 8:8/1/e001468. [PMID: 33093129 PMCID: PMC7583070 DOI: 10.1136/bmjdrc-2020-001468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Allostatic load (AL) defines cardiometabolic, inflammatory, and neuroendocrine changes in the body in response to internal and external stressors. It is largely unknown whether gestational diabetes mellitus (GDM) alters maternal and fetal AL, which in turn affects GDM outcomes. Whether dietary intakes and quality can modify AL and thus influence GDM progression is also unknown. RESEARCH DESIGN AND METHODS In this study, we recruited 35 GDM and 30 non-GDM women in gestational week 25-33. Fasting blood samples were collected at enrollment, and cord venous blood samples were collected at delivery for the measurement of a series of AL biomarkers to calculate the composite AL index. Three-day dietary recalls were conducted at enrollment. RESULTS Results suggest that GDM women had 60% higher composite AL index scores (p value=0.01). Maternal AL index was associated with shorter duration of gestation (β=-0.33, p value=0.047) and higher fetal AL index (β=0.47, p value=0.006) after adjusting for GDM status. Dietary intake of monounsaturated fatty acids was negatively associated with maternal AL index (β=-0.20, p value=0.006). GDM women had lower total caloric intake and dietary glycemic load, yet their linolenic acid, vitamin C and E intakes were also decreased (all p value<0.05). These dietary differences were not related to birth outcomes measured. CONCLUSIONS In this study, GDM status and dietary intakes modify AL in this population. AL may serve as an indicator of GDM control. Future research on dietary interventions that can improve maternal AL markers during GDM is warranted.
Collapse
Affiliation(s)
| | - Patricia Maples
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Betul Kalkan
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Kaydine Edwards
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Ella Gilboa
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Ikhtiyor Djuraev
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| | - Shuli Zou
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lori Hoepner
- Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lawrence Fordjour
- Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Wen-Ching Lee
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - John Kral
- Department of Surgery, Medicine, and Cell Biology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mudar Dalloul
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Xinyin Jiang
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York, USA
| |
Collapse
|
44
|
Weber KA, Carmichael SL, Yang W, Tinker SC, Shaw GM. Periconceptional stressors and social support and risk for adverse birth outcomes. BMC Pregnancy Childbirth 2020; 20:487. [PMID: 32831042 PMCID: PMC7446063 DOI: 10.1186/s12884-020-03182-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022] Open
Abstract
Background The prevalence of preterm birth and low birth weight has been increasing slightly in recent years. A few studies have suggested that psychosocial stress during pregnancy may increase risk for these adverse birth outcomes. To extend those observations, we analyzed various major life event stressors separately and cumulatively as potential risk factors for preterm birth and low birth weight using granular categories of each outcome in a large, population-based study. Additionally, we assessed if greater social support buffered any effects. Methods Data were from a nested prevalence study of 4395 women in the National Birth Defects Prevention Study who delivered live-born non-malformed infants (controls) between 2006 and 2011. Participants completed a standardized, computer-assisted interview between 6 weeks and 24 months after delivery that included questions on stress and social support from 3 months before pregnancy to the 3rd month of pregnancy. Cumulative stress and support indices were also calculated. Preterm birth was divided into “early preterm” (< 32 weeks), “late preterm” (32–36 weeks) and “term.” Low birthweight was divided into “very low birth weight” (< 1500 g), “low birth weight” (1500–2499 g) and “normal birth weight” (≥2500 g). Relative risks and 95% confidence intervals (95% CI) were calculated using Poisson regression. Results For women reporting relationship difficulties, there was a suggestive risk of early preterm birth (RR: 1.9, 95%CI: 0.9–3.9) and very low birthweight (RR: 2.0, 95%CI: 0.9–4.4). For women reporting that they or someone close to them were victims of abuse, violence, or crime, there was an increased risk of low birthweight (RR: 1.8, 95%CI: 1.1–2.7) and late preterm birth (RR: 1.5, 95%CI: 1.0–2.2). There were no strong associations observed between social support questions and the various outcomes. Conclusions Our results add some support to prior evidence that certain stressors may be associated with increase selected adverse birth outcomes risk. We did not find strong evidence that social support buffered the observed risks in our study.
Collapse
Affiliation(s)
- Kari A Weber
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road x1C21, Stanford, California, 94305, USA.
