Primary Submission Category: Reproductive health
Allostatic load change from first trimester to post-pregnancy differs by self-identified race/ethnicity
Authors: Mitali Ray, Zhirui Deng, Robert Silver, Philip Greenland, Lynn Yee, George Saade, William Grobman, Rebecca McNeil, Dianxu Ren, Janet Catov,
Presenting Author: Mitali Ray*
Pregnancy is a cardiovascular stress test that can identify individuals with accelerated cardiovascular disease (CVD) progression, which is the leading cause of death. Racial disparities persist in adverse pregnancy outcomes and accelerated CVD. Allostatic load (AL) is a quantitative, physiological measure of “wear and tear” on the body from chronic stress that may be a driver of racial disparities and CVD, as systemic inequities contribute to differential stress exposures. Our study evaluated AL change from the first trimester to post-pregnancy according to the social construct of race.
This is a secondary analysis of the nuMoM2b-Heart Health Study, a prospective cohort of a geographically diverse, nulliparous population followed 2-7 years after delivery. We computed AL scores (N=4,508) using 11 biomarkers (pulse pressure [first-trimester] or heart rate [follow-up], albumin, CRP, BMI, creatinine, glucose, HDL, insulin, LDL, total cholesterol, triglycerides). We applied the count-based approach where we assigned 1 for high-risk and 0 for healthy ranges (<25th percentiles for albumin, HDL, and creatinine; >75th percentiles for all other biomarkers) and total AL score was the sum of these individual risk scores (range: 0-11) for each timepoint. We computed AL change overall and by self-identified race/ethnicity (NH-White: 2,801; NH-Black: 624; Hispanic: 736; Asian: 135; Multi-racial: 212) and performed paired t-tests.
While AL decreased significantly in the overall sample from first trimester to 2-7 years later (mean change±SD: -0.30±2.02, p<0.001), mean AL decreased significantly among NH-White (-0.43±2.00, p<0.001) and Asian (-0.62±1.93, p<0.001), but not NH-Black (0.09±1.93), Hispanic (-0.11±2.11), or Multi-racial (-0.08±2.18) participants. Our results suggest a partial reduction of allostatic load following pregnancy. Variations by race/ethnicity reveal that some groups may have a blunted post-pregnancy stress recovery that could contribute to accelerated CVD risk.