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.
Methods
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.
Results
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).
Conclusion
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.
AgyemangP.Powell-WileyT. M. (2013). Obesity and Black women: Special considerations related to genesis and therapeutic approaches. Current Cardiovascular Risk Reports, 7(5), 378–386. https://doi.org/10.1007/s12170-013-0328-7
2.
AllisonP. D. (2001). Missing data. Sage University Papers Series.
BeckieT. M. (2012). A systematic review of allostatic load, health, and health disparities. Biological Research For Nursing, 14(4), 311–346. https://doi.org/10.1177/1099800412455688
6.
BediU. S.AroraR. (2007). Cardiovascular manifestations of posttraumatic stress disorder. Journal of the National Medical Association, 99(6), 642–649.
CollinsL. M.SchaferJ. L.KamC. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6(4), 330–351.
9.
CopenC. E.ThomaM. E.KirmeyerS. (2015). Interpregnancy intervals in the United States: Data from the birth certificate and the national survey of family growth. National Vital Statistics Reports, 64(3), 1–11. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_03.pdf
10.
DormannC. F.ElithJ.BacherS.BuchmannC.CarlG.CarréG.MarquézJ. R. G.GruberB.LafourcadeB.LeitãoP. J.MünkemüllerT.McCleanC.OsborneP. E.ReinekingB.SchröderB.SkidmoreA. K.ZurellD.LautenbachS. (2013). Collinearity: A review of methods to deal with it and a simulation study evaluating their performance. Ecography, 36(1), 27–46. https://doi.org/10.1111/j.1600-0587.2012.07348.x
11.
Dunkel SchetterC.SchaferP.LanziR. G.Clark-KauffmanE.RajuT. N.HillemeierM. M.Community Child HealthN. (2013). Shedding light on the mechanisms underlying health disparities through community participatory methods: The stress pathway. Perspectives on Psychological Science, 8(6), 613–633. https://doi.org/10.1177/1745691613506016
12.
EndersC. K. (2010). Applied missing data analysis. The Guilford Press.
13.
GillespieS. L.AndersonC. M.ZhaoS.TanY.KlineD.BrockG.OdeiJ.O’BrienE.SimsM.LazarusS. A.HoodD. B.WilliamsK. P.JosephJ. J. (2019). Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study. Psychoneuroendocrinology, 109(7), 104369. https://doi.org/10.1016/j.psyneuen.2019.06.020
GuoX.ZhengL.WangJ.ZhangX.ZhangX.LiJ.SunY. (2013). Epidemiological evidence for the link between sleep duration and high blood pressure: A systematic review and meta-analysis. Sleep Medicine, 14(4), 324–332. https://doi.org/10.1016/j.sleep.2012.12.001
17.
HabersaatS.BorghiniA.NessiJ.PierrehumbertB.Forcada-GuexM.AnsermetF.Muller-NixC. (2014). Posttraumatic stress symptoms and cortisol regulation in mothers of very preterm infants. Stress and Health, 30(2), 134–141. https://doi.org/10.1002/smi.2503
18.
HadiH. A.CarrC. S.Al SuwaidiJ. (2005). Endothelial dysfunction: Cardiovascular risk factors, therapy, and outcome. Vascular Health and Risk Management, 1(3), 183–198.
19.
HowellE. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387–399. https://doi.org/10.1097/GRF.0000000000000349
HuxV. J.RobertsJ. M.OkunM. L. (2017). Allostatic load in early pregnancy is associated with poor sleep quality. Sleep Medicine, 33, 85–90. https://doi.org/10.1016/j.sleep.2016.09.001
22.
JanevicT.ZeitlinJ.EgorovaN.HebertP. L.BalbierzA.HowellE. A. (2020). Neighborhood racial and economic polarization, hospital of delivery, and severe maternal morbidity. Health Affairs, 39(5), 768–776. https://doi.org/10.1377/hlthaff.2019.00735
23.
Kaufman-ShriquiV.O’CampoP.MisirV.SchaferP.MorinisJ.VanceM.Dunkel SchetterC.RajuT. N. K.HillemeierM. M.LanziR.ChinchilliV. M. (2020). Neighbourhood-level deprivation indices and postpartum women’s health: Results from the Community Child Health Network (CCHN) multi-site study. Health and Quality of Life Outcomes, 18(1), 38. https://doi.org/10.1186/s12955-020-1275-x
24.
KimJ. H. (2019). Multicollinearity and misleading statistical results. Korean Journal of Anesthesiology, 72(6), 558–569. https://doi.org/10.4097/kja.19087
25.
LeimertK. B.OlsonD. M. (2020). Racial disparities in pregnancy outcomes: Genetics, epigenetics, and allostatic load. Current Opinion in Physiology, 13, 155–165. https://doi.org/10.1016/j.cophys.2019.12.003
26.
MatteiJ.DemissieS.FalconL. M.OrdovasJ. M.TuckerK. (2010). Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Social Science & Medicine, 70(12), 1988–1996. https://doi.org/10.1016/j.socscimed.2010.02.024
27.
McClainA. C.XiaoR. S.TuckerK. L.FalconL. M.MatteiJ. (2022). Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults. Psychological Medicine, 52(14), 3073–3085. https://doi.org/10.1017/S0033291720005139
McEwenB. S. (2000). Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacology, 22(2), 108–124. https://doi.org/10.1016/S0893-133X(99)00129-3
30.
