Association between maternal depression symptoms and child telomere length

The biological mechanisms that explain how adverse early life events influence adult disease risk are poorly understood. One proposed mechanism is via the induction of accelerated biological aging, for which telomere length is considered a biomarker. We aimed to determine if maternal depression pre- and post-partum was associated with telomere length in children at 4 years of age (n = 4299). Mothers completed structured questionnaires assessing depression during pregnancy (Edinburgh Depression Scale), at 9 months (Edinburgh Depression Scale), and at 54 months postpartum (Patient Health Questionnaire 9). Regression methods were used to investigate the relationship between telomere length (DNA from saliva) and maternal depression score recorded at each stage. Significant covariates included in the final model were: maternal age at pregnancy; child sex; child ethnicity; gestational age group, and rurality group. Child telomere length was found to be longer if their mother had a higher depression score at both postpartum time points tested (9 months of age; coefficient 0.003, SE = 0.001, P = 0.01, 54 months of age; coefficient 0.003, SE = 0.002, P = 0.02). Although these findings seem paradoxical, increased telomere length may be an adaptive response to early life stressors. We propose several testable hypotheses for these results and to determine if the positive association between depression and telomere length is a developmental adaptation or an indirect consequence of environmental factors.

A longitudinal study of how women's prenatal and postnatal concerns related to the COVID-19 pandemic predicts their infants' social-emotional development

Infant social-emotional development may be impacted by the COVID-19 pandemic. This study investigated associations between maternal pre- and postnatal pandemic-related concerns and social-emotional developmental risk. Data, collected in 2020-2021, came from 220 mothers (87% white, 6% Hispanic, 1% Black, 3% Asian, 1% American Indian, Mage  = 32.46 years), and infants (53.18% male, Mage  = 12.98 months) in the United States. Maternal postnatal pandemic-related concerns were associated with total risk scores (B = 6.09, p-value <.001) and offspring risk of scoring positive for problems related to inflexibility (B = 4.07, p-value = .006). The total score association was moderated by self-reported social support. Infants may be detrimentally impacted by the pandemic via maternal pandemic-related concerns. Maternal social support may buffer infants.

Associations between duration of first trimester intrauterine exposure to genocide against the Tutsi and health outcomes in adulthood

OBJECTIVES

Hundreds of thousands of Rwandans were conceived during the 1994 genocide against the Tutsi, including thousands conceived by genocidal rape. We explore whether the duration of first trimester exposure to the genocide is associated with variation in adult mental health outcomes in individuals exposed to varying degrees of genocide-related stress in utero.

MATERIALS AND METHODS

We recruited 30 Rwandans conceived via genocidal rape, 31 Rwandans conceived by genocide survivors not raped, and 30 individuals of Rwandan-descent who were conceived outside of Rwanda at the time of the genocide (control group). Individuals were age- and sex-matched across groups. Adult mental health was assessed through standardized questionnaires for vitality, anxiety, and depression.

RESULTS

Among the genocide only group, a longer duration of first trimester prenatal exposure was associated with higher anxiety scores and lower vitality (both p < 0.010), and higher depression scores (p = 0.051). Duration of first trimester exposure was not associated with any measures of mental health among the genocidal rape or control group.

DISCUSSION

Duration of exposure to genocide in the first trimester of gestation was associated with variation in adult mental health among the genocide only group. The lack of association between duration of first trimester exposure to genocide and adult mental health in the genocidal rape group may reflect the fact that stress associated with conception through rape persisted beyond the genocide period itself, encompassing all of gestation and likely beyond. Geopolitical and community interventions are needed in the context of extreme events during pregnancy to mitigate adverse intergenerational outcomes.

Childbirth fear in the USA during the COVID-19 pandemic: key predictors and associated birth outcomes

Background and objectives

Childbirth fear, which has been argued to have an adaptive basis, exists on a spectrum. Pathologically high levels of childbirth fear is a clinical condition called tokophobia. As a chronic stressor in pregnancy, tokophobia could impact birth outcomes. Many factors associated with tokophobia, including inadequate labor support, were exacerbated by the COVID-19 pandemic.

Methodology

We used longitudinally collected data from a convenience sample of 1775 pregnant persons in the USA to evaluate the association between general and COVID-19 pandemic-related factors and tokophobia using the fear of birth scale. We also assessed associations between tokophobia, low birth weight and preterm birth when adjusting for cesarean section and other covariates among a subset of participants (N = 993).

