Allostatic Load in Women with a History of Low Birth Weight Infants: The National Health and Nutrition Examination Survey

Abstract

Background: The purpose of our study was to determine whether women of reproductive age with history of low birth weight (LBW) deliveries have higher allostatic load (AL), a measure of the cumulative toll of chronic stress, than those with normal-weight deliveries. Methods: We used data from women ages 17-35 who responded to the National Health and Nutrition Examination Survey (NHANES) reproductive-health questionnaire, 1999-2006. Women reported history of LBW infants and those who were preterm. We classified preterm-LBW and term-LBW as surrogates for preterm birth (PTB) and small for gestational age (SGA), respectively. Normal weight included those without LBW infant history. We utilized nine biomarkers measured in NHANES to determine AL and used linear regression to compare unadjusted and adjusted means. Results: We identified 877 women divided among SGA (2%), PTB (10%), and normal groups (88%). The SGA group had higher unadjusted and adjusted AL scores than did the normal group (2.82 -0.35 vs. 1.92 -0.07, p = 0.011); women in the PTB group had higher AL scores than did the referent in adjusted analyses (2.58 -0.21 vs. 1.92 -0.07, p = 0.001). Conclusions: Women with history of SGA or PTB had higher AL than did those with normal birth weight outcomes. This suggests a link between adverse pregnancy outcomes, chronic stress, and subclinical disease.

Racial Discrimination and Adverse Birth Outcomes: An Integrative Review

“…In this regard, experiencing racial discrimination, and the exclusion that ensues, elicits a stress response that has detrimental effects on health . Briefly, allostatic load represents the chronic physiologic and psychosocial stress experienced over the life course by combining several markers of physical function into a composite score of biologic risk . Research has demonstrated that women with a history of small‐for‐gestational‐age birth or preterm birth have higher allostatic load than those women giving birth to normal birth weight infants .…”

Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics

“…This quantification of AL has proved its explanatory power in understanding the relationship between specific stressors and physical health, initially using data from the MacArthur Studies of Successful Aging (39) and National Health and Nutrition Examination Survey (NHANES) data for adults (14). More recently, AL has been employed to predict risk of adverse reproductive (40) and pediatric health outcomes (5), although empiric evidence on its utility in pregnancy is conflicting (35,41). Incorporation of a profile of biomarkers for stress, aging, and immune response may permit a more comprehensive and predictive AL assessment.…”

Testing allostatic load factor structures among adolescents: A structural equation modeling approach

“…Thus, AL is the biological result of chronic overactivity of these stress response pathways (Hux & Roberts, ), which over time leads to systemic dysregulation across numerous biological systems and increased risk for chronic disease. Indeed, a vast body of literature has linked elevated AL to a myriad of chronic diseases in adulthood, including a variety of psychological disorders (Beckie, Duffy, & Groer, ; Kuhn et al, ), cardiovascular disease (Havranek et al, ; Steptoe & Kivimaki, ), diabetes (Steptoe et al, ), and adverse pregnancy outcomes (Hux, Catov, & Roberts, ; Hux & Roberts, ), as well as others. However, there is a lack of consistency across the literature in how AL is operationalized and scored, which makes the comparison and validity of findings across studies challenging (Beckie, ).…”