The association between biomarkers and psychosocial measures of stress and discrimination among pregnant African-American women from the metro Atlanta area Público

Abstract

Objective: African-American (AA) women are at twice the risk of preterm birth (PTB) than white women, and also face unique, intersectional stressors related to their gender and race. Research on the distinct stressors AA women face reveals that chronic stress, often measured during pregnancy, is a risk factor of growing interest in the etiology of PTB. This study aims to explore the associations between biomarkers and psychosocial measures of lifetime stress in a socioeconomically diverse cohort of pregnant, AA women.

Study Design and Setting: This study is a cross-sectional analysis of 144 women enrolled in the ongoing Microbiome Preterm Birth study, a prospective study of pregnant AA women receiving prenatal care at Emory University Midtown Hospital or Grady Hospital in Atlanta, GA. All included women had complete psychosocial exposure (the Jackson Hogue Phillips Contextualized Stress Measure [JHP] & the Experiences of Discrimination Scale [EOD]) and biomarker outcome (DexIC50, Dex Top, & Dex Bottom) data. Bivariate and multivariable linear regression analyses were performed.

Results: There was no evidence of a statistically significant relationship between the JHP or EOD and the biomarkers of chronic stress. Further, there was no evidence of effect modification of by depression.

Conclusions: More work is needed to understand the degree to which psychosocial measures of chronic stress are empirically associated with chronic stress biomarkers in pregnant AA women.

Keywords: birth outcomes; discrimination; race; stress

Table of Contents

1. Introduction …………………………………………………………………….....1

1.1 Background & Rationale…………………………………………………….....1

1.2 Objectives…………………….……………………………………………….......2

1.3 Assumptions…………………………..……………………………………….....3

2. Literature Review ………………………………………………………………....3

2.1 Background.……………..……………………………………………………......3

2.2 Stress & Preterm Birth…….……………………………………………….......6

2.3 Racism as a Stressor……………………………………………………….........9

2.3.1 Associations between race- and racism-related stress and birth

outcomes in mixed-race study cohorts.…………………………………..........10

2.3.2 Associations between race- and racism-related stress and birth

outcomes in all-African-American study cohorts ………………………........12

2.3.3 Limitations in the Reviewed Literature on the Association between

Racism as a Stressor ad PTB ……………………………………………..............14

2.4 Psychosocial Measures of Racism & Discrimination.………….………...16

2.4.1 The Jackson, Hogue, Phillips (JHP) Contextualized Stress

Measure………………………………………………………………..….................16

2.4.2 Experiences of Discrimination (EOD) Scale ……………...………........18

2.5 Biomarkers of Chronic Stress……………………………………………….....19

2.5.1 Glucocorticoid Receptor Resistance…………..…………...……….........20

2.6 Summary..……………………………………………………………………........21

3. Methods.……………………………………………………………………………...22

3.1 Study Design & Sample.……………………………………………………......22

3.2 Scale Scoring………………………………………………………………….......25

3.3 Statistical Analysis…………..………………………………………………......27

4. Results ……………………...………………………………………………………..29

4.1 Univariate Analyses …………………………………………………………......29

4.2 Bivariate Analyses ………………………………………...………………........33

4.3 Multivariable Analyses………………………………………………..…....…...37

4.3.1 Depression as Outcome…………………………………………..................41

5. Discussion …………………………………………………………………………….42

6. Appendix - All Scales Used………………………………………………………...47

Edinburgh Depression Scale…………………………………………………......…..47

Experiences of Discrimination Scale…………………………………………….....48

Jackson Hogue Phillips Contextualized Stress Measure………………………..49

Perceived Stress Scale…………………………………………………………..........52

Stressful Life Events Index…………………………………………………….....….53

7. References……………………………………………………………………………..54

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palabra Clave	stress discrimination birth outcomes race
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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