Maternal Allostatic Load Research Articles

Examination of Maternal Allostatic Load Among Postpartum Women With Distinct Postpartum Symptom Typologies.

An increased allostatic load (cumulative physiologic wear and tear of the body) can lead to adverse health outcomes. Symptom experiences are known to influence allostatic load. Yet, the relationships between postpartum symptom typologies and maternal allostatic load remain unknown. We used Community Child Health Network data and included participants with allostatic load data at 6, 12, or 24 months postpartum. Bivariate and multivariate analyses were conducted to examine associations between postpartum symptom typologies and (a) overall allostatic load, (b) allostatic load subscales for body systems (neuroendocrine, cardiovascular, metabolic, and inflammatory), and (c) individual biomarkers within the subscale. Overall allostatic load at 12 months postpartum was different by symptom typologies before (p = .042) and after adjusting for confounders (p = .029). Postpartum women in typology 5 (high overall) had the highest adjusted overall allostatic load (M = 4.18, SE = .27). At 12 months, adjusted allostatic load for the cardiovascular subscale was higher in typologies 3 (moderate-high sleep symptoms, M = 1.78, SE = .13) and 5 (high overall, M = 1.80, SE = .17). Within the cardiovascular subscale, those in typology 3 had higher adjusted odds for a clinically significant level of pulse rate (aOR = 2.01, CI = 1.22, 3.31). Postpartum women who experienced high symptom severity across all symptoms (typology 5) at 6 months had higher overall allostatic load at 12 months postpartum. Typologies 3 and 5 had the highest symptom severity in sleep-related symptoms and higher cardiovascular subscale scores. Postpartum symptom management should target symptom burden in an effort to reduce allostatic load thereby improving postpartum women's health outcomes.

Breastfeeding Duration Is Inversely Associated with Postpartum Allostatic Load: A Possible Mechanism for Improved Maternal Health.

Background: Allostatic load, a multisystem composite measure of chronic stress reflecting the cumulative wear and tear on the body, has utility in explaining maternal and child health disparities and predicting future health when measured during the peripartum period. Research using cross-sectional data has demonstrated an inverse association between concurrent breastfeeding status and maternal postpartum allostatic load. However, the relationship between breastfeeding duration and postpartum allostatic load has not been determined. Objective: This study aimed to examine the association between breastfeeding duration and postpartum allostatic load using prospective data, and to compare the association by race/ethnicity to better understand etiologies of health inequities. Materials and Methods: A secondary analysis of a data sample of 1,791 postpartum women from the Community Child Health Research Network was conducted. Multiple linear regression tested the association between and breastfeeding duration and allostatic load (range 0-10, calculated from 10 biomarkers) at 6 and 12 months postpartum, adjusting for race/ethnicity, maternal age, education, poverty level, study center, smoking, marital status, and prepregnancy body mass index. Stratified analyses examined differences in associations by race/ethnicity. Results: Breastfeeding duration was inversely associated with maternal allostatic load. In adjusted models, mothers who breastfed ≥6 months had 0.41 points lower allostatic load at 6 months (95% CI: -0.71 to -0.11) and 0.36 points lower allostatic load at 12 months postpartum (95% CI: -0.69 to -0.036) compared with mothers who never breastfed. Effect sizes varied in strength and significance across race/ethnic groups. Conclusions: Study findings suggest that extended breastfeeding for at least 6 months is linked with reduced chronic stress load in mothers during the first year postpartum. The inconsistency of findings across race/ethnic groups signals the importance of adjusting for prepregnancy allostatic load in future studies.

