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The Relationship Between Race, Inflammation and Psychosocial Factors Among Pregnant Women

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Abstract

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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References

  1. Institute of Medicine. (2006). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.

    Google Scholar 

  2. Culhane, J. F., & Goldenberg, R. L. (2011). Racial disparities in preterm birth. Seminars in Perinatology, 35(4), 234–239.

    Article  PubMed  Google Scholar 

  3. 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.

    Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Speilberger, C. (1983). State-trait anxiety inventory for adults, manual, instrument and scoring guide. Palo Alto: Mind Garden.

    Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Rasmussen, H., Scheier, M., & Greenhouse, J. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37(3), 239–256.

    Article  PubMed Central  PubMed  Google Scholar 

  10. 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.

    PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Google Scholar 

  15. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress damages immune system and health. Discovery Medicine, 5(26), 165–169.

    PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Arbour, M., Corwin, E., Salsberry, P., et al. (2012). Racial differences in the health of childbearing-aged women. MCN, 37(4), 262–268.

    Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  24. 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.

    Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  CAS  Google Scholar 

  27. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Fitzgerald, K. (2001). The cytokine factsbook (2nd ed.). San Diego: Academic Press.

    Google Scholar 

  30. Kishimoto, T., Akira, S., & Taga, T. (1992). Interleukin-6 and its receptor: A paradigm for cytokines. Science, 258(5082), 593–597.

    Article  CAS  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Lobel, M., & Dunkel-Schetter, C. (1990). Conceptualizing stress to study effects on health. Anxiety Research, 3, 213–230.

    Article  Google Scholar 

  35. Speilberger, C. (1983). Manual for the state-trait anxiety inventory. Palo Alto: CA Consulting Psychologist Press.

    Google Scholar 

  36. 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.

    CAS  Google Scholar 

  37. WHO Consultation on Obesity. (2000). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894.

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  CAS  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  43. 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.

    Article  CAS  PubMed  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. 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.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

  49. 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.

    Article  CAS  PubMed  Google Scholar 

  50. 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.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Eyler, A. A., Baker, E., Cromer, L., et al. (1998). Physical activity and minority women: A qualitative study. Health Education & Behavior, 25, 640–652.

    Article  CAS  Google Scholar 

  53. 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.

    Article  PubMed Central  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. 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.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

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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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA, 15213, USA

    Janet M. Catov & James M. Roberts

  2. Magee-Womens Research Institute, Pittsburgh, PA, USA

    Janet M. Catov & James M. Roberts

  3. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Janet M. Catov & James M. Roberts

  4. Clinical and Translational Research Institute, Pittsburgh, PA, USA

    James M. Roberts

  5. Nemours/Jefferson Department of Pediatrics, Philadelphia, PA, USA

    Diane J. Abatemarco

  6. Department of Pharmacology Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA

    Melanie Flint

  7. Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA

    MinJae Lee

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  1. Janet M. Catov
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Correspondence to Janet M. Catov.

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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

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