Results

Tokophobia was highly prevalent (62%). Mothers who self-identified as Black (odds ratio (OR) = 1.90), had lower income (OR = 1.39), had less education (OR = 1.37), had a high-risk pregnancy (OR = 1.65) or had prenatal depression (OR = 4.95) had significantly higher odds of tokophobia. Concerns about how COVID-19 could negatively affect maternal and infant health and birth experience were also associated with tokophobia (ORs from 1.51 to 1.79). Tokophobia was significantly associated with increased odds of giving birth preterm (OR = 1.93).

Conclusions and implications

Tokophobia increases the odds of preterm birth and is more prevalent among individuals who are Black, have a lower income, and have less education. Tokophobia may, therefore, be an underappreciated contributor to inequities in US birth outcomes. The COVID-19 pandemic likely compounded these effects.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

BACKGROUND

The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores.

METHODS

This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey.

RESULTS

Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05).

CONCLUSIONS

The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

Children born of genocidal rape: What do we know about their experiences and needs?

BACKGROUND

An often under addressed and tragic legacy of genocide is the conception of children from rape. While the experience has been documented from their mothers' perspective, the perspectives and needs of individuals born of genocidal rape has been under-studied.

METHODS

We conducted an integrative review of all peer-reviewed articles that reported on studies conducted among individuals born of genocidal rape published through 2020. We used an inductive process to identify and describe the themes from those studies.

RESULTS

Twelve studies met the inclusion criteria. Ten articles reported on youth born of genocidal rape in Rwanda aged between 16 and 21 years, and two articles represented the perspective of adolescents in the former Yugoslavia aged 1416 years. Four themes were indentified: (1) birth origin stories associated with the crime of the father, (2) fractured sense of belonging to the victim-mother, perpetrator-father, their families, and the community at large, (3) intergenerational legacy of trauma and family identity, and (4) strategies to move forward including knowing the truth about one's origin, mental health, and peer support.

CONCLUSION

These findings suggest that understanding increased risk of adverse health outcomes of youth born of genocidal rape could inform the design of evidence-based interventions for these and similar populations.

A transdisciplinary approach to understand the epigenetic basis of race/ethnicity health disparities

Health disparities correspond to differences in disease burden and mortality among socially defined population groups. Such disparities may emerge according to race/ethnicity, socioeconomic status and a variety of other social contexts, and are documented for a wide range of diseases. Here, we provide a transdisciplinary perspective on the contribution of epigenetics to the understanding of health disparities, with a special emphasis on disparities across socially defined racial/ethnic groups. Scientists in the fields of biological anthropology, bioinformatics and molecular epidemiology provide a summary of theoretical, statistical and practical considerations for conducting epigenetic health disparities research, and provide examples of successful applications from cancer research using this approach.

Protective resources that promote wellbeing among New Zealand moms with young children facing socioeconomic disadvantage

Poor maternal mental health and well-being during early stages of parenting impact child developmental outcomes. The primary objective of this study was to explore protective resources that may confer resilience among mothers living in low resourced neighborhoods in New Zealand. A purposive, non-probabilistic sampling method was used to recruit an ethnically representative sample of mothers with children under the age of five living in high deprivation neighborhoods in Auckland, New Zealand (n = 74). Data was collected via focus groups and interviews. Analyses consisted of both a deductive, theory-driven approach, and an inductive, data-driven approach. The most frequently mentioned resources that supported positive mental health and well-being included: 1) social support, and specifically family and instrumental support; 2) neighborhood cohesion, including collective efficacy and neighborhood permanence; and 3) alignment with social and cultural norms, though tensions surrounding cultural identity were also identified as sources of stress by some mothers. These findings highlight how the socioecological context impacts subjective perceptions of environmental demands and modifiable factors that may be promoted to improve maternal mental health and well-being and subsequent child health and development outcomes.