Prospective association between maternal allostatic load during pregnancy and child mitochondrial content and bioenergetic capacity

BackgroundMitochondria are multifunctional energy-producing and signaling organelles that support life and contribute to stress adaptation. There is a growing understanding of the dynamic relationship between stress exposure and mitochondrial biology; however, the influence of stress on key domains of mitochondrial biology during early-life, particularly the earliest phases of intra-uterine/prenatal period remains largely unknown. Thus, the goal of this study was to examine the impact of fetal exposure to stress (modeled as the biological construct allostatic load) upon mitochondrial biology in early childhood. MethodsIn n = 30 children (range: 3.5–6 years, 53% male), we quantified mitochondrial content via citrate synthase (CS) activity and mtDNA copy number (mtDNAcn), and measured mitochondrial bioenergetic capacity via respiratory chain enzyme activities (complexes I (CI), II (CII), and IV (CIV)) in platelet-depleted peripheral blood mononuclear cells (PBMCs). In a cohort of healthy pregnant women, maternal allostatic load was operationalized as a latent variable (sum of z-scores) representing an aggregation of early-, mid- and late-gestation measures of neuroendocrine (cortisol), immune (interleukin-6, C-reactive protein), metabolic (homeostasis model assessment of insulin resistance, free fatty acids), and cardiovascular (aggregate systolic and diastolic blood pressure) systems, as well as an anthropometric indicator (pre-pregnancy body mass index [BMI]). ResultsAn interquartile increase in maternal allostatic load during pregnancy was associated with higher mitochondrial content (24% and 15% higher CS and mtDNAcn), and a higher mitochondrial bioenergetic capacity (16%, 23%, and 25% higher CI, CII and CIV enzymatic activities) in child leukocytes. The positive association between maternal allostatic load during pregnancy and child mitochondrial content and bioenergetic capacity remained significant after accounting for the effects of key pre- and post-natal maternal and child covariates (p’s < 0.05, except CI p = 0.073). ConclusionWe report evidence that prenatal biological stress exposure, modeled as allostatic load, was associated with elevated child mitochondrial content and bioenergetic capacity in early childhood. This higher mitochondrial content and bioenergetic capacity (per leukocyte) may reflect increased energetic demands at the immune or organism level, and thus contribute to wear-and-tear and pathophysiology, and/or programmed pro-inflammatory phenotypes. These findings provide potential mechanistic insight into the cellular processes underlying developmental programming, and support the potential role that changes in mitochondrial content and bioenergetic functional capacity may play in altering life-long susceptibility for health and disease.

Breastfeeding Is Inversely Associated with Allostatic Load in Postpartum Women: Cross-Sectional Data from Nationally Representative US Women

BackgroundThe postpartum period is a critical transition period when exposures to protective factors such as breastfeeding can have long-lasting health impact. Studies have suggested downregulating effects of breastfeeding on stress biomarkers such as cortisol but have not explored the way breastfeeding interacts with allostatic load, a multisystem indicator of chronic stress. ObjectiveWe aimed to examine the association between breastfeeding and maternal allostatic load among women within 2 y postpartum using nationally representative data. MethodsA cross-sectional analysis of 10 waves of data from the NHANES (1999–2018) was conducted in a sample of 1302 women aged ≥18 y who provided information on breastfeeding through the reproductive health questionnaire. Clinical and empirical allostatic load scores (range: 0–10; higher numbers associated with increased risk) were derived for each participant based on 10 biomarkers reflecting metabolic, cardiovascular, and immune health. Multiple linear regression tested associations between breastfeeding and allostatic load, adjusting for maternal age, race and ethnicity, education, poverty level, and survey wave. ResultsBreastfeeding had a significant inverse association with allostatic load in unadjusted and adjusted models. Controlling for age, race and ethnicity, education, poverty level, and survey wave, breastfeeding women had a 0.36-point lower clinical allostatic load score than nonbreastfeeding women (β = −0.36, SE = 0.11; 95% CI: −0.59, −0.14; P = 0.002) and a 0.44-point lower empirical allostatic load score (β = −0.44, SE = 0.15; 95% CI: −0.74, −0.14; P = 0.005). ConclusionsOur study suggests that breastfeeding is protective of maternal stress and provides a more comprehensive picture of breastfeeding's influence on multiple body systems, exemplifying physiological benefits beyond effects on single biomarkers. However, limitations of cross-sectional data and non-classification of breastfeeding duration, mode, and intensity should be considered when interpreting these findings, and further research to address the role of breastfeeding and allostatic load is needed.

