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Allostatic Load and Adverse Pregnancy Outcomes.
Amir J Lueth1, Amanda A Allshouse, Nathan M Blue
1Departments of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, The Ohio State University, Columbus, Ohio, University of Pennsylvania, Philadelphia, Pennsylvania, University of Pittsburgh, Pittsburgh, Pennsylvania, University of California, Irvine, Irvine, California, and School of Medicine, Indiana University, Indianapolis, Indiana; and the Department of Population Health Sciences, University of Utah Health, Salt Lake City, Utah.
Obstetrics and Gynecology
|November 11, 2022
Summary
High allostatic load, a measure of chronic stress, in early pregnancy is linked to adverse pregnancy outcomes, especially hypertensive disorders of pregnancy (HDP). This stress marker also partially explains racial disparities in pregnancy complications.
Area of Science:
- Reproductive Health
- Maternal-Fetal Medicine
- Psychoneuroimmunology
Background:
- Chronic stress, estimated by allostatic load, may impact pregnancy health.
- Understanding the relationship between allostatic load and adverse pregnancy outcomes is crucial for maternal health.
- Racial disparities in adverse pregnancy outcomes warrant investigation into mediating factors like allostatic load.
Purpose of the Study:
- To assess the association between allostatic load in the first trimester and adverse pregnancy outcomes.
- To determine if allostatic load mediates the relationship between race and adverse pregnancy outcomes.
- To explore if race moderates the association between allostatic load and adverse pregnancy outcomes.
Main Methods:
- Secondary analysis of the prospective observational nuMoM2b cohort study.
- High allostatic load defined as 4+ of 12 biomarkers in the worst quartile in the first trimester.
- Multivariable logistic regression and mediation/moderation analyses used to examine associations.
Main Results:
- 34.7% of 4,266 individuals had high allostatic load.
- High allostatic load was significantly associated with composite adverse pregnancy outcomes (aOR 1.5) and hypertensive disorders of pregnancy (HDP) (aOR 2.5).
- Allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes; HDP association with allostatic load differed by race.
Conclusions:
- First-trimester high allostatic load is associated with adverse pregnancy outcomes, particularly HDP.
- Allostatic load acts as a partial mediator in the pathway linking race to adverse pregnancy outcomes.
- The impact of allostatic load on HDP varies by self-reported race, highlighting complex interactions.
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