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Am J Perinatol 2021; 38(13): 1412-1419
DOI: 10.1055/s-0040-1713368
Original Article

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy

Madeleine Caplan 
1   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, School of Medicine, Duke University, Durham, North Carolina
,
Lauren S. Keenan-Devlin
2   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
,
Alexa Freedman
3   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Institute for Policy Research, Northwestern University, University of Chicago Pritzker School of Medicine, Evanston, Illinois
,
William Grobman
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Pathik D. Wadhwa
5   Department of Psychiatry and Human Behavior, University of California, School of Medicine, UC Irvine Development, Health and Disease Research Program, Irvine, California
,
Claudia Buss
6   UC Irvine Development, Health and Disease Research Program, University of California Irvine, Irvine, California
7   Department of Medical Psychology, Charité, University Medicine Berlin, Berlin, Germany
,
Gregory E. Miller
8   Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, Illinois
,
Ann E.B. Borders
9   Department of Obstetrics and Gynecology, NorthShore University Health System, Center for Healthcare Studies, Institute for Public Health and Medicine, University of Chicago Pritzker School of Medicine, Northwestern University, Evanston, Illinois
› Author Affiliations Funding Funding for this study was provided by HHSN275201200007I–HHSN27500005. National Children's Study: Vanguard Study–Task Order 5: Stress and Cortisol Measurement for the National Children's Study. A.E.B.B. was the principal investigator.
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Abstract

Objective Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship.

Study Design A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP.

Results Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06–2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03–2.20). No mediation effect by inflammation was observed.

Conclusion Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP.

Key Points

  • This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).

  • Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.

  • A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment.

Keywords

hypertensive disorders of pregnancy - preeclampsia - gestational hypertension - inflammation - psychosocial stress


Publication History

Received: 18 November 2019

Accepted: 07 May 2020

Article published online:
02 July 2020

© 2020. Thieme. All rights reserved.

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