Associations Between Breastfeeding and Postpartum Allostatic Load: NHANES 1999–2016

Abstract Objectives Current evidence suggests breastfeeding has a modulating effect on maternal stress. We aimed to examine the association between breastfeeding and maternal allostatic load, a marker of chronic stress and adverse health, among women within one year postpartum, using nationally representative data. We hypothesized that women who were breastfeeding had lower allostatic load compared to women who were not breastfeeding. Methods A cross sectional analysis of nine waves of data from the National Health and Nutrition Examination Survey (NHANES 1999–2016) was conducted on a sample of 1203 women &amp;gt;18 years old, within their first year postpartum, who provided information on breastfeeding status through the reproductive health questionnaire. An allostatic load score (range 0–10) was derived for each participant based on ten biomarkers reflecting metabolic, cardiovascular, and immune health. Simple linear regression was used to test bivariate associations between potential confounders and allostatic load. Confounders were then incorporated into multiple linear regression models. The final model tested associations between breastfeeding and allostatic load, adjusting for maternal age, race/ethnicity, education, and poverty status. Results Our findings showed that breastfeeding had a significant inverse association with allostatic load in unadjusted and adjusted models. Furthermore, controlling for age, race/ethnicity, education, and poverty status, we found that breastfeeding women had 0.2727 points lower allostatic load score than non-breastfeeding women (ß = −0.2727, SE = 0.0958, P = 0.0045). Conclusions Our study suggests breastfeeding is protective of maternal stress, demonstrating an inverse association with allostatic load among women during the first year postpartum. Our results provide a more comprehensive picture of breastfeeding's influence on multiple body systems, exemplifying physiological benefits beyond effects on single biomarkers. Funding Sources No funding was used to support this study.

Parental attachment anxiety: Associations with allostatic load in mothers of 1-year-olds

Growing evidence indicates that individual differences in attachment style are related to health outcomes. The present study extends this literature by examining whether attachment anxiety in both mothers and fathers predicts maternal health the year following the birth of a child in a sample of 698 low-income, racially diverse couples. We hypothesized that maternal perceptions of partner responsiveness would mediate these associations. Maternal allostatic load, a measure of cumulative wear-and-tear on the body due to stress, was used as an indicator of maternal health. Maternal biomarkers (blood pressure, adiposity, blood metabolites, inflammation, and diurnal cortisol) were scored using clinical or top-quartile cutoffs to compute an allostatic load index. Attachment anxiety and perceived partner responsiveness were assessed in interviews. Path models were used to test indirect associations between mother and father attachment anxiety and maternal allostatic load through perceived partner responsiveness. We found that higher mother and father attachment anxiety were each independently and indirectly associated with higher maternal allostatic load through lower maternal perceptions of partner responsiveness. These findings highlight the need to consider both relationship and partner factors in understanding maternal health.

Allostatic Load During the Interconception Period in Women Who Had Gestational Diabetes Mellitus [14C