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road x1C21, Stanford, California, 94305, USA
| | - Wei Yang
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road x1C21, Stanford, California, 94305, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road x1C21, Stanford, California, 94305, USA
| | | |
Collapse
|
45
|
Buen M, Amaral E, Souza RT, Passini R, Lajos GJ, Tedesco RP, Nomura ML, Dias TZ, Rehder PM, Sousa MH, Cecatti JG. Maternal Work and Spontaneous Preterm Birth: A Multicenter Observational Study in Brazil. Sci Rep 2020; 10:9684. [PMID: 32546709 PMCID: PMC7297738 DOI: 10.1038/s41598-020-66231-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Spontaneous preterm birth (sPTB) is a major pregnancy complication involving biological, social, behavioural and environmental mechanisms. Workload, shift and intensity may play a role in the occurrence of sPTB. This analysis is aimed addressing the effect of occupational activities on the risk for sPTB and the related outcomes. We conducted a secondary analysis of the EMIP study, a Brazilian multicentre cross-sectional study. For this analysis, we included 1,280 singleton sPTB and 1,136 singleton term birth cases. Independent variables included sociodemographic characteristics, clinical complications, work characteristics, and physical effort devoted to household chores. A backward multiple logistic regression analysis was applied for a model using work characteristics, controlled by cluster sampling design. On bivariate analysis, discontinuing work during pregnancy and working until the 7th month of pregnancy were risks for premature birth while working during the 8th - 9th month of pregnancy, prolonged standing during work and doing household chores appeared to be protective against sPTB during pregnancy. Previous preterm birth, polyhydramnios, vaginal bleeding, stopping work during pregnancy, or working until the 7th month of pregnancy were risk factors in the multivariate analysis. The protective effect of variables compatible with exertion during paid work may represent a reverse causality. Nevertheless, a reduced risk associated with household duties, and working until the 8th-9th month of pregnancy support the hypothesis that some sort of physical exertion may provide actual protection against sPTB.
Collapse
Affiliation(s)
- Mariana Buen
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Eliana Amaral
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Renato T Souza
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Renato Passini
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | | | - Marcelo L Nomura
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Tábata Z Dias
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | - Patrícia M Rehder
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil
| | | | - José Guilherme Cecatti
- Department of Obstetrics & Gynecology, University of Campinas (Unicamp), School of Medicine, São Paulo, Brazil.
| | | |
Collapse
|
46
|
Corwin E, Dunlop AL, Fernandes J, Li S, Pearce B, Jones DP. Metabolites and metabolic pathways associated with glucocorticoid resistance in pregnant African-American women. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2020; 1-2. [PMID: 33693436 PMCID: PMC7943062 DOI: 10.1016/j.cpnec.2020.100001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Glucocorticoid resistance (GR) is associated with exposure to chronic stress and an increased risk of metabolic and inflammatory disorders in both animal and human populations. Studies on ethnic disparities highlight the African-American (AA) population as having a high propensity to both GR and chronic stress exposure. Glucocorticoids and inflammation play a very important role in pregnancy outcome and fetal development. To date, however, the metabolites and metabolic pathways associated with GR during pregnancy have not been identified, obscuring the mechanisms by which adverse health consequences arise, and thus impeding targeted therapeutic intervention. The objective of this study was to perform untargeted high-resolution metabolomics (HRM) profiling on 273 pregnant AA women, to identify metabolites and metabolic pathways associated with GR during the first trimester of pregnancy and to evaluate their cross-sectional association with birth outcomes and psychosocial variables related to chronic stress exposure. For this study, GR was determined by the concentration of dexamethasone required for 50% inhibition (Dex IC50) of the cytokine tumor-necrosis factor alpha (TNF-alpha) release in vitro in response to a standard dose of lipopolysaccharide. The results for Metabolome-Wide Association Studies (MWAS) and pathway enrichment analysis for serum metabolic associations with Dex IC50, showed energy (nicotinamide and TCA cycle), amino acid, and glycosphingolipid metabolism as top altered pathways. Bioinformatic analysis showed that GR, as indicated by elevated Dex IC50 in the pregnant women, was associated with increased inflammatory metabolites, oxidative stress related metabolites, increased demand for functional amino acids to support growth and development, and disruption in energy-related metabolites. If confirmed in future studies, targeting these physiologically significant metabolites and metabolic pathways may lead to future assessment and intervention strategies to prevent inflammatory and metabolic complications observed in pregnant populations. GR is associated with chronic stress and is a risk factor for adverse health outcomes, especially among African Americans. Metabolites and metabolic pathways associated with GR relate to energy production, amino acid metabolism, and inflammation. Findings provide a foundation for future studies investigating risk factors in this health disparity population.