COVID-19-Related Changes to Pregnant People's Work-Plans Increase Prenatal Depression

The COVID-19 pandemic has caused unprecedented rates of unemployment in the United States. Pregnant workers may be especially affected as they are over-represented in low-wage service and hospitality industries impacted by the pandemic. We surveyed an online convenience sample of currently working pregnant people living in the U.S. (n = 1,417) to determine whether COVID-19-related changes to how long individuals planned to work during their pregnancy, and uncertainty about these changes, were associated with prenatal depression. As hypothesized, both COVID-19-related work-plan changes (OR = 1.81, 95% CI 1.36-2.42, p < 0.001) and uncertainty about the precise nature of these changes (OR = 2.62, 95% CI 1.14-6.0, p = 0.022) were associated with significantly higher odds of a clinically-significant depression score. These effects appeared to be even greater among individuals who continued working outside the home during the pandemic. Since the U.S. is one of the few countries in the world that does not guarantee paid parental leave, pregnant people may be forced to choose between keeping their jobs and risking infection during the COVID-19 pandemic. Our results demonstrate a need for immediate suspension of the eligibility requirements for the Family and Medical Leave Act and/or universal access to both paid family leave and prenatal depression screening. This would help to alleviate these concerns and provide pregnant people with more options while preserving their employment status and financial security.

Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda

Rwandans conceived by rape during the 1994 genocide against the Tutsi have endured a violent beginning and a troubled childhood. Given compelling evidence of the influence of prenatal environments and adverse childhood experiences (ACEs) on future health, these individuals are at high risk of poor mental and physical health outcomes. The purpose of the study was to characterize mental and physical health outcomes in young adults who were exposed prenatally to maternal stress due to the genocide in general and those conceived by genocidal rape, and to determine whether ACEs compound these effects. Ninety-one 24-year-old Rwandans - 30 conceived by genocidal rape, 31 born of genocide survivors not raped, and a control group of 30 born of women with neither exposure - completed the Adverse Childhood Experiences International Questionnaire and measures of multiple physical and mental health characteristics. Data were collected from March 7 to April 6, 2019. Findings demonstrated that 1) individuals conceived during the genocide had poorer mental function (p = 0.002) and higher scores in post-traumatic stress disorder (PTSD), anxiety, depression, physical function, pain intensity, and sleep disturbance compared to young adults who were not exposed to genocide (all p < 0.033); 2) individuals conceived by genocidal rape reported more depression, PTSD, and pain interference compared to those prenatally exposed to maternal genocide stress only (all p < 0.008); and 3) among the group conceived via genocidal rape, the effects of prenatal exposures on depression, physical function, pain intensity and pain interference were exacerbated by ACEs (all p < 0.041). Being conceived during genocide, especially through genocidal rape, is associated with poor adult physical and mental health. The role of ACEs in exacerbating prenatal genocide exposure highlights opportunities for interventions to reduce these effects.

Maternity Care Preferences for Future Pregnancies Among United States Childbearers: The Impacts of COVID-19

The COVID-19 pandemic has impacted maternity care decisions, including plans to change providers or delivery location due to pandemic-related restrictions and fears. A relatively unexplored question, however, is how the pandemic may shape future maternity care preferences post-pandemic. Here, we use data collected from an online convenience survey of 980 women living in the United States to evaluate how and why the pandemic has affected women's future care preferences. We hypothesize that while the majority of women will express a continued interest in hospital birth and OB/GYN care due to perceived safety of medicalized birth, a subset of women will express a new interest in out-of-hospital or "community" care in future pregnancies. However, factors such as local provider and facility availability, insurance coverage, and out-of-pocket cost could limit access to such future preferred care options. Among our predominately white, educated, and high-income sample, a total of 58 participants (5.9% of the sample) reported a novel preference for community care during future pregnancies. While the pandemic prompted the exploration of non-hospital options, the reasons women preferred community care were mostly consistent with factors described in pre-pandemic studies, (e.g. a preference for a natural birth model and a desire for more person-centered care). However, a relatively high percentage (34.5%) of participants with novel preference for community care indicated that they expected limitations in their ability to access these services. These findings highlight how the pandemic has potentially influenced maternity care preferences, with implications for how providers and policy makers should anticipate and respond to future care needs.

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States

BACKGROUND

The COVID-19 pandemic has negatively affected physical and mental health worldwide. Pregnant women already exhibit an elevated risk for depression compared to the general public, a pattern expected to be exacerbated by the pandemic. Certain lifestyle factors, including moderate exercise, may help support mental health during pregnancy, but it is unclear how the pandemic may impact these associations across different locations. Here, we test whether: (i) reported exercise routine alterations during the pandemic are associated with depression scores; and, (ii) the likelihood of reporting pandemic-related exercise changes varies between women living in metro areas and those in non-metro areas.

