Departments of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, The Ohio State University, Columbus, Ohio, University of Pennsylvania, Philadelphia, Pennsylvania, University of Pittsburgh, Pittsburgh, Pennsylvania, University of California, Irvine, Irvine, California, and School of Medicine, Indiana University, Indianapolis, Indiana; and the Department of Population Health Sciences, University of Utah Health, Salt Lake City, Utah.
Obstet Gynecol. 2022 Dec 1;140(6):974-982. doi: 10.1097/AOG.0000000000004971. Epub 2022 Nov 2.
To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes.
This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes.
Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA.
High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
评估作为慢性应激指标的全身适应负荷与不良妊娠结局之间的关系。
这是 nuMoM2b（未生育妊娠结局研究：监测孕妇）的二次分析，这是一项前瞻性观察队列研究。我们的主要暴露是在孕早期存在 4 种或更多 12 种生物标志物中处于“最差”四分位数的高全身适应负荷，定义为二分类变量。主要结局是复合不良妊娠结局：妊娠高血压疾病（HDP）、早产、小于胎龄儿（SGA）和死胎。次要结局包括复合结局的组成部分。多变量逻辑回归用于检验高全身适应负荷与不良妊娠结局之间的关联，并对潜在混杂因素进行调整。进行中介和调节分析，以评估全身适应负荷在种族差异与不良妊娠结局之间的因果途径中的作用。
在 4266 名个体中，有 34.7%存在高全身适应负荷。复合不良妊娠结局发生在 1171 例（27.5%）：HDP 占 14.0%，早产占 8.6%（48.0%自发性和 52.2%有指征），SGA 占 11.0%，死胎占 0.3%。在调整了母亲年龄、孕次、吸烟、孕早期出血和医疗保险后，高全身适应负荷与复合不良妊娠结局（调整后的优势比[aOR] 1.5，95%CI 1.3，1.7）和 HDP（aOR 2.5，95%CI 2.0-2.9）显著相关，但与早产或 SGA 无关。高全身适应负荷部分介导了自我报告种族与不良妊娠结局之间的关联。全身适应负荷与 HDP 之间的关联因自我报告种族而异，但与复合不良妊娠结局、早产或 SGA 无关。
孕早期高全身适应负荷与不良妊娠结局相关，尤其是 HDP。全身适应负荷是种族与不良妊娠结局之间的部分中介因素。全身适应负荷与 HDP 之间的关联因自我报告种族而异。