INTRODUCTION: Gestational diabetes mellitus (GDM) is a condition disproportionately affecting racial/ethnic minorities, but the reasons for this disparity remain unclear. GDM in one pregnancy also greatly predicts GDM in future pregnancies. Allostatic load (AL) measures cumulative effects of physical and psychological stress on multiple body systems. Directly measuring and monitoring AL presents a novel way of assessing health risk biomarkers in mothers. We aim to determine the relationship between maternal AL and GDM in the interconception period. METHODS: Data collection occurred through the 5-site NIH Community Child Health Network. AL was analyzed as an absolute value plus individual indices to determine associations to GDM at both 6 and 12 months postpartum. ANOVAs were performed to assess relationships between AL, stress, and resiliency in women with and without GDM. RESULTS: There are significant differences in AL between the GDM (N=61) and non-GDM (N=1421) groups at 6 and 12 months (P &lt; .001), particularly in the African-American group at both time points (P &lt; .001). There was no significant change in AL from 6 to 12 months postpartum for either group. There were no significant differences between the groups for self-reported measures of stress and resiliency. Total chronic life stress is significantly correlated with AL at both times for both groups (P &lt; .01). CONCLUSION: Differences in AL between mothers with and without GDM highlights a worse picture of health postpartum for women with GDM, especially African-American women. Women with increased AL and GDM need more rigorous and focused interconception care in order to prevent GDM and improve overall health.

Maternal Allostatic Load, Caretaking Behaviors, and Child Dental Caries Experience: A Cross-Sectional Evaluation of Linked Mother-Child Data From the Third National Health and Nutrition Examination Survey.

We evaluated the associations between chronic maternal stress measured by allostatic load (AL), maternal caretaking behaviors, and child dental caries experience. We also assessed the role of socioeconomic status in these associations. We used data from the Third National Health and Nutrition Examination Survey (1988-1994). We included children aged 2 to 6 years who linked to a maternal record (n = 716 maternal-child pairs). The main exposure was maternal AL index (0, 1, or ≥ 2). The primary outcome of interest was child dental caries experience (none or any). We evaluated the association between maternal AL and (1) maternal caretaking behaviors, and (2) child caries status and the role of socioeconomic status in these relationships. Children of mothers with an AL index of at least 2 were significantly more likely to have not been breastfed and to have dental caries than were children of mothers with a normal AL before adjusting for measures of socioeconomic status. Maternal chronic stress, indicated by elevation in markers of AL, has an important role in child caretaking behaviors and in children's oral health.

The Preconception Stress and Resiliency Pathways Model: a multi-level framework on maternal, paternal, and child health disparities derived by community-based participatory research.

Emerging evidence supports the theoretical and clinical importance of the preconception period in influencing pregnancy outcomes and child health. Collectively, this evidence affirms the need for a novel, integrative theoretical framework to design future investigations, integrate new findings, and identify promising, evidence-informed interventions to improve intergenerational health and reduce disparities. This article presents a transdisciplinary framework developed by the NIH Community Child Health Network (CCHN) through community-based participatory research processes. CCHN developed a Preconception Stress and Resiliency Pathways (PSRP) model by building local and multi-site community-academic participatory partnerships that established guidelines for research planning and decision-making; reviewed relevant findings diverse disciplinary and community perspectives; and identified the major themes of stress and resilience within the context of families and communities. The PSRP model focuses on inter-relating the multiple, complex, and dynamic biosocial influences theoretically linked to family health disparities. The PSRP model borrowed from and then added original constructs relating to developmental origins of lifelong health, epigenetics, and neighborhood and community influences on pregnancy outcome and family functioning (cf. MCHJ 2014). Novel elements include centrality of the preconception/inter-conception period, role of fathers and the parental relationship, maternal allostatic load (a composite biomarker index of cumulative wear-and-tear of stress), resilience resources of parents, and local neighborhood and community level influences (e.g., employment, housing, education, health care, and stability of basic necessities). CCHN's integrative framework embraces new ways of thinking about how to improve outcomes for future generations, by starting before conception, by including all family members, and by engaging the community vigorously at multiple levels to promote resiliency, reduce chronic and acute stressors, and expand individualized health care that integrates promotive and prevention strategies. If widely adopted, the PSRP model may help realize the goal of sustaining engagement of communities, health and social services providers, and scientists to overcome the siloes, inefficiencies, and lack of innovation in efforts to reduce family health disparities. Model limitations include tremendous breadth and difficulty measuring all elements with precision and sensitivity.