Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status

Madeleine U. Shalowitz; Christine Dunkel Schetter; Marianne M. Hillemeier; Vernon M. Chinchilli; Emma K. Adam; Calvin J. Hobel; Sharon Landesman Ramey; Maxine Reed Vance; Patricia O'Campo; John M. Thorp Jr; Teresa E. Seeman; Tonse N. K. Raju; Eunice Kennedy Shriver National Institute of Child Human Development Community Child Health Network

doi:10.1055/s-0038-1675618

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(10): 1079-1089
DOI: 10.1055/s-0038-1675618

Original Article

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

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status

Madeleine U. Shalowitz

¹Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois

²Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois

,

Christine Dunkel Schetter

³Department of Psychology, University College of Los Angeles, Los Angeles, California

,

Marianne M. Hillemeier

⁴Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania

,

Vernon M. Chinchilli

⁵Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

,

Emma K. Adam

⁶School of Human Development and Social Policy, Northwestern University, Evanston, Illinois

,

Calvin J. Hobel

⁷Department of Obstetrics, Gynecology, and Pediatrics, Cedars-Sinai Hospital, Los Angeles, California

,

Sharon Landesman Ramey

⁸Department of Psychology, Virginia Technical Carilion School of Medicine and Research Institute, Roanoke, Virginia

⁹Department of Psychiatry, Virginia Technical Carilion School of Medicine and Research Institute, Roanoke, Virginia

,

Maxine Reed Vance

¹⁰Baltimore Healthy Start, Baltimore, Maryland

,

Patricia O'Campo

¹¹Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

,

John M. Thorp Jr

¹²Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina

,

Teresa E. Seeman

¹³Department of Internal Medicine, UCLA Geffen School of Medicine, Los Angeles, California

¹⁴Department of Epidemiology, UCLA School of Public Health, Los Angeles, California

,

Tonse N. K. Raju

¹⁵Branch of Perinatal Medicine and Neonatology, Eunice Kennedy Shriver National Institute of Child and Human Development, Bethesda, Maryland

,

Eunice Kennedy Shriver National Institute of Child Human Development Community Child Health Network

› Author Affiliations

Abstract

Objective Allostatic load (AL) represents multisystem physiological “wear-and-tear” reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities.

Study Design The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope.

Results Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum.

Conclusion Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Keywords

postpartum health - allostatic load - cardiovascular risk - metabolic risk

Full Text

References

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