Maternal Income during Pregnancy is Associated with Chronic Placental Inflammation at Birth

Lauren S. Keenan-Devlin; Linda M. Ernst; Kharah M. Ross; Sameen Qadir; William A. Grobman; Jane L. Holl; Amy Crockett; Gregory E. Miller; Ann E. B. Borders

doi:10.1055/s-0037-1601353

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(10): 1003-1010
DOI: 10.1055/s-0037-1601353

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Maternal Income during Pregnancy is Associated with Chronic Placental Inflammation at Birth

Lauren S. Keenan-Devlin

¹Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois

,

Linda M. Ernst

²Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Kharah M. Ross

³Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois

,

Sameen Qadir

¹Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois

,

William A. Grobman

⁴Division of Maternal-Fetal Medicine and Center for Healthcare Studies, Department of Obstetrics and Gynecology, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Jane L. Holl

⁵Department of Pediatrics, Northwestern University Feinberg School of Medicine, Center for Healthcare Studies—Institute for Public Health and Medicine, Greenville, South Carolina

,

Amy Crockett

⁶Department of Obstetrics and Gynecology, Greenville Hospital System University Medical Center, Greenville, South Carolina

,

Gregory E. Miller

³Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois

,

Ann E. B. Borders

⁷Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine; Northwestern University Center for Healthcare Studies—Institute for Public Health and Medicine, Evanston, Illinois

› Author Affiliations

Abstract

Objective This study aims to examine whether maternal household income is associated with histological evidence of chronic placental inflammation.

Study Design A total of 152 participants completed surveys of household income and consented to placenta collection at delivery and postpartum chart review for birth outcomes. Placental inflammatory lesions were evaluated via histological examination of the membranes, basal plate, and villous parenchyma by a single, experienced pathologist. Associations between household income and the presence of inflammatory lesions were adjusted for known perinatal risk factors.

Results Overall, 45% of participants reporting household income below $30,000/y had chronic placental inflammation, compared with 25% of participants reporting income above $100,000 annually (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.25, 14.28; p = 0.02). Middle-income groups showed intermediate rates of chronic inflammatory lesions, at 40% for those reporting $30,000 and 50,000 (OR = 3.60, 95% CI = 1.05, 12.53; p = 0.04) and 38% for those reporting $50,000 to 100,000 (OR = 1.57, 95% CI = 0.60, 4.14; p = 0.36). Results remained significant after adjustment for maternal age, race, and marital status.

Conclusion Chronic placental inflammation is associated with maternal household income. Greater occurrence of placental lesions in low-income mothers may arise from a systemic inflammatory response to social and physical environmental factors.

Keywords

chronic inflammation - chronic deciduitis - chronic villitis - income - placenta - pregnancy - stress

Full Text

References

References
1 Kim CJ, Romero R, Chaemsaithong P, Kim JS. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am J Obstet Gynecol 2015; 213 (4, Suppl) S53-S69
2 Edmondson N, Bocking A, Machin G, Rizek R, Watson C, Keating S. The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis. Pediatr Dev Pathol 2009; 12 (01) 16-21
3 Kim CJ, Romero R, Kusanovic JP. , et al. The frequency, clinical significance, and pathological features of chronic chorioamnionitis: a lesion associated with spontaneous preterm birth. Mod Pathol 2010; 23 (07) 1000-1011
4 Lee J, Romero R, Xu Y. , et al. A signature of maternal anti-fetal rejection in spontaneous preterm birth: chronic chorioamnionitis, anti-human leukocyte antigen antibodies, and C4d. PLoS One 2011; 6 (02) e16806 . Doi: 10.1371/journal.pone.0016806
5 Redline RW. Placental inflammation. Semin Neonatol 2004; 9 (04) 265-274
6 Redline RW. Inflammatory responses in the placenta and umbilical cord. Semin Fetal Neonatal Med 2006; 11 (05) 296-301
7 Labarrere CA, Faulk WP. Maternal cells in chorionic villi from placentae of normal and abnormal human pregnancies. Am J Reprod Immunol 1995; 33 (01) 54-59
8 Labarrere CA, McIntyre JA, Faulk WP. Immunohistologic evidence that villitis in human normal term placentas is an immunologic lesion. Am J Obstet Gynecol 1990; 162 (02) 515-522
9 Redline RW. Villitis of unknown etiology: noninfectious chronic villitis in the placenta. Hum Pathol 2007; 38 (10) 1439-1446
10 Friedman EM, Herd P. Income, education, and inflammation: differential associations in a national probability sample (The MIDUS study). Psychosom Med 2010; 72 (03) 290-300
11 Paul K, Boutain D, Agnew K, Thomas J, Hitti J. The relationship between racial identity, income, stress and C-reactive protein among parous women: implications for preterm birth disparity research. J Natl Med Assoc 2008; 100 (05) 540-546
12 Gruenewald TL, Cohen S, Matthews KA, Tracy R, Seeman TE. Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Soc Sci Med 2009; 69 (03) 451-459
13 Schootman M, Andresen EM, Wolinsky FD, Malmstrom TK, Morley JE, Miller DK. Adverse housing and neighborhood conditions and inflammatory markers among middle-aged African Americans. J Urban Health 2010; 87 (02) 199-210
14 Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002; 162 (11) 1286-1292
15 Gowda C, Hadley C, Aiello AE. The association between food insecurity and inflammation in the US adult population. Am J Public Health 2012; 102 (08) 1579-1586
16 Bermudez EA, Rifai N, Buring JE, Manson JE, Ridker PM. Relation between markers of systemic vascular inflammation and smoking in women. Am J Cardiol 2002; 89 (09) 1117-1119
17 Jousilahti P, Salomaa V, Rasi V, Vahtera E, Palosuo T. Association of markers of systemic inflammation, C reactive protein, serum amyloid A, and fibrinogen, with socioeconomic status. J Epidemiol Community Health 2003; 57 (09) 730-733
18 Evans GW, English K. The environment of poverty: multiple stressor exposure, psychophysiological stress, and socioemotional adjustment. Child Dev 2002; 73 (04) 1238-1248
19 Santiago CDC, Wadsworth ME, Stump J. Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families. J Econ Psychol 2011; 32 (02) 218-230
20 Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss III JF, Petraglia F. Inflammation and pregnancy. Reprod Sci 2009; 16 (02) 206-215
21 Coussons-Read ME, Okun ML, Nettles CD. Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Brain Behav Immun 2007; 21 (03) 343-350
22 Miller GE, Chen E, Sze J. , et al. A functional genomic fingerprint of chronic stress in humans: blunted glucocorticoid and increased NF-kappaB signaling. Biol Psychiatry 2008; 64 (04) 266-272
23 Ernst LM, Grobman WA, Wolfe K. , et al. Biological markers of stress in pregnancy: associations with chronic placental inflammation at delivery. Am J Perinatol 2013; 30 (07) 557-564
24 Baker AM, Braun JM, Salafia CM. , et al. Risk factors for uteroplacental vascular compromise and inflammation. Am J Obstet Gynecol 2008; 199 (03) 256.e1-256.e9
25 Salafia CM, Ernst LM, Pezzullo JC, Wolf EJ, Rosenkrantz TS, Vintzileos AM. The very low birthweight infant: maternal complications leading to preterm birth, placental lesions, and intrauterine growth. Am J Perinatol 1995; 12 (02) 106-110
26 Redline RW, Patterson P. Villitis of unknown etiology is associated with major infiltration of fetal tissue by maternal inflammatory cells. Am J Pathol 1993; 143 (02) 473-479