8. Reactivation of latent Epstein–Barr virus in pregnancy: Effects of race and implications for preterm birth

Abstract

Stress-induced immune dysregulation during pregnancy may contribute to adverse birth outcomes. As a robust indicator of cellular immune competence, we examined EBV reactivation in association with gestational age, race, racial discrimination, and preterm birth among 56 women. We assessed psychosocial factors and serum EBV capsid antigen antibody titers at each trimester and ∼5 weeks postpartum. African–Americans ( n = 38) and Whites ( n = 18) did not differ in age, income, parity, or BMI (ps ⩾ .51). EBV reactivation was lower in 3rd versus 1st trimester ( p = .002). At every timepoint, African–Americans showed greater EBV reactivation than Whites (ps p = .03(1st), .04(2nd), .12(3rd), .06(postpartum)]. Associations of race and discrimination with EBV reactivation were not accounted for by perceived stress, depressive symptoms, anxiety, or health behaviors. In the full sample, controlling for race, for every 2-fold increase in EBV antibody titers, the odds of preterm birth were 3.4 times higher (95%CI = 1.4, 11.9, p = .02). In African–Americans, the odds of preterm birth were 4.0 times higher for each 2-fold increase in antibody titers (95%CI = 1.3, 23.6), p = .01]. The ability of the cellular immune response to suppress latent EBV is enhanced in late compared to early gestation. Compared to Whites, African–American women show impaired cellular immune competence across pregnancy and postpartum, particularly those reporting greater racial discrimination. EBV reactivation may be associated with increased odds of preterm birth, particularly among African–Americans.