Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes

Abstract

Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index (BMI) at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N=111). Results CPD scores ranged from 0-6, out of a total of 8 parameters (Mean 2.09; SD=1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3,397 grams (SD=522.89), and the mean gestational age was 39.64 weeks (SD=1.08). CPD was not significantly associated with either birth weight or gestational age (p=0.42 and p=0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.

Allostatic load, a measure of chronic physiological stress, is associated with pregnancy outcomes, but not fertility, among women with unexplained infertility

“…Two small studies have measured AL in mid-late pregnancy in relation to birthweight and gestational age at birth (Wallace and Harville, 2013;McKee et al, 2017). In the first (n = 42), AL was inversely associated with gestational age at birth but not birth size (Wallace and Harville, 2013), while in the second (n = 111), AL was not associated with birthweight or gestational age (McKee et al, 2017). Given the sizes of the cohorts, neither study could examine preterm birth, low birthweight or pre-eclampsia and in both cases, the neuroendocrine component of AL was insufficiently captured.…”

Reducing Psychological Stress in Peripartum Women With Heart Rate Variability Biofeedback: A Systematic Review

“…These psychological stessors have the potential to permanently alter the maternal–fetal physiology and catalyze long-standing health issues for the dyad (Abbaszadeh et al, 2013; DiPietro, 2012; King & Laplante, 2005; Shapiro, Fraser, Frasch, & Séguin, 2013). The range of potential health issues is multisystemic and includes greater risk of postpartum depression, impaired maternal–child bonding (Giurgescu et al, 2015; Grote et al, 2010), and poor birth outcomes (Clemens & Dibben, 2017; Hobel, Goldstein, & Barrett, 2008; McKee, Seplaki, Fisher, Groth, & Fernandez, 2017).…”

Prenatal allostatic load and preterm birth: A systematic review

“…Of the three included studies, two were prospective cohorts (Wallace and Harville, 2013 ; McKee et al, 2017 ) and one was a doctoral thesis with secondary analysis of a prospective cohort (Sayre, 2016 ) ( Table 1 ). All three studies examined gestational age as an outcome of interest in addition to other infant birth outcomes.…”

“…The three studies examined cohorts ranging from 42 to 156 pregnant participants who received prenatal clinic care in the United States. Biomarkers were measured at prenatal care visits between 28 and 40 weeks' gestation (McKee et al, 2017 ), during each trimester (Sayre, 2016 ), and between 26 and 28 weeks' gestation (Wallace and Harville, 2013 ), respectively.…”

“…Wallace and Harville's ( 2013 ) study was the only one to include neuroendocrine biomarkers (i.e., cortisol and dehydroepiandrosterone sulfate). McKee et al ( 2017 ) and Sayre ( 2016 ) included immune biomarkers: interleukin (IL)-6 and C-reactive protein (CRP), and IL-1β, IL-6, IL-10, and CRP, respectively. McKee et al ( 2017 ) and Wallace and Harville ( 2013 ) included metabolic biomarkers: 1-hour oral glucose tolerance test (1-hour OGTT) and cholesterol, and glycosylated hemoglobin and 1-hour OGTT, respectively.…”