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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.
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.