Allostatic Load and Adverse Pregnancy Outcomes

Lueth, Amir J.; Allshouse, Amanda A.; Blue, Nathan M.; Grobman, William A.; Levine, Lisa D.; Simhan, Hyagriv N.; Kim, Jin‐Kyung; Johnson, Jeff; Wilson, Fernando A.; Murtaugh, Maureen; Silver, Robert M.

doi:10.1097/aog.0000000000004971

Cited by 16 publications

(13 citation statements)

References 49 publications

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“…Studies have highlighted that AL may be a key biological mediator of the minority stress effects on racial disparities in health and mortality. 20,23,24,76,85,86 Notably, high allostatic load is associated with both mental and physical health outcomes 1 and with greater all-cause mortality, 19 with additive contribution of AL to exposomic burden in explaining mortality. 23,76 Our results in a young developing population therefore concur with the existing literature in older populations regarding the links between environment and AL and between AL and health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Allostatic load in early adolescence: gene / environment contributions and relevance for mental health

Hoffman,

Tran,

Moore

et al. 2023

Preprint

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Background. Allostatic load is the cumulative 'wear and tear' on the body due to chronic adversity. We aimed to test poly-environmental (exposomic) and polygenic contributions to allostatic load and their combined contribution to early adolescent mental health. Methods. We analyzed data on N = 5,035 diverse youth (mean age 12) from the Adolescent Brain Cognitive Development Study (ABCD). Using dimensionality reduction method, we calculated and overall allostatic load score (AL) using body mass index [BMI], waist circumference, blood pressure, blood glycemia, blood cholesterol, and salivary DHEA. Childhood exposomic risk was quantified using multi-level environmental exposures before age 11. Genetic risk was quantified using polygenic risk scores (PRS) for metabolic system susceptibility (type 2 diabetes [T2D]) and stress-related psychiatric disease (major depressive disorder [MDD]). We used linear mixed effects models to test main, additive, and interactive effects of exposomic and polygenic risk (independent variables) on AL (dependent variable). Mediation models tested the mediating role of AL on the pathway from exposomic and polygenic risk to youth mental health. Models adjusted for demographics and genetic principal components. Results. We observed disparities in AL with non-Hispanic White youth having significantly lower AL compared to Hispanic and Non-Hispanic Black youth. In the diverse sample, childhood exposomic burden was associated with AL in adolescence (beta=0.25, 95%CI 0.22-0.29, P<.001). In European ancestry participants (n=2,928), polygenic risk of both T2D and depression was associated with AL (T2D-PRS beta=0.11, 95%CI 0.07-0.14, P<.001; MDD-PRS beta=0.05, 95%CI 0.02-0.09, P=.003). Both polygenic scores showed significant interaction with exposomic risk such that, with greater polygenic risk, the association between exposome and AL was stronger. AL partly mediated the pathway to youth mental health from exposomic risk and from MDD-PRS, and fully mediated the pathway from T2D-PRS. Conclusions. AL can be quantified in youth using anthropometric and biological measures and is mapped to exposomic and polygenic risk. Main and interactive environmental and genetic effects support a diathesis-stress model. Findings suggest that both environmental and genetic risk be considered when modeling stress-related health conditions.

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Section: Discussionmentioning

confidence: 99%

Allostatic load in early adolescence: gene / environment contributions and relevance for mental health

Hoffman,

Tran,

Moore

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…The total allostatic load score was summed for an allostatic load index ranging from 0 to 12. Low allostatic load was reported as an index of less than 4, and high allostatic load was an index of 4 or more because previous studies found this threshold to be discriminatory 16,17 . Allostatic load was included in analysis as a dichotomous variable (high versus low).…”

Section: Methodsmentioning

confidence: 99%

“…Low allostatic load was reported as an index of less than 4, and high allostatic load was an index of 4 or more because previous studies found this threshold to be discriminatory. 16,17 Allostatic load was included in analysis as a dichotomous variable (high versus low). Clinically relevant thresholds for some variables, particularly in pregnancy, are unavailable.…”

Section: Allostatic Loadmentioning

confidence: 99%

Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study

Lueth

Allshouse

Blue

et al. 2023

BJOG

Self Cite

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Objective: To assess the relationship between allostatic load, a measure of cumulative chronic stress in early pregnancy and cardiovascular disease risk, 2-7 years postpartum, and pathways contributing to racial disparities in cardiovascular disease risk. Design: Secondary analysis of a prospective cohort study. Setting Multicenter Population: Pregnant women. Methods: Our primary exposure was high allostatic load in the first trimester, defined as at least 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine and albumin) in the unfavourable quartile. Logistic regression was used to test the association between high allostatic load and main outcome adjusted for confounders: time from index pregnancy and follow up, age, education, smoking, gravidity, bleeding in the first trimester, index adverse pregnancy outcomes, and health insurance. Each main outcome component and allostatic load were analysed secondarily. Mediation and moderation analyses assessed the role of high allostatic load in racial disparities of cardiovascular disease risk. Main outcome measure: Incident cardiovascular disease risk: hypertension, or metabolic disorders. Results: Cardiovascular disease risk was identified in 1462/4022 individuals (hypertension: 36.6%, metabolic disorder: 15.4%). After adjustment, allostatic load was associated with cardiovascular disease risk (adjusted odds ratio [aOR] 2.0, 95% CI 1.8-2.3), hypertension (aOR 2.1, 95% CI 1.8-2.4) and metabolic disorder (aOR 1.7, 95% CI 1.5-2.1). Allostatic load was a partial mediator between race and cardiovascular disease risk. Race did not significantly moderate this relationship. Conclusions: High allostatic load during pregnancy is associated with cardiovascular disease risk. The relationships between stress, subsequent cardiovascular risk and race warrant further study.

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“…It has been associated with adverse pregnancy outcomes such as preterm birth, stillbirth, newborns small for gestational age, and hypertensive disorders of pregnancy. [56][57][58] Allostatic load in relation to stereotype threat, along with other forms of systemic racism, may explain some of the reproductive and pregnancy disparities in Black individuals.…”

Section: : Partus Sequitur Ventrem and The Intersection Between Race ...mentioning

confidence: 99%

Historical Primer on Obstetrics and Gynecology Health Inequities in America

Nnoli

2023

Obstetrics &Amp; Gynecology

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Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

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Allostatic Load and Adverse Pregnancy Outcomes

Cited by 16 publications

References 49 publications

Allostatic load in early adolescence: gene / environment contributions and relevance for mental health

Allostatic load in early adolescence: gene / environment contributions and relevance for mental health

Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study

Historical Primer on Obstetrics and Gynecology Health Inequities in America

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