Allostatic load in early pregnancy is associated with poor sleep quality

Abstract

Background Allostatic load (AL) measures the cumulative impact of chronic stress and is associated with adverse health outcomes. A novel scoring system has previously been developed for AL in early pregnancy that is associated with pre-eclampsia. It was hypothesized that AL, as identified by the present model, is associated with psychosocial stressors and, specifically, poor sleep quality. Methods Women were selected from a low-risk, community-dwelling study population who enrolled at <15 weeks gestation. Nine physiologic components were divided among the domains of cardiovascular, metabolic, and inflammatory function. Spearman’s rank correlations were used to examine the association of AL with age, income, the Revised Prenatal Distress Questionnaire (NuPDQ), Inventory of Depressive Symptoms (IDS), and Pittsburgh Sleep Quality Index (PSQI). The Wilcoxon rank-sum test was used to compare AL by race and educational attainment. Results A total of 103 women were identified, with: a mean age of 29.8 ± 5.0 years, 17.5% black, and mean gestational age 12.2 ± 1.1 weeks. Allostatic load was positively correlated with the PSQI (ρ=0.23, p=0.018). There were no associations with age, income, prenatal distress, race, or depression scores. College-educated women had lower AL compared with those with less education (0.57 ± 0.43 vs 0.81 ± 0.55, p=0.045). Conclusion Higher AL, measured by the pregnancy-specific model, was associated with poorer sleep quality and lower educational attainment, both of which were considered to be chronic stressors. These relationships were consistent with previous findings in non-pregnant populations, and suggest that AL may be useful for capturing the physiologic impact of chronic stress in early pregnancy.

Allostatic Load and Its Impact on Health: A Systematic Review

“…Allostatic load was associated with healthdamaging lifestyle habits, such as lack of physical activity, unhealthy diet and poor sleep, in several investigations [52,228,229,233,239]. The metabolic syndrome, which may be fre quently associated with allostatic load [17], is an important example of the devastating effects of harmful lifestyles and of the need to prevent its occurrence as early as possible in life [314].…”

“…Several studies showed a significant association be tween depressive and anxiety symptoms and allostatic Psychother Psychosom 2021;90:11-27 DOI: 10.1159/000510696 load [279][280][281][282][283], not confirmed by others [233,[284][285][286]. In the association between childhood physical abuse and depression in adulthood, allostatic load appeared to have a mediating role [287].…”

“…Physical activity was found to be associated with lower allostatic load [227][228][229], whereas poor sleep quality [230][231][232][233], unhealthy diet and overweight [52,218,228,[234][235][236][237][238][239], alcohol consumption [52,92,228,229,240] and smoking habits [241] were associated with high allo static load levels.…”

Socioeconomic Status in Pregnant Women and Sleep Quality During Pregnancy

“…Understanding sleep patterns during pregnancy may have significant impacts on gestational outcomes [17]. During pregnancy, poor quality of sleep (PQOS) and sleep disorders have been associated with hypertensive states like preeclampsia (Preeclampsia can occur as early as 20 weeks of gestation, if one is at risk than symptoms usually occurs around 34th week) [18,19].…”

Sleep disturbances and modulations in inflammation: Implications for pregnancy health

“…Sleep is gaining recognition as an important factor to consider when studying or treating pregnant women. For example, many epidemiological reports have linked poor sleep or insomnia to poor health outcomes, including depression (Okun, Kiewra, Luther, Wisniewski, & Wisner, 2011;Okun, Kiewra, Luther, et al, 2011;Volkovich, Tikotzky, & Manber, 2016;Wolynczyk-Gmaj et al, 2017;Yang et al, 2017;Hux, Roberts, & Okun, 2017), preterm birth (Okun, Luther, Prather, et al, 2011;Blair, Porter, Leblebicioglu, & Christian, 2015;Li et al, 2016) and longer labor times (Evans, Dick, & Clark, 1995;Lee & Gay, 2004). The undisputed association between stress and sleep is particulary poignant in pregnancy, as stress is independently associated with poor pregnancy outcomes (Okun, Roberts, Begley, Catov, & Patrick, 2013;Palagini et al, 2014;Hux et al, 2017).…”