METHODS

This cross-sectional study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant women in the United States. Participants were recruited April-June 2020 (n = 1,856). Linear regression analyses assessed whether reported COVID-19-related exercise change was associated with depression score as measured by the Edinburgh Postnatal Depression Survey. Logistic regression analyses tested whether a participant's Rural-Urban Continuum Code classification of "metro" was linked with higher odds of reporting exercise changes compared to a "non-metro" classification.

RESULTS

Women who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Moreover, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas.

CONCLUSIONS

These results suggest that the ability to maintain an exercise routine during the pandemic may help support maternal mental health. It may therefore be prudent for providers to explicitly ask patients how the pandemic has impacted their exercise routines and consider altered exercise routines a potential risk factor for depression. An effort should also be made to recommend exercises that are tailored to individual space restrictions and physical health.

The influence of experiential knowledge and societal perceptions on decision-making regarding non-invasive prenatal testing (NIPT)

Background

Non-invasive prenatal testing (NIPT) allows women to access genetic information about their fetuses without the physical risk inherent to prior testing methods. The advent of NIPT technology has led to concerns regarding the quality and process of informed consent, as a view of NIPT as “routine” could impair women’s considered approach when choosing to undergo testing. Prior studies evaluating NIPT decision-making have focused on the clinical encounter as the primary environment for acquisition of biomedical information and decision formation. While important, this conceptualization fails to consider how additional sources of knowledge, including embodied and empathetic experiential knowledge, shape perceptions of risk and the societal use of NIPT.

Methods

In order to address this issue, qualitative, semi-structured interviews with 25 women who had been offered NIPT were performed. Participants came from a well-resourced, rural setting near a major academic medical center in the US. Women were categorized by NIPT use/non-use as well as whether their described decision-making process was perceived as making a significant decision requiring contemplation (“significant”) versus a rapid or immediate decision (“routinized”). A constructivist general inductive approach was used to explore themes in the data, develop a framework of NIPT decision-making, and compare the perceptions of women with differential decision-making processes and outcomes.

Results

A framework for decision-making regarding NIPT was developed based on three emergent factors: perceptions of the societal use of NIPT, expected emotional impact of genetic information, and perceived utility of genetic information. Analysis revealed that perceptions of widespread use of NIPT, pervasive societal narratives of NIPT use as “forward-thinking,” and a perception of information as anxiety-relieving contributed to routinized uptake of NIPT. In contrast, women who displayed a lack of routinization expressed fewer stereotypes regarding the audience for NIPT and relied on communication with their social networks to consider how they might use the information provided by NIPT.

Conclusions

The findings of this study reveal the societal narratives and perceptions that shape differential decision-making regarding NIPT in the U.S. context. Understanding and addressing these perceptions that influence NIPT decision-making, especially routinized uptake of NIPT, is important as the use and scope of this technology increases.

COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States

Objectives

The COVID‐19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long‐term offspring health. However, the impacts of COVID‐19‐associated financial stress on maternal depression in pregnancy has not been investigated.

Methods

Here, we evaluated whether COVID‐19‐associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score ≥ 15) among pregnant women living in the United States during the COVID‐19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 (N = 2099).

Results

Forty‐three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID‐19‐related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001).

Conclusions

Financial stress caused by the COVID‐19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long‐term offspring health.

The Maternal Nutritional Buffering Model: an evolutionary framework for pregnancy nutritional intervention

Evidence that fetal nutrition influences adult health has heightened interest in nutritional interventions targeting pregnancy. However, as is true for other placental mammals, human females have evolved mechanisms that help buffer the fetus against short-term fluctuations in maternal diet and energy status. In this review, we first discuss the evolution of increasingly elaborate vertebrate strategies of buffering offspring from environmental fluctuations during development, including the important innovation of the eutherian placenta. We then present the Maternal Nutritional Buffering Model, which argues that, in contrast to many micronutrients that must be derived from dietary sources, the effects of short-term changes in maternal macronutrient intake during pregnancy, whether due to a deficit or supplementation, will be minimized by internal buffering mechanisms that work to ensure a stable supply of essential resources. In contrast to the minimal effects of brief macronutrient supplementation, there is growing evidence that sustained improvements in early life and adult pre-pregnancy nutrition could improve birth outcomes in offspring. Building on these and other observations, we propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself. Our model leads to the prediction that birth weight will be more strongly influenced by the mother’s chronic pre-pregnancy nutrition than by pregnancy diet, and highlights the need for policy solutions aimed at optimizing future, intergenerational health outcomes.

Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself.

How maternal adversity impacts offspring

Adversities experienced by female baboons early in life can affect the survival of their offspring years later.

The Impact of Individual and Parental American Indian Boarding School Attendance on Chronic Physical Health of Northern Plains Tribes

This study investigated the relationship of American Indian boarding school attendance and chronic physical health. We hypothesized boarding school attendance would be associated with an increased number of chronic physical health problems. We also examined the relationship between boarding school attendance and the 15 chronic health problems that formed the count of the chronic health conditions. American Indian attendees had a greater count of chronic physical health problems compared with nonattendees. Father's attendance was independently associated with chronic physical health problems. Attendees were more likely to have tuberculosis, arthritis, diabetes, anemia, high cholesterol, gall bladder disease, and cancer than nonattendees.

Prenatal and Postnatal Mother-to-Child Transmission of Acculturation's Health Effects in Hispanic Americans

BACKGROUND

Hispanic Americans consistently exhibit an intergenerational increase in the prevalence of many noncommunicable chronic physical and mental disorders.

METHODS

We review and synthesize evidence suggesting that a constellation of prenatal and postnatal factors may play crucial roles in explaining this trend. We draw from relevant literature across several disciplines, including epidemiology, anthropology, psychology, medicine (obstetrics, neonatology), and developmental biology.

RESULTS

Our resulting model is based on evidence that among women, the process of postmigration cultural adjustment (i.e., acculturation) is associated, during pregnancy and after delivery, with psychological and behavioral states that can affect offspring development in ways that may alter susceptibility to noncommunicable chronic disease risk in subsequent-generation Hispanic Americans. We propose one integrated process model that specifies the biological, behavioral, psychological, and sociocultural pathways by which maternal acculturation may influence the child's long-term health. We synthesize evidence from previous studies to describe how acculturation among Hispanic American mothers is associated with alterations to the same biobehavioral systems known to participate in the processes of prenatal and postnatal developmental programming of disease risk. In this manner, we focus on the concepts of biological and cultural mother-to-child transmission across the prenatal and postnatal life phases. We critique and draw from previous hypotheses that have sought to explain this phenomenon (of declining health across generations). We offer recommendations for examining the transgenerational effects of acculturation.

CONCLUSION

A life course model with a greater focus on maternal health and well-being may be key to understanding transgenerational epidemiological trends in minority populations, and interventions that promote women's wellness may contribute to the elimination or reduction of health disparities.

Impact of prenatal stress on offspring glucocorticoid levels: A phylogenetic meta-analysis across 14 vertebrate species

Prenatal exposure to maternal stress is commonly associated with variation in Hypothalamic Pituitary Adrenal (HPA)-axis functioning in offspring. However, the strength or consistency of this response has never been empirically evaluated across vertebrate species. Here we meta-analyzed 114 results from 39 studies across 14 vertebrate species using Bayesian phylogenetic mixed-effects models. We found a positive overall effect of prenatal stress on offspring glucocorticoids (d' = 0.43) though the 95% Highest Posterior Density Interval overlapped with 0 (-0.16-0.95). Meta-regressions of potential moderators highlighted that phylogeny and life history variables predicted relatively little variation in effect size. Experimental studies (d' = 0.64) produced stronger effects than observational ones (d' = -0.01), while prenatal stress affected glucocorticoid recovery following offspring stress exposure more strongly (d' = 0.75) than baseline levels (d' = 0.48) or glucocorticoid peak response (d' = 0.36). These findings are consistent with the argument that HPA-axis sensitivity to prenatal stress is evolutionarily ancient and occurs regardless of a species' overall life history strategy. These effects may therefore be especially important for mediating intra-specific life-history variation. In addition, these findings suggest that animal models of prenatal HPA-axis programming may be appropriate for studying similar effects in humans.

The relationship of five boarding school experiences and physical health status among Northern Plains Tribes

PURPOSE

American Indian (AI) boarding school attendance is related to poor physical health status; however, little is known about how specific aspects of this experience contribute to poor health. Five experiences (age of first attendance, limited family visits, forced church attendance, prohibition on practicing AI culture and traditions, and punishment for use of AI language) may be independently associated with physical health status in adulthood. We expected the effect to be greater for those who began boarding school at older ages.

