Racial Differences in the Biochemical Effects of Stress in Pregnancy

Abstract

Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors.

The intersection of race and socioeconomic status is associated with inflammation patterns during pregnancy and adverse pregnancy outcomes

“…A systematic review of adverse birth outcomes demonstrated a robust relationship between low-SES and either preterm birth or low birth weight in 92 of 106 studies reviewed. 9 Similarly, our findings are congruent with national 29 We suspect that the inconsistent findings of prior studies may result from two attributes of pregnancy inflammation. First, inflammatory factors operate in a coordinated fashion, and the cumulative activity of multiple biomarkers may be more important than the levels of one or two isolated cytokines.…”

Psychometric validation of a patient‐reported experience measure of obstetric racism© (The PREM‐OB Scale™ suite)

“…1 In contrast, a growing body of knowledge, particularly generated and disseminated by Black women scholars, continues to illuminate the association between perinatal health inequities and historical and contemporary racism. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Unfortunately, translating this knowledge into meaningful change is challenging. A growing body of work highlights the failure of leading scholars and journals, 1,17,18 funders, 7 and large-scale quality improvement organizations 19,20 to earnestly interrogate racism as a critical driver of health inequities.…”

More Than Shelter: Housing for Urban Maternal and Infant Health

“…Racial disparities in maternal health outcomes in the United States are not the result of inherent biological differences but are a direct outcome of racism experienced by women of color. Racism and social disadvantage are intertwined structural determinants of health in the United States, with Black mothers more likely to receive repetitive prenatal stress from systemic discrimination [ 12 ]. State-level indicators of structural racism in employment and education were found to be directly associated with differences in infant mortality rates for Black but not White women in the United States [ 13 ].…”