(852) First-trimester Allostatic Load Varies by Self-identified Race/Ethnicity and HDP

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To compare first-trimester allostatic load (AL), a measure of “wear and tear” due to chronic stress exposure, among nulliparous individuals who developed hypertensive disorders of pregnancy (HDP; gestational hypertension, preeclampsia) versus those who had no adverse pregnancy outcomes (APO).

Study Design: This is a secondary analysis utilizing data from a large prospective cohort study of a diverse, nulliparous population. This analysis included participants who had biomarkers from serum samples collected at 8w0d-13w6d weeks’ gestation. We compared 623 participants who developed HDP with 2,361 who did not develop HDP or other APO (i.e., stillbirth, preterm birth, small-for-gestational age birth). We calculated a composite AL index from 9 biomarkers in three domains: cardiovascular (SBP, DBP, pulse pressure), inflammatory (CRP), and metabolic (BMI, HDL, total cholesterol, triglycerides, waist-hip ratio). P</span>articipants received 1 point for each biomarker that fell within high-risk range; a mean score within each domain was calculated and the composite AL was computed by summing the 3 domain scores (total score: 0-3). One-way ANOVA with post hoc Tukey’s test, and Student t-test were used to compare AL index by self-identified race/ethnicity and by occurrence of HDP, as appropriate.

Results: Black participants had a significantly greater AL index (n=328, 0.96 ±0.74) than any other racial group (White [n=2,093]: 0.73 ±0.68, p < 0.0001; Hispanic [n=475]: 0.83 ±0.72, p=0.04; Asian [n=90]: 0.48 ±0.38, p < 0.0001). When evaluating first-trimester AL by HDP status, those who developed HDP had a significantly greater AL index than those without any APO (0.99 ±0.75 vs. 0.71 ±0.66, < 0.0001). After stratification by HDP, those with HDP status had a higher AL index in each race/ethnicity sub-group. The magnitude of the association between HDP and AL was similar by race/ethnicity.

Conclusion: First-trimester AL is higher among Black individuals and also among those who develop HDP. These relationships point to possible antecedents of the racial/ethnic disparity in HDP.

Primary & Presenting Author(s)

Mitali Ray, PhD, RN (she/her/hers)
K99/R00 Postdoctoral Scholar
University of Pittsburgh
Pittsburg, Pennsylvania, United States

Coauthor(s)

RM
Rebecca B. McNeil, PhD
RTI International
Research Triangle, North Carolina, United States
William A. Grobman, MD, MBA
Vice Chair, Clinical Operations, Maternal Fetal Medicine
The Ohio State University
Columbus, Ohio, United States
Janet M. Catov, PhD
Associate Professor
Magee-Womens Research Institute
Pittsburgh, Pennsylvania, United States
MS
Mandy J. Schmella, BS, PhD, RN
Assistant Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
YC
Yvette P. Conley, BS, MS, PhD
Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States