MelinB.LundbergU.SöderlundJ.GranqvistM. (1999). Psychological and physiological stress reactions of male and female assembly workers: A comparison between two different forms of work organization. Journal of Organizational Behavior, 20(2), 47–61. https://doi.org/10.1002/(SICI)1099-1379(199901)20:1<47::AID-JOB871>3.0.CO;2-F
31.
MurphyH. R.GuY.WuQ.BrunnerJ.PanischL. S.BestM.ArnoldM. S.DubersteinZ. T.PutzigJ.CarnahanJ.GrothS. W.BarrettE. S.QiuX.O’ConnorT. G. (2022). Prenatal diurnal cortisol: Normative patterns and associations with affective symptoms and stress. Psychoneuroendocrinology, 143(4), 105856. https://doi.org/10.1016/j.psyneuen.2022.105856
32.
Najat NakishbandyB. M.BarawiS. A. (2014). Level of C - reactive protein as an indicator for prognosis of premature uterine contractions. Journal of Prenatal Medicine, 8(1–2), 25–30.
33.
O’CampoP.SchetterC. D.GuardinoC. M.VanceM. R.HobelC. J.RameyS. L.ShalowitzM. U. (2016). Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income women. SSM-Population Health, 2, 850–858. https://doi.org/10.1016/j.ssmph.2016.10.014
34.
PeekM. K.CutchinM. P.SalinasJ. J.SheffieldK. M.EschbachK.StoweR. P.GoodwinJ. S. (2010). Allostatic load among non-hispanic whites, non-hispanic blacks, and people of Mexican origin: Effects of ethnicity, nativity, and acculturation. American Journal of Public Health, 100(5), 940–946. https://doi.org/10.2105/AJPH.2007.129312
RameyS. L.SchaferP.DeClerqueJ. L.LanziR. G.HobelC.ShalowitzM.ChinchilliV.RajuT. N.Community Child Health Network (2015). The preconception stress and resiliency pathways model: A multi-level framework on maternal, paternal, and child health disparities derived by community-based participatory research. Maternal and Child Health Journal, 19(4), 707–719. https://doi.org/10.1007/s10995-014-1581-1
37.
RangarajV. R.KnutsonK. L. (2016). Association between sleep deficiency and cardiometabolic disease: Implications for health disparities. Sleep Medicine, 18, 19–35. https://doi.org/10.1016/j.sleep.2015.02.535
38.
RigganK. A.GilbertA.AllyseM. A. (2021). Acknowledging and addressing allostatic load in pregnancy care. Journal of Racial and Ethnic Health Disparities, 8(1), 69–79. https://doi.org/10.1007/s40615-020-00757-z
39.
RodriquezE. J.KimE. N.SumnerA. E.NapolesA. M.Perez-StableE. J. (2019). Allostatic load: Importance, markers, and score determination in minority and disparity populations. Journal of Urban Health, 96(Suppl 1), 3–11. https://doi.org/10.1007/s11524-019-00345-5
40.
RossK. M.GuardinoC.Dunkel SchetterC.HobelC. J. (2020). Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health. Ethnicity and Health, 25(8), 1145–1160. https://doi.org/10.1080/13557858.2018.1493433
41.
ScheyerK.UrizarG. G.Jr. (2016). Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Archives of Women’s Mental Health, 19(2), 317–328. https://doi.org/10.1007/s00737-015-0563-7
42.
SchoberP.VetterT. R. (2018). Repeated measures designs and analysis of longitudinal data: If at first you do not succeed-try, try again. Anesthesia & Analgesia, 127(2), 569–575. https://doi.org/10.1213/ANE.0000000000003511
43.
ScrogginsJ. K.Reuter-RiceK.BrandonD.YangQ. (2023). Identification of postpartum symptom subgroups and associated long-term maternal depressive symptoms and well-being. Research in Nursing & Health, 46(5), 485–501. https://doi.org/10.1002/nur.22336
44.
SeemanT.EpelE.GruenewaldT.KarlamanglaA.McEwenB. S. (2010). Socio-economic differentials in peripheral biology: Cumulative allostatic load. Annals of the New York Academy of Sciences, 1186(1), 223–239. https://doi.org/10.1111/j.1749-6632.2009.05341.x
45.
SeemanT. E.CrimminsE.HuangM.-H.SingerB.BucurA.GruenewaldT.BerkmanL. F.ReubenD. B. (2004). Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging. Social Science & Medicine, 58(10), 1985–1997. https://doi.org/10.1016/s0277-9536(03)00402-7
46.
ShalowitzM. U.SchetterC. D.HillemeierM. M.ChinchilliV. M.AdamE. K.HobelC. J.RameyS. L.VanceM. R.O’CampoP.ThorpJ. M.Jr.SeemanT. E.RajuT. N. K.Eunice Kennedy shriver national Institute of child human development community child health network. (2019). cardiovascular and metabolic risk in women in the first year postpartum: Allostatic load as a function of race, ethnicity, and poverty status. American Journal of Perinatology, 36(10), 1079–1089. https://doi.org/10.1055/s-0038-1675618
WallaceM.DyerL.Felker-KantorE.BennoJ.VildaD.HarvilleE.TheallK. (2021). Maternity care deserts and pregnancy-associated mortality in Louisiana. Women’s Health Issues, 31(2), 122–129. https://doi.org/10.1016/j.whi.2020.09.004
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