Allostasis: A Theoretical Framework for Understanding and Evaluating Perinatal Health Outcomes

Shannon, Maureen; King, Tekoa L.; Kennedy, Holly Powell

doi:10.1111/j.1552-6909.2007.00126.x

Cited by 52 publications

(49 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17,23,24 However, to our knowledge no study has investigated the relationship between pre-pregnancy allostatic load and length of gestation and birthweight or racial differences in these outcomes. Our previous work in this area includes a small prospective study of allostatic load in pregnant women (measured at 26–28 weeks gestation) and its impact on number of pregnancy outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preconception Biomarkers of Allostatic Load and Racial Disparities in Adverse Birth Outcomes: the Bogalusa Heart Study

Wallace

Harville

Theall

et al. 2013

Paediatric Perinatal Epid

View full text Add to dashboard Cite

Background Large disparities in adverse birth outcomes persist between African American and white women in the US despite decades of research, policy, and public health intervention. Allostatic load is an index of dysregulation across multiple physiologic systems that results from chronic exposure to stress in the physical and socio-cultural environment which may lead to earlier health deterioration among racially or socio-economically disadvantaged groups. The purpose of this investigation was to examine relationships between maternal biomarkers of allostatic load prior to conception and the occurrence of preterm birth and small for gestational age infants among a cohort of white and African American women participants in the Bogalusa Heart Study. Methods Data from women participants were linked to the birth record of their first-born infant. Principal components analysis was used to construct an index of allostatic load as a summary of the weighted contribution of nine biomarkers representing three physiologic domains: cardiovascular, metabolic, and immune systems. A series of Poisson regression models based on samples ranging from 1467 to 375 women were used to examine race, individual biomarkers of allostatic load, and quartiles of the allostatic load index as predictors of preterm birth (n = 150, 10.2%) and small for gestational age (n = 135, 9.2%). Results There was no evidence of a relationship between maternal preconception allostatic load and either adverse birth outcome in this sample. Further, there was no evidence of effect modification of by race or education. Conclusions More work is needed in understanding the biological mechanisms linking social inequities to racial disparities in adverse birth outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Preconception Biomarkers of Allostatic Load and Racial Disparities in Adverse Birth Outcomes: the Bogalusa Heart Study

Wallace

Harville

Theall

et al. 2013

Paediatric Perinatal Epid

View full text Add to dashboard Cite

show abstract

“…22 Although research on allostatic load as a measure of lifelong chronic stress is in its infancy and its relationship to birth outcomes remains largely hypothetical, it marks a radical shift in how we think about stress and pregnancy outcomes, one which may have dramatic ramifications on how we approach prenatal care. For a more thorough examination of how allostatic load may impact pregnancy outcomes, with particular reference to racial disparities, see Shannon et al 23 and Lu and Halfon. 20 Assessing Psychosocial Stress Given the evidence suggesting that a wide array of maternal psychosocial stressors can contribute to poor pregnancy outcomes, the means by which these various stressors can be assessed are of particular relevance to clinicians.…”

Section: Allostatic Load and Adverse Pregnancy Outcomesmentioning

confidence: 99%

Psychosocial Stress and Pregnancy Outcome

Hobel

Goldstein

Barrett

2008

Clinical Obstetrics &Amp; Gynecology

440

326

View full text Add to dashboard Cite

This article is intended to help clinicians better understand the ever-expanding body of research on whether psychosocial stress (both acute and chronic) is linked to 2 major adverse pregnancy outcomes: preterm birth and low birth weight. We summarize the existing literature and then review assessment tools commonly used to diagnose various types of psychosocial stress, with attention to how and when assessments should be made. After discussing the physiologic mechanisms hypothesized to underlie these relationships, we examine the range of existing interventions aimed at reducing psychosocial stress and review their efficacy at improving birth outcomes. Future directions for prevention of adverse pregnancy outcomes are discussed and suggest that an entirely new approach may be necessary.

show abstract

“…3 African Americans and individuals of lower socioeconomic status bear a disproportionate amount of this burden, 3,4 and some propose that chronic stress may explain persistent racial and socioeconomic disparities in these pregnancy outcomes. [5][6][7][8] Allostatic load (AL) reflects the cumulative burden of chronic physiologic and psychologic stress and is measured by combining multiple subclinical biomarkers of systemic function into a single continuous index score of biologic risk.…”

Section: Introductionmentioning

confidence: 99%

Allostatic Load in Women with a History of Low Birth Weight Infants: The National Health and Nutrition Examination Survey

Hux

Catov

Roberts

2014

Journal of Women's Health

View full text Add to dashboard Cite

Background: The purpose of our study was to determine whether women of reproductive age with history of low birth weight (LBW) deliveries have higher allostatic load (AL), a measure of the cumulative toll of chronic stress, than those with normal-weight deliveries. Methods: We used data from women ages 17-35 who responded to the National Health and Nutrition Examination Survey (NHANES) reproductive-health questionnaire, 1999-2006. Women reported history of LBW infants and those who were preterm. We classified preterm-LBW and term-LBW as surrogates for preterm birth (PTB) and small for gestational age (SGA), respectively. Normal weight included those without LBW infant history. We utilized nine biomarkers measured in NHANES to determine AL and used linear regression to compare unadjusted and adjusted means. Results: We identified 877 women divided among SGA (2%), PTB (10%), and normal groups (88%). The SGA group had higher unadjusted and adjusted AL scores than did the normal group (2.82 -0.35 vs. 1.92 -0.07, p = 0.011); women in the PTB group had higher AL scores than did the referent in adjusted analyses (2.58 -0.21 vs. 1.92 -0.07, p = 0.001). Conclusions: Women with history of SGA or PTB had higher AL than did those with normal birth weight outcomes. This suggests a link between adverse pregnancy outcomes, chronic stress, and subclinical disease.

show abstract

Allostasis: A Theoretical Framework for Understanding and Evaluating Perinatal Health Outcomes

Cited by 52 publications

References 78 publications

Preconception Biomarkers of Allostatic Load and Racial Disparities in Adverse Birth Outcomes: the Bogalusa Heart Study

Preconception Biomarkers of Allostatic Load and Racial Disparities in Adverse Birth Outcomes: the Bogalusa Heart Study

Psychosocial Stress and Pregnancy Outcome

Allostatic Load in Women with a History of Low Birth Weight Infants: The National Health and Nutrition Examination Survey

Contact Info

Product

Resources

About