METHODS

Data on AI boarding school attenders (n = 771) came from the AI-Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project. Multiple linear regression models examined the association of these five experiences with physical health status. Additionally, we conducted a separate set of regressions to test for an interaction effect of age of first attendance.

RESULTS

Each of the five experiences noted above were independently associated with poorer physical health status compared to those who did not have these experiences. An interaction effect for those punished for use of AI language and who were aged 8 or older was confirmed.

CONCLUSIONS

Findings are consistent with reports that boarding school attendance is related to poor AI adult health. To inform AI health programs, the relationship of specific diseases and boarding school attendance should be considered.

Dark shadow of the long white cloud: Neighborhood safety is associated with self-rated health and cortisol during pregnancy in Auckland, Aotearoa/New Zealand

Auckland, Aotearoa/New Zealand is a culturally and ethnically diverse city. Despite popular global conceptions regarding its utopian nature, the lived experience for many individuals in Auckland attests to the substantial social, economic, and health inequalities that exist there. In particular, rapidly rising home prices constrain housing decisions and force individuals to live in less desirable neighborhoods, with potential impacts on individual health. One of the pathways through which adverse neighborhood conditions could impact health is through alterations in the functioning of the hypothalamic pituitary adrenal (HPA)-axis, which regulates the physiological stress response. This paper evaluates the relationship between perceived neighborhood safety, self-rated health, and cortisol, an end product of HPA-axis activation, among women in late pregnancy. Pregnant women living in neighborhoods where they were concerned about safety of their property had poorer self-rated health and elevated morning cortisol, even after adjusting for maternal age, material deprivation, and ethnicity. However, fear of personal safety was unrelated to self-rated health and cortisol. These results suggest that maternal health in pregnancy is sensitive to perceptions regarding neighborhood safety. Such findings are important since higher cortisol levels in pregnancy could not only influence maternal health, but also the health and development of women's children.

Acculturation and health: the moderating role of socio-cultural context

Acculturation represents an important construct for elucidating the determinants and consequences of health disparities in minority populations. However, the processes and mechanisms underlying acculturation's effects on health are largely undetermined and warrant further study. We integrate concepts from anthropology and statistics to describe the role of sociocultural context as a putative modifier of the relationship between acculturation and health. Sociocultural context may influence the extent to which exposure to host culture leads to internalization of host cultural orientation, and may influence the extent to which acculturation leads to stress and adoption of unhealthy behaviors. We focus on specific aspects of sociocultural context: (1) neighborhood ethno-cultural composition; (2) discrimination; (3) discrepancy between origin and host environments; (4) discrepancy between heritage and host cultures; (5) origin group, host group, and individual attitudes towards assimilation; (6) variation in targets of assimilation within host community; (7) public policy and resources; (8) migration selection bias. We review and synthesize evidence for these moderation effects among first- and later-generation immigrants, refugees, and indigenous populations. Furthermore, we propose best-practices data-collection and statistical-analysis methods for this purpose, in order to improve our understanding of the complex, multilevel aspects of the relationship between acculturation and health.

Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults

OBJECTIVES

Hypertension prevalence is high among American Indians (AIs). AIs experience a substantial burden of interpersonal racial discrimination, which in other populations has been associated with higher blood pressure. The purpose of this study is to understand whether racial discrimination experiences are associated with higher blood pressure in AIs.

MATERIALS AND METHODS

We used the Everyday Discrimination Scale to evaluate the relationship between discrimination and measured blood pressure among 77 AIs from two reservation communities in the Northern Plains. We used multivariate linear regression to evaluate the association of racial discrimination with systolic and diastolic blood pressure, respectively. Racial discrimination, systolic blood pressure, and diastolic blood pressure were analyzed as continuous variables. All analyses adjusted for sex, waist circumference, age, posttraumatic stress disorder status, and education.

RESULTS

We found that 61% of participants experienced discrimination that they attributed to their race or ancestry. Racial discrimination was associated with significantly higher diastolic blood pressure (β = 0.22, SE = 0.09, p = .02), and with a similar non-significant trend toward higher systolic blood pressure (β = 0.25, SE = 0.15, p = .09).

