Elsevier

Psychoneuroendocrinology

Volume 38, Issue 9, September 2013, Pages 1786-1796
Psychoneuroendocrinology

Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women

https://doi.org/10.1016/j.psyneuen.2013.02.015Get rights and content

Summary

Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r = −0.73, p < 0.0001), IL6/IL10 (r = −0.38, p = 0.01), IL1β/IL10 (r = −0.44, p = 0.004) and TNFα/IL10 (r = −0.41; p = 0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r = −0.25, p = 0.43; IL6/IL10: r = 0.12, p = 0.70; IL1 β/IL10: r = 0.05, p = 0.87; TNFα/IL10: r = 0.10; p = 0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p < 0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.

Section snippets

Subjects recruitment and inclusion/exclusion criteria

The subjects were 96 women in the second or early third trimester of pregnancy who responded to ads placed in prenatal clinics and on community billboards. Subjects who met inclusion criteria during an initial phone conversation were scheduled for a home visit during their 32–36th week of pregnancy. Inclusion criteria were that each subject was between the ages of 18–40 years, anticipating a vaginal birth of a singleton fetus, in good health without pregnancy restrictions, a non-smoker, not

Statistical analysis

For comparative analyses, women were grouped three ways; first, as either Caucasian or of a racial/ethnic minority (Race), and second, as being either of high or low income (Income). These categories were determined by self-report of race/ethnicity and by self-report of participation in WIC or other government assistance programs respectively. For the third group, women were separated based on the presence or absence of either of the two risk factors: being minority or low income. This category

Results

Demographic data for the 96 pregnant women in this study are included in Table 1. As shown, 18 participants self-reported minority racial or ethnic status, 11 of whom self-identified as African American and 7 as Hispanic. Twenty two participants reported receiving government aid. Twenty-nine were of minority status or reported receiving government aid and were categorized as the high general risk group; 66 participants were Caucasian and did not receive government aid and were categorized as

Discussion

In this report, we describe the effects of chronic social stress on the relationship between cortisol and the pro-inflammatory cytokines in a uniquely vulnerable population, pregnant women. The most significant finding is that chronic stress related to minority status or low income was associated with elevated cortisol without a compensatory decrease in pro-inflammatory cytokine concentration; such a diminished negative feedback relationship between cortisol and pro-inflammatory cytokines is

Role of the funding source

This study was funded by a grant to Dr. Elizabeth J. Corwin (R01NR011278) from the National Institutes of Health, National Institute of Nursing Research (NINR). Without their generous contribution to all aspects of this study (subject recruitment and compensation, data collection, bioassays, etc.) this study could not have been accomplished.

Conflict of interest

All authors report no conflict of interest to disclose, including that related to any financial, personal or other relationships with other people or organizations within three years of beginning the work submitted.

Acknowledgements

The research reported in this article was supported by a grant from the National Institute of Nursing Research, R01 NR011278, to Elizabeth J. Corwin.

The authors thank Dr. Andrew H. Miller for his intellectual contributions to the manuscript. We also thank Laurel Ware, RN and Tina Fay, RN for their recruitment and data collection efforts, and Runfeng Jing, MD for conducting the bioassays.

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