Affiliation:
1. Department of Obstetrics and Gynecology University of Utah Health Salt Lake City Utah USA
2. Department of Obstetrics and Gynecology Ohio State University Columbus Ohio USA
3. Department of Obstetrics and Gynecology University of Pennsylvania Philadelphia Pennsylvania USA
4. Department of Obstetrics and Gynecology University of Pittsburgh Pittsburgh Pennsylvania USA
5. Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston Texas USA
6. Department of Obstetrics and Gynecology Northwestern University Evanston Illinois USA
7. Intermountain Health Department of Population Health Sciences University of Utah Health Utah Salt Lake City USA
8. Department of Obstetrics and Gynecology Cedars‐Sinai Medical Center Los Angeles California USA
9. Department of Obstetrics and Gynecology University of California Irvine Irvine California USA
10. Department of Obstetrics and Gynecology, School of Medicine Indiana University Bloomington Indiana USA
Abstract
AbstractObjectiveTo 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.DesignSecondary analysis of a prospective cohort study.Setting Multicenter PopulationPregnant women.MethodsOur 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 measureIncident cardiovascular disease risk: hypertension, or metabolic disorders.ResultsCardiovascular 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.ConclusionsHigh allostatic load during pregnancy is associated with cardiovascular disease risk. The relationships between stress, subsequent cardiovascular risk and race warrant further study.
Funder
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Heart, Lung, and Blood Institute
Subject
Obstetrics and Gynecology