title: Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes.
abstract: Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N = 111). Results CPD scores ranged from 0 to 6, out of a total of 8 parameters (Mean 2.09; SD = 1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3397 g (SD = 522.89), and the mean gestational age was 39.64 weeks (SD = 1.08). CPD was not significantly associated with either birth weight or gestational age (p = 0.42 and p = 0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA. kimckee@med.umich.edu.|Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA. kimckee@med.umich.edu.
authors.forename: Kimberly Schmitt
authors.identifier: 0000-0002-2905-5000
authors.initials: KS
authors.lastname: McKee
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Seplaki
authors.affiliation: Temple Clinical Research Institute, Department of Clinical Sciences, Temple University School of Medicine, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.|Population Research, Fox Chase Cancer Center, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Fisher
authors.affiliation: School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd. Box SON, Rochester, NY, 14642, USA.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Groth
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA.
authors.forename: I Diana
authors.initials: ID
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D052636:Allostasis / Q000502:physiology; D000704:Analysis of Variance; D001724:Birth Weight / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001824:Body Constitution / Q000502:physiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D016014:Linear Models; D009518:New York; D036801:Parturition / Q000502:physiology*; D011247:Pregnancy / Q000502:physiology*; D011795:Surveys and Questionnaires
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: Allostatic load; Birth weight; Cumulative physiologic dysfunction; Gestational age; Pregnancy