Systemic Inflammation among Pregnant African American Women Is Related to Depressive Symptoms and Intimate Partner Violence

Abstract

Systemic inflammation (e.g., higher levels of pro-inflammatory cytokine interleukin [IL]-6 and C-reactive protein [CRP]) during pregnancy increases risk for both the mother and the infant. For the mother, systemic inflammation is associated with an increased risk of pregnancy complications (e.g., preeclampsia). For the infant, cytokine dysregulation may lead to long term immune dysregulation and susceptibility to metabolic diseases. Pregnant African American women are more likely to have greater systemic inflammation compared with pregnant non-Hispanic White women. They also experience a higher prevalence of chronic conditions (e.g., asthma), have higher levels of depressive symptoms, and report more incidents of intimate partner violence (IPV). We hypothesize that maternal systemic inflammation is related to chronic disease, depressive symptoms, and IPV among pregnant African American women. Pregnant African American women (n=180) were recruited at prenatal clinics in the Midwest. Women completed a questionnaire and had blood drawn at a prenatal visit. Plasma cytokine levels (interferon [IFN]-γ, tumor necrosis factor [TNF]-α, IL-6, IL8 and IL10) were measured by multiplex array and CRP was measured by ELISA. Data were log (x+1) transformed and analyzed using descriptive statistics and correlational analysis (Pearson and point-biserial correlations). Women had a mean age of 27±5.5 years (range 18-41) and a mean gestational age at data collection of 16±5.8 weeks (range 8-29). Fifty-five percent of women were employed, 42% had annual household income < $10,000, and 16% smoked cigarettes during pregnancy. Twenty-five percent of women reported asthma, 8% hypertension, 6% diabetes, and 4% thyroid disease. Twenty-seven percent of women had Center for Epidemiological Studies-Depression (CES-D) scores ≥ 23, which have been correlated with depression diagnosis. IPV during the year before pregnancy was more frequent (8%) than IPV during pregnancy (5.1%). Women who reported hypertension had higher levels of TNF-α (r= 0.151, p< 0.05); and women with asthma had higher levels of CRP (r= 0.20, p< 0.01). Women who reported higher CES-D scores (r= 0.19, p< 0.05) had higher CRP levels. Women who reported IPV during pregnancy had higher IL-8 levels (r= 0.17, p< 0.05). Women who were employed had lower levels of IL-6 compared to women who were not employed (r= -0.180, p< 0.05). These results indicate that systemic inflammation is related to chronic health conditions (hypertension, asthma), depressive symptoms, IPV and employment status in pregnant African American women. The relationships between systemic inflammation, depressive symptoms and IPV, with a focus on metabolic and molecular pathways should be investigated to better understand the mechanisms by which maternal and fetal health are affected.