The Relationship between Racial Identity, Income, Stress and C-Reactive Protein among Parous Women: Implications for Preterm Birth Disparity Research

Paul, Kathleen; Boutain, Doris M.; Agnew, Kathy; Thomas, Joycelyn; Hitti, Jane

doi:10.1016/s0027-9684(15)31300-6

Cited by 49 publications

(35 citation statements)

References 31 publications

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“…[4][5][6][7][8] We further found that chronic medical problems are independently associated with high antenatal psychosocial stress. Our findings did not show a significant independent association between antenatal psychosocial stress and several maternal characteristics seen in prior studies (ie, race, 7,31,32 marital status, 31 age, 7 education, 7 poverty, 7,32 and cigarette smoking [33][34][35] ). Levels of psychosocial stress likely change throughout the course of pregnancy, although few studies have measured psychosocial stress at different antenatal time points.…”

Section: Commentcontrasting

confidence: 97%

Psychosocial Stress during Pregnancy

Woods

Melville

Guo

et al. 2010

Obstetric Anesthesia Digest

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OBJECTIVE:We sought to identify factors associated with high antenatal psychosocial stress and describe the course of psychosocial stress during pregnancy. STUDY DESIGN:We performed a cross-sectional analysis of data from an ongoing registry. Study participants were 1522 women receiving prenatal care at a university obstetric clinic from January 2004 through March 2008. Multiple logistic regression identified factors associated with high stress as measured by the Prenatal Psychosocial Profile stress scale. RESULTS:The majority of participants reported antenatal psychosocial stress (78% low-moderate, 6% high). Depression (odds ratios [OR], 9.6; 95% confidence interval [CI], 5.5-17.0), panic disorder (OR, 6.8; 95% CI, 2.9 -16.2), drug use (OR, 3.8; 95% CI, 1.2-12.5), domestic violence (OR, 3.3; 95% CI, 1.4 -8.3), and having Ն2 medical comorbidities (OR, 3.1; 95% CI, 1.8 -5.5) were significantly associated with high psychosocial stress. For women who screened twice during pregnancy, mean stress scores declined during pregnancy (14.8 Ϯ 3.9 vs 14.2 Ϯ 3.8; P Ͻ .001).CONCLUSION: Antenatal psychosocial stress is common, and high levels are associated with maternal factors known to contribute to poor pregnancy outcomes.

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Section: Commentcontrasting

confidence: 97%

Psychosocial Stress during Pregnancy

Woods

Melville

Guo

et al. 2010

Obstetric Anesthesia Digest

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“…However, further analysis controlling for waist circumference, sleep latency, smoking, and perceived stress (as measured by the Perceived Stress Scale) eliminated the statistical significance of the relationship between race and CRP levels. Another study by Paul and colleagues [115] noted that controlling for perceived psychosocial stress dramatically reduced the relationship between CRP and race.…”

Section: Discrimination Stressmentioning

confidence: 98%

Systematic Review of the Evidence of a Relationship Between Chronic Psychosocial Stress and C-Reactive Protein

2013

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“…After controlling for other variables (e.g., body mass index, smoking), minority and low income women experience worse pregnancy outcomes, including a 64% increase in preterm birth in African American women compared to white women (Institute of Medicine, 2007), and their offspring fare worse in developmental, behavioral, and physical outcomes than infants born to non-minority women (Reichman et al, 2008). Reproductiveage African American and low income women also report increased levels of stress (Paul et al, 2008), a phenomenon these authors and others (Dominguez, 2011; Rich-Edwards and Grizzard, 2005) ascribe to race and class discrimination.…”

mentioning

confidence: 98%

Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women

Corwin

Guo

Pajer

et al. 2013

Psychoneuroendocrinology

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Summary Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r = −0.73, p < 0.0001), IL6/IL10 (r = 0.38, p = 0.01), IL1β/IL10 (r = −0.44, p = −0.004) and TNFα/IL10 (r = −0.41; p = 0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r = −0.25, p = 0.43; IL6/IL10:r = 0.12, p = 0.70; IL1 β/IL10: r = 0.05, p = 0.87; TNFα/IL10: r = 0.10; p = 0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p < 0.05). Without cytokine glucocorticoid feedback, a pregnant woman’s ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.

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The Relationship between Racial Identity, Income, Stress and C-Reactive Protein among Parous Women: Implications for Preterm Birth Disparity Research

Cited by 49 publications

References 31 publications

Psychosocial Stress during Pregnancy

Psychosocial Stress during Pregnancy

Systematic Review of the Evidence of a Relationship Between Chronic Psychosocial Stress and C-Reactive Protein

Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women

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