A Biological Mechanism for Adverse Maternal-Child Outcomes in Disadvantaged Populations

Wednesday, 24 July 2013: 9:10 AM

Elizabeth Corwin, RN, PhD, FNP
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
Anne Dunlop, MD
School of Nursing, Emory University, Atlanta, GA
Ying Guo, PhD
School of Public Health, Emory University, Atlanta, GA

Learning Objective 1: Understand the mechanism by which exposure to chronic social disadvantage during pregnancy and the postpartum period can lead to glucocorticoid resistance and chronic inflammation.

Learning Objective 2: Describe how exposure to glucocorticoid resistance and chronic inflammation during pregnancy and the postpartum period may contribute to adverse maternal and infant outcomes.

Purpose: This study aimed to explore mechanisms underlying adverse health outcomes in minority women. Minority women experience higher rates of perinatal complications compared to Caucasian women and higher risk of chronic disease across the lifespan. Biological and social contributors have been proposed to explain these disparities yet underlying mechanisms remain unclear. We tested the hypothesis that minority pregnant and postpartum women are unable to regulate inflammatory and stress responses compared to Caucasian women.

Methods: Data was collected from women were during the 3rd trimester of pregnancy through 6-months postpartum. Plasma was collected for pro- and anti-inflammatory cytokine levels and saliva 5 times the preceding day for cortisol levels and area under the curve (AUC). Linear regression was used to assess differences in pro- and anti-inflammatory cytokine ratios and cortisol. Demographic variables significantly different between groups were controlled for in analyses.

Results: Of 113 participants, 23 were of minority status. Minority women were younger (p=0.01) and of lower income  (p< 0.05). Controlling for age and income, minority women had higher cortisol secretion, as indicated by area under the curve (AUC) than Caucasian women prenatally (p=0.021) and at 6-months (p=0.02) especially at the time points of 11AM (prenatal p=0.01; 6-month p = 0.02) and 4PM (prenatal p=0.04; 6-month p=0.02). An increase in pro- to anti-inflammatory cytokine ratio of interleukin-1 beta to interleukin-10 was found in minority compared to Caucasian women at 1- (p=0.02) and 3-months (p=0.01) postpartum indicating increased pro-inflammatory profile.

Conclusion: This study suggests social disadvantage related to minority status is associated with activation of the stress response and dysregulation of the inflammatory response in a vulnerable population, pregnant and postpartum women. Elevated cortisol and increased inflammation are known risk factors for poor perinatal outcomes and poor long term health and may contribute to the health disparity seen across the lifespan in minority women.