Collapse
Affiliation(s)
| | - Anne L Dunlop
- Emory University School of Medicine and School of Nursing, Emory University, United States
| | | | - Shuzhao Li
- School of Medicine, Emory University, United States
| | - Bradley Pearce
- Rollins School of Public Health, Emory University, United States
| | - Dean P Jones
- School of Medicine, Emory University, United States
| |
Collapse
|
47
|
Aker A, McConnell RER, Loch-Caruso R, Park SK, Mukherjee B, Rosario ZY, Vélez-Vega CM, Huerta-Montanez G, Alshawabkeh AN, Cordero JF, Meeker JD. Interactions between chemicals and non-chemical stressors: The modifying effect of life events on the association between triclocarban, phenols and parabens with gestational length in a Puerto Rican cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 708:134719. [PMID: 31785910 PMCID: PMC6957748 DOI: 10.1016/j.scitotenv.2019.134719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 04/13/2023]
Abstract
BACKGROUND Phenols and parabens are common additives to consumer products. There is evidence of adverse birth outcomes in association with prenatal exposure to these chemicals, in addition to psychosocial factors. We previously reported an increase in gestational length with bisphenol-A, methylparaben and propylparaben, and a decrease in gestational length with triclocarban. OBJECTIVES We examined the modifying effect of psychosocial stress on the association between chemicals and gestational length in up to 752 women among a pregnancy cohort study. METHODS Urinary biomarkers were measured at up to three time points in pregnancy. Multiple linear regression models were conducted to investigate the association between gestational length and the interaction between average exposure biomarkers and LES. Multiple linear regression models regressing the exposure biomarkers in relation to gestational length were also stratified by LES, Negative LES, and Positive LES, based on the subjective ratings of events. Results were transformed into the change in gestational length for an inter-quartile-range difference in the exposure. RESULTS Of the four psychosocial stress measures, only the life events score (LES) was a significant modifier. Associations between triclocarban, bisphenol-S, methyl- and propylparaben in relation to gestational length were stronger among women with negative Total LES scores. Among women with negative Total LES scores, bisphenol-S and triclocarban were associated with a 3-5 day decrease in gestational length [(-3.15; 95% CI: -6.06, -0.24); (-4.68; 95% CI: -8.47, -0.89)], whereas methylparaben and propylparaben were associated with a 2-3 day increase in gestational length [(2.21; 95% CI: 0.02, 4.40); (2.92; 95% CI: 0.58, 5.26)]. Significant interactions were driven by negative life events, but the association with triclocarban was driven by few positive life events. CONCLUSIONS Associations between exposure biomarkers and gestational length were stronger in the presence of negative life events. This provides evidence that stress makes the body more vulnerable to chemical exposure.
Collapse
Affiliation(s)
- Amira Aker
- Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Rafael E Rios McConnell
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Rita Loch-Caruso
- Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Sung Kyun Park
- Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Zaira Y Rosario
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Carmen M Vélez-Vega
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | | | | | - José F Cordero
- College of Public Health, Athens, University of Georgia, GA, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA.
| |
Collapse
|
48
|
Verstraeten BSE, McCreary JK, Weyers S, Metz GAS, Olson DM. Prenatal two-hit stress affects maternal and offspring pregnancy outcomes and uterine gene expression in rats: match or mismatch? Biol Reprod 2020; 100:195-207. [PMID: 30084951 DOI: 10.1093/biolre/ioy166] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/29/2018] [Indexed: 01/01/2023] Open
Abstract
Maternal stress and inflammation excesses can lead to adverse pregnancy outcomes and offspring development. We evaluated whether distinct prenatal stressors affect pregnancy, maternal and offspring outcomes, and uterine gene expression differently when combined than either alone. Long-Evans dams were exposed to psychological or/and (two-hit) immune stress (interleukin-1 beta [IL-1β]), on gestational days 12-18 and 17-delivery, respectively. Gestational length, maternal weight gain, glycaemia and corticosterone levels, offspring weight, and gender effects were recorded. Maternal and offspring uteri were collected at weaning and on postnatal day 160 correspondingly. Uterine expression of genes involved in local progesterone metabolism, neuroendocrine and immune systems were analyzed using quantitative real-time polymerase chain reaction. Maternal two-hit stress increased gestational length variation and the occurrence of adverse pregnancy outcomes while reducing gestational weight gain. Pup weight was negatively affected by prenatal stressors in a gender-specific way. In dams, IL-1β upregulated gene expression of neuroendocrine (Crh, Crhr1) and cytokine genes (Il1b, Il1rn, Il6, and Il10). Conversely, transcriptional patterns in offspring uteri were more variable with gene-specific up- or downregulation by each stressor separately, while exposure to both extensively reduced the expression of neuroendocrine (Hsd11b1), cytokine (Il1a, Il1rn, Il6), and IL-1 receptor genes. In conclusion, maternal stress affects physiological and molecular processes in dams and their offspring; two hits have different effects than single stressors. Outcomes appear generation-, gender-, and stressor-specific. Dampening of offspring uterine gene expression after exposure to multiple stressors could fit within the match/mismatch hypothesis of perinatal programming, with offspring preparing for a stressful life.
Collapse
Affiliation(s)
- Barbara S E Verstraeten
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.,Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - J Keiko McCreary
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Steven Weyers
- Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - David M Olson
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.,Departments of Pediatrics and Physiology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
49
|
Racial disparities in pregnancy outcomes: genetics, epigenetics, and allostatic load. CURRENT OPINION IN PHYSIOLOGY 2020. [DOI: 10.1016/j.cophys.2019.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
50
|
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.
Collapse
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
| |
Collapse
|