African American women have higher rates of preterm birth (PTB) than women from other racial or ethnic backgrounds. We explored the possibility that African American women experience higher anxiety/lower optimism levels, leading to excess inflammation, a possible pathway leading to PTB. In a cohort of 434 nulliparous women (African American, n = 119; Caucasian, n = 315), standardized measures of anxiety and optimism were completed at 20 weeks’ gestation. C-reactive protein (CRP) was measured in serum collected at the same time, and interleukin-6 (IL-6) was additionally measured in African American women. African American women tended to have higher rates of anxiety (>75th percentile) compared to Caucasian women (27.3 vs. 19.2 %, p = 0.08), but rates of low optimism (<25th percentile) did not vary by race. Contrary to our hypothesis, higher concentrations of CRP among African American women were associated with lower risk of anxiety in the highest quartile, adjusted for covariates (OR 0.65, 95 % CI 0.44, 0.98). Low optimism in African American women was also associated with lower IL-6, but results were only marginally significant (OR 0.43, 95 % CI 0.17, 1.10). CRP, anxiety, and optimism were not correlated among Caucasian women. African American women with high anxiety or low optimism had lower concentrations of pro-inflammatory markers at mid-gestation compared to those without these characteristics. Our results suggest that chronic anxiety among African American women may contribute to intractable race disparities in pregnancy outcomes via an impaired inflammatory response.
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Institute of Medicine. (2006). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.
Culhane, J. F., & Goldenberg, R. L. (2011). Racial disparities in preterm birth. Seminars in Perinatology, 35(4), 234–239.
Kramer, M. R., Hogue, C. J., Dunlop, A. L., et al. (2011). Preconceptional stress and racial disparities in preterm birth: an overview. Acta Obstetricia et Gynecologica Scandinavica. doi:10.1111/j.1600-0412.2011.01136.x.
Dunkel Schetter, C. (2011). Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62(1), 531–558. doi:10.1146/annurev.psych.031809.130727.
Kessler, R. C., Mcgonagle, K. A., Zhao, S. Y., et al. (1994). Lifetime and 12-month prevalence of Dsm-Iii-R psychiatric-disorders in the United-States—Results from the National-Comorbidity-Survey. Archives of General Psychiatry, 51(1), 8–19.
Kessler, R. C., Petukhova, M., Sampson, N. A., et al. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184.
Speilberger, C. (1983). State-trait anxiety inventory for adults, manual, instrument and scoring guide. Palo Alto: Mind Garden.
Dunkel Schetter, C., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Current Opinion in Psychiatry, 25, 141–148.
Rasmussen, H., Scheier, M., & Greenhouse, J. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37(3), 239–256.
Giltay, E. J., Kamphuis, M. H., Kalmijn, S., et al. (2006). Dispositional optimism and the risk of cardiovascular death: The zutphen elderly study. Archives of Internal Medicine, 166(4), 431–436.
Matthews, K. A., Raikkonen, K., Sutton-Tyrrell, K., et al. (2004). Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosomatic Medicine, 66(5), 640–644. doi:10.1097/01.psy.0000139999.99756.a5.
Roy, B., Diez-Roux, A. V., Seeman, T., et al. (2010). Association of optimism and pessimism with inflammation and hemostasis in the multi-ethnic study of atherosclerosis (MESA). Psychosomatic Medicine, 72(2), 134–140. doi:10.1097/PSY.0b013e3181cb981b.
Lobel, M., DeVincent, C. J., Kaminer, A., et al. (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19(6), 544–553.
Catov, J., Abatemarco, D., Marcovik, N., et al. (2009). Anxiety and Optimism associated with gestational age at birth and fetal growth. Maternal and Child Health Journal. doi:10.1007/s10995-009-0513-y.
Diez Roux, A. V. (2012). Conceptual approaches to the study of health disparities. Annual Review of Public Health, 33(1), 41–58. doi:10.1146/annurev-publhealth-031811-124534.
Bankier, B., Barajas, J., Martinez-Rumayor, A., et al. (2008). Association between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. European Heart Journal, 29(18), 2212–2217. doi:10.1093/eurheartj/ehn326.
Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress damages immune system and health. Discovery Medicine, 5(26), 165–169.
Raison, C. L., Capuron, L., & Miller, A. H. (2006). Cytokines sing the blues: Inflammation and the pathogenesis of depression. Trends in Immunology, 27(1), 24–31.
Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21(7), 901–912.
Gruenewald, T. L., Cohen, S., Matthews, K. A., et al. (2009). Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Social Science and Medicine, 69(3), 451–459.
Arbour, M., Corwin, E., Salsberry, P., et al. (2012). Racial differences in the health of childbearing-aged women. MCN, 37(4), 262–268.
Romero, R., Gotsch, F., Pineles, B., et al. (2007). Inflammation in pregnancy: Its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutrition Reviews, 65(12 Pt 2), S194–S202.
Pitiphat, W., Gillman, M. W., Joshipura, K. J., et al. (2005). Plasma C-reactive protein in early pregnancy and preterm delivery. American Journal of Epidemiology, 162(11), 1108–1113.
Sorokin, Y., Romero, R., Mele, L., et al. (2010). Maternal serum interleukin-6, C-reactive protein, and matrix metalloproteinase-9 concentrations as risk factors for preterm birth <32 weeks and adverse neonatal outcomes. American Journal of Perinatology. doi:10.1055/s-0030-1249366.
Catov, J. M., Bodnar, L. M., Ness, R. B., et al. (2007). Inflammation and dyslipidemia related to risk of spontaneous preterm birth. American Journal of Epidemiology, 166(11), 1312–1319. doi:10.1093/aje/kwm273.
Brou, L., Almli, L. M., Pearce, B. D., et al. (2012). Dysregulated biomarkers induce distinct pathways in preterm birth. BJOG: An International Journal of Obstetrics & Gynaecology, 119(4), 458–473.
Menon, R., Pearce, B., Velez, D., et al. (2009). Racial disparity in pathophysiologic pathways of preterm birth based on genetic variants. Reproductive Biology and Endocrinology, 7(1), 62.
Simhan, H. N., & Bodnar, L. M. (2006). Prepregnancy body mass index, vaginal inflammation, and the racial disparity in preterm birth. American Journal of Epidemiology, 163(5), 459–466. doi:10.1093/aje/kwj053.
Fitzgerald, K. (2001). The cytokine factsbook (2nd ed.). San Diego: Academic Press.
Kishimoto, T., Akira, S., & Taga, T. (1992). Interleukin-6 and its receptor: A paradigm for cytokines. Science, 258(5082), 593–597.
Menon, R., Torloni, M. R., Voltolini, C., et al. (2011). Biomarkers of spontaneous preterm birth: An overview of the literature in the last four decades. Reproductive Sciences, 18(11), 1046–1070. doi:10.1177/1933719111415548.
Cassidy-Bushrow, A. E., Peters, R. M., Johnson, D. A., et al. (2012). Association of depressive symptoms with inflammatory biomarkers among pregnant African-American women. Journal of Reproductive Immunology, 94(2), 202–209.
Christian, L. M., Franco, A., Glaser, R., et al. (2009). Depressive symptoms are associated with elevated serum proinflammatory cytokines among pregnant women. Brain, Behavior, and Immunity, 23(6), 750–754. doi:10.1016/j.bbi.2009.02.012.
Lobel, M., & Dunkel-Schetter, C. (1990). Conceptualizing stress to study effects on health. Anxiety Research, 3, 213–230.
Speilberger, C. (1983). Manual for the state-trait anxiety inventory. Palo Alto: CA Consulting Psychologist Press.
Rini, C., Dunkel-Schetter, C., Wadhwa, P., et al. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Psychology, 18, 333–345.
WHO Consultation on Obesity. (2000). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894.
Britton, J. R. (2005). Pre-discharge anxiety among mothers of well newborns: Prevalence and correlates. Acta Paediatrica, 94(12), 1771–1776. doi:10.1080/08035250500192664.
