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Perinatal Food Insecurity and Postpartum Psychosocial Stress are Positively Associated Among Kenyan Women of Mixed HIV Status

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Abstract

Stress and food insecurity (FI) are associated with poor perinatal and HIV outcomes. We hypothesized that FI would increase postpartum stress among women in Kenya, and that the impact would be greater in women with HIV. Among 371 pregnant women, we identified latent FI trajectories across the perinatal period, and estimated their association with postpartum stress. Stress metrics included the Perceived Stress Scale (PSS) and hair cortisol concentrations (HCC). We identified two FI trajectories: persistent moderate FI and persistent mild FI. Moderate FI (vs. mild) was associated with higher PSS; this association was stronger among HIV-negative women. We observed a trend towards higher HCC associated with moderate FI, which did not differ by HIV status. HCC and PSS were not correlated. In summary, moderate FI (vs. mild) was associated with increased stress. The lack of PSS–HCC correlation could reflect different physiological pathways. Interventions to mitigate FI could alleviate postpartum stress.

Resumen

Hay una asociación entre el estrés y la inseguridad alimentaria en el hogar y resultados adversos para la salud perinatal y VIH. Nuestra hipótesis era que el estrés y la inseguridad alimentaria en el hogar incrementaría el estrés en el periodo de posparto entre mujeres en Kenia, y que el impacto seria mayor en aquellas mujeres con VIH. Identificamos trayectorias en materia del estrés y la inseguridad alimentaria en el hogar en estado latente y se estimo la asociación con el estrés en el periodo posparto entre 317 mujeres embarazadas. Se incluyeron la escala de estrés percibido (EEP) y la concentración de cortisol en las muestras de cabellos (CCC) recogidos como métricas de estrés. Identificamos dos trayectorias del estrés y la inseguridad alimentaria en el hogar, persistente moderada, y persistente liviana. Hay una asociación mayor entre EEP la trayectoria moderada del estrés y la inseguridad alimentaria en el hogar que la trayectoria liviana. Esta asociación es mayor entre las mujeres VIH-negativas. Observamos que hay una tendencia hacia un nivel mas alto de CCC y una asociación con la trayectoria moderada del estrés y la inseguridad alimentaria en el hogar, sin diferir entre estados de VIH. Las métricas CCC y EEP no están correlacionadas. En resumen, hay una asociación entre la trayectoria moderada del estrés y la inseguridad alimentaria en el hogar y un aumento del estrés. La falta de correlación entre CCC-EEP podría reflejar diferentes vías fisiológicas. Intervenciones destinadas para mitigar el estrés y la inseguridad alimentaria en el hogar podría aliviar el estrés en el periodo de posparto.

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Acknowledgements

We would like to thank the anonymous reviewers whose comments have greatly improved this manuscript, and the women and their infants who participated in this study.

Funding

This work was supported by the National Institute of Mental health at the National Institutes of Health [K01 MH098902 and R21 MH108444 to SLY; K01 MH119910 and T32 MH19105-30 supporting PMM; K23 MH116807 to ELT]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

    Pamela M. Murnane & Torsten B. Neilands

  2. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Pamela M. Murnane

  3. Department of Anthropology, Northwestern University, Evanston, IL, USA

    Joshua D. Miller & Shalean M. Collins

  4. Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA

    Emily L. Tuthill

  5. Kenya Medical Research Institute, Nairobi, Kenya

    Maricianah Onono

  6. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA

    Craig R. Cohen

  7. Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Sheri D. Weiser

  8. Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Mark L. Laudenslager

  9. Department of Anthropology & Global Health; Faculty Fellow, Institute for Policy Research, Northwestern University, Evanston, IL, USA

    Sera L. Young

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  1. Pamela M. Murnane
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Correspondence to Sera L. Young.

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Murnane, P.M., Miller, J.D., Tuthill, E.L. et al. Perinatal Food Insecurity and Postpartum Psychosocial Stress are Positively Associated Among Kenyan Women of Mixed HIV Status. AIDS Behav 24, 1632–1642 (2020). https://doi.org/10.1007/s10461-019-02676-5

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