CONCLUSION

The results of this analysis suggest that racial discrimination may contribute to higher diastolic blood pressure within Native communities. These findings highlight one pathway through which the social environment can shape patterns of biology and health in AI and other socially and politically marginalized groups.

Ethnic discrimination predicts poor self-rated health and cortisol in pregnancy: insights from New Zealand

Despite growing research emphasis on understanding the health effects of ethnic discrimination, little work has focused on how such exposures may influence a woman's biology and health during pregnancy. Understanding such effects is important given evidence that maternal stress experience in pregnancy can have long term effects on offspring health. Here we present data evaluating the relationship between perceived discrimination, self-rated health, and the stress hormone cortisol measured in late pregnancy among a diverse sample of women living in Auckland, New Zealand (N = 55). We also evaluated possible intergenerational impacts of maternal discrimination on stress reactivity in a subset of offspring (N = 19). Pregnant women were recruited from two antenatal care clinics in Auckland. Women were met in their homes between 34 and 36 weeks gestation, during which time a prenatal stress questionnaire was administered and saliva samples (morning and evening from two days) were obtained. Offspring cortisol reactivity was assessed at the standard six week postnatal vaccination visit. We found that 34% of women reported having experienced ethnic discrimination, with minority and immigrant women being more likely to report being angry or upset in response to discrimination experience compared with NZ-born women of European descent. Women reporting discrimination experience had worse self-rated health, higher evening cortisol and gave birth to infants with higher cortisol reactivity, all independent of ethnicity and material deprivation. These findings suggest that discrimination experience can have biological impacts in pregnancy and across generations, potentially contributing to the ethnic gradient in health.

The vitamin D hypothesis revisited: race-based disparities in birth outcomes in the United States and ultraviolet light availability

Skin color has been proposed to contribute to race-based health disparities in the United States because of differences in ultraviolet (UV) light-induced vitamin D synthesis. The prediction of this hypothesis, herein named the UVD hypothesis, is that racial disparities in health outcomes are correlated with UV light availability. This paper investigates whether UV light availability is associated with disparities in the rates of low birth weight (LBW) and preterm birth (PTB) between whites and blacks, because these outcomes are thought to be influenced by vitamin D status and to shape disease risk in later life. Data on LBW and PTB from 2007 (n = 2,825,620 births) were compared with data on UV light exposure across the United States. Contrary to the predictions of the UVD hypothesis, LBW and PTB rate disparities were greatest in states with the highest UV light exposure. Notably, income inequality was positively and significantly related to LBW and PTB disparities, even after controlling for UV light availability. The results of this analysis demonstrate that there is a significant environmental gradient in racial disparities in birth outcomes in the United States, but other social or environmental factors associated with living in the southern United States are likely stronger contributors to disparities in birth outcomes than UV light-induced vitamin D status.

Early origins of health disparities: material deprivation predicts maternal evening cortisol in pregnancy and offspring cortisol reactivity in the first few weeks of life

OBJECTIVES

Maternal hypothalamic pituitary adrenal-axis function regulates production of the stress hormone cortisol, which during pregnancy can cross the placenta and have lasting impacts on fetal growth and development. This article provides a preliminary test of the hypothesis that a woman's socioeconomic status (SES) predicts her cortisol during pregnancy and her offspring's cortisol during the early postnatal period among an ethnically diverse sample in Auckland, New Zealand to evaluate whether differences in cortisol contribute to the intergenerational inheritance of health disparities within this population.

METHODS

Maternal saliva samples were collected at waking and prior to sleep on 2 days in late pregnancy (34-36 weeks gestation; N = 55), and a subset of offspring saliva was collected before (N = 48) and 20 min after a standard vaccination at 6 weeks of age (N = 19). SES was quantified using a locally validated index of material deprivation, the NZ Deprivation Index for individuals (NZiDep).

RESULTS

We found that, after controlling for ethnicity and other covariates, women with higher NZiDep scores had significantly higher evening but similar morning cortisol, consistent with a pattern of chronic strain. Infants of women reporting greater material deprivation had elevated cortisol response to vaccination.

CONCLUSIONS

These findings suggest that maternal SES experience impacts maternal cortisol in pregnancy and offspring cortisol reactivity soon after birth, with potential long-term effects on offspring biology and health. Additional research is needed to clarify how biological and behavioral factors in both the prenatal and postnatal period facilitate this relationship.