Coussons-Read, M. E., Lobel, M., Carey, J. C., et al. (2012). The occurrence of preterm delivery is linked to pregnancy-specific distress and elevated inflammatory markers across gestation. Brain, Behavior, and Immunity, 26(4), 650–659.
Abel, E. L., & Kruger, M. (2002). Physician attitudes concerning legal coercion of pregnant alcohol and drug abusers.[see comment]. American Journal of Obstetrics and Gynecology, 186(4), 768–772.
Paul, I. M., Downs, D. S., Schaefer, E. W., et al. (2013). Postpartum anxiety and maternal-infant health outcomes. Pediatrics, 131(4), e1218–e1224. doi:10.1542/peds.2012-2147.
Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130(4), 601.
Wikby, A., Johansson, B., Ferguson, F., et al. (1994). Age-related changes in immune parameters in a very old population of Swedish people: A longitudinal study. Experimental Gerontology, 29(5), 531–541.
Cohen, S., & Hamrick, N. (2003). Stable individual differences in physiological response to stressors: Implications for stress-elicited changes in immune related health. Brain, Behavior, and Immunity, 17(6), 407–414.
Pitsavos, C., Panagiotakos, D. B., Papageorgiou, C., et al. (2006). Anxiety in relation to inflammation and coagulation markers, among healthy adults: The ATTICA Study. Atherosclerosis, 185(2), 320–326.
Ranjit, N., Diez-Roux, A. V., Shea, S., et al. (2007). Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Archives of Internal Medicine, 167(2), 174–181. doi:10.1001/archinte.167.2.174.
Bankier, B., Barajas, J., Martinez-Rumayor, A., et al. (2009). Association between anxiety and C-reactive protein levels in stable coronary heart disease patients. Psychosomatics, 50(4), 347–353. doi:10.1176/appi.psy.50.4.347.
Liukkonen, T., Räsänen, P., Jokelainen, J., et al. (2011). The association between anxiety and C-reactive protein (CRP) levels: Results from the Northern Finland 1966 birth cohort study. European Psychiatry, 26(6), 363–369.
Coussons-Read, M. E. P., Okun, M. L. M. A., Schmitt, M. P. B. S., et al. (2005). Prenatal stress alters cytokine levels in a manner that may endanger human pregnancy. Psychosomatic Medicine, 67(4), 625–631.
Menon, R., Arora, C. P., Hobel, C. J., et al. (2008). Corticotrophin-releasing hormone in lipopolysaccharide-stimulated term fetal membranes and amniotic fluid from term and preterm birth in African Americans and Caucasians. Reproductive Sciences, 15(5), 477–483. doi:10.1177/1933719108315300.
Welsh, P., Polisecki, E., Robertson, M., et al. (2010). Unraveling the directional link between adiposity and inflammation: A bidirectional Mendelian randomization approach. Journal of Clinical Endocrinology and Metabolism, 95(1), 93–99. doi:10.1210/jc.2009-1064.
Eyler, A. A., Baker, E., Cromer, L., et al. (1998). Physical activity and minority women: A qualitative study. Health Education & Behavior, 25, 640–652.
Fang, C. Y., Reibel, D. K., Longacre, M. L., et al. (2010). Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. Journal of Alternative and Complementary Medicine, 16(5), 531–538. doi:10.1089/acm.2009.0018.
Dunn, C., Hanieh, E., Roberts, R., et al. (2012). Mindful pregnancy and childbirth: Effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Archives of Women’s Mental Health, 15(2), 139–143.
Krieger, N., Kosheleva, A., Waterman, P. D., et al. (2011). Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born black Americans. American Journal of Public Health, 101(9), 1704–1713. doi:10.2105/ajph.2011.300168.
The authors would like to thank Bruce R. Campbell, MLS, from the Magee-Womens Research Institute for his editing assistance in the preparation of this manuscript.
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Catov, J.M., Flint, M., Lee, M. et al. The Relationship Between Race, Inflammation and Psychosocial Factors Among Pregnant Women. Matern Child Health J 19, 401–409 (2015). https://doi.org/10.1007/s10995-014-1522-z
- Psychosocial factors
- Race disparity