Geographic variation in chin shape challenges the universal facial attractiveness hypothesis

The universal facial attractiveness (UFA) hypothesis proposes that some facial features are universally preferred because they are reliable signals of mate quality. The primary evidence for this hypothesis comes from cross-cultural studies of perceived attractiveness. However, these studies do not directly address patterns of morphological variation at the population level. An unanswered question is therefore: Are universally preferred facial phenotypes geographically invariant, as the UFA hypothesis implies? The purpose of our study is to evaluate this often overlooked aspect of the UFA hypothesis by examining patterns of geographic variation in chin shape. We collected symphyseal outlines from 180 recent human mandibles (90 male, 90 female) representing nine geographic regions. Elliptical Fourier functions analysis was used to quantify chin shape, and principle components analysis was used to compute shape descriptors. In contrast to the expectations of the UFA hypothesis, we found significant geographic differences in male and female chin shape. These findings are consistent with region-specific sexual selection and/or random genetic drift, but not universal sexual selection. We recommend that future studies of facial attractiveness take into consideration patterns of morphological variation within and between diverse human populations.

Maternal cortisol disproportionately impacts fetal growth in male offspring: evidence from the Philippines

OBJECTIVES

Lower birth weight (BW) reoccurs across generations, but the intermediate mechanisms remain poorly understood. One potential pathway involves cortisol, which may be elevated in women born small and in turn could lead to fetal growth restriction in offspring. To test this possibility, we evaluated whether BW predicts hypothalamic-pituitary-adrenal (HPA) function in the nonpregnant state in a cohort of young Filipino women, and whether differences in HPA function predict offspring BW.

METHODS

Multiple regression relating maternal BW, adult salivary cortisol profiles and recalled offspring BW (N = 488) among participants of the Cebu Longitudinal Health and Nutrition Survey.

RESULTS

Maternal BW related inversely to evening cortisol in adulthood (P < 0.04). Maternal BW and evening cortisol were both stronger predictors of male than of female BW (maternal BW: P < 0.0001 for males; P = 0.07 for females; bedtime cortisol: P = 0.003 for males; P = 0.3 for females). Waking and 30-min postwaking cortisol did not predict offspring BW. Controlling for evening cortisol did not diminish the relationship between maternal and offspring BW in males or females.

CONCLUSIONS

Being born small predicted higher evening cortisol in adulthood among these young mothers. Lower maternal BW and elevated evening cortisol independently predicted giving birth to lower BW offspring, with effects greatest and only significant among males. We speculate that sex differences in sensitivity to maternal stress hormones could help explain the stronger relationships between BW and cardiovascular disease (CVD) risk factors reported among the males in this and other populations.

Biological memories of past environments: epigenetic pathways to health disparities

Human health tends to mirror gradients in social standing related to class, ethnicity and race. Past research in the social sciences suggests that environmental experiences related to social status contribute to these disparities, but the underlying biological mechanisms are only partially understood. Here, we review research related to three domains of environmental exposure that point to epigenetic contributions to health disparities: nutrition, psychosocial stress, and environmental toxicant exposure. Each exposure has effects that may persist across the life course and in some instances may be transmitted to offspring via epigenetic inheritance. Since epigenetic markings provide a "memory" of past experiences, minimizing future disparities in health will be partially contingent upon our ability to address inequality in the current environment. We suggest that future research in environmental epigenetics focus on establishing the reversibility of stress-induced epigenetic modifications, and also on identifying positive epigenetic effects of environmental enrichment.

Timescales of human adaptation: the role of epigenetic processes

Human biology includes multiple adaptive mechanisms that allow adjustment to varying timescales of environmental change. Sensitive or critical periods in early development allow for the transfer of environmental information between generations, which helps an organism track gradual environmental change. There is growing evidence that offspring biology is responsive to experiences encoded in maternal biology and her epigenome as signaled through the transfer of nutrients and hormones across the placenta and via breast milk. Principles of evolutionary and comparative biology lead to the expectation that transient fluctuations in early experience should have greater long-term impacts in small, short-lived species compared with large, long-lived species such as humans. This implies greater buffering of the negative effects of early-life stress in humans, but also a reduced sensitivity to short-term interventions that aim to improve long-term health outcomes. Taking the timescales of adaptation seriously will allow the design of interventions that emulate long-term environmental change and thereby coax the developing human body into committing to a changed long-term strategy, yielding lasting improvements in human health and wellbeing.