title: Adverse Perinatal Outcomes and Postpartum Multi-Systemic Dysregulation: Adding Vitamin D Deficiency to the Allostatic Load Index.
abstract: Background Allostatic load (AL) is an index of multi-system physiological "wear-and-tear," operationalizing emergent chronic disease risk and predicting morbidity and mortality. AL has been proposed as an organizing framework for studying pregnancy outcomes and additional AL biomarkers for the study of maternal health would be valuable. Objectives To test whether adverse perinatal outcomes are associated with postpartum AL and if including vitamin D deficiency (serum 25(OH)D < 20 ng/ml) as an additional marker of postpartum AL increases the association. Methods The Community Child Health Network is a community-based participatory research network that enrolled women at birth and followed them for 2 years measuring ten biomarkers (body mass index, waist: hip ratio, pulse, systolic and diastolic blood pressures, cortisol slope, c-reactive protein, hgbA1c, HDL, and total cholesterol) at 6 and 12 months postpartum. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, preeclampsia, and gestational diabetes) was collected from medical charts in a sample of 164 women from one site and serum 25(OH)D status was measured 24-39 weeks postpartum in this cohort. Results Twenty-nine percent experienced one or more of the four adverse perinatal outcomes. Serum 25(OH)D was significantly inversely correlated with the AL index (Spearman's r = -0.247, p = 0.002). Logistic regression results adjusting for maternal age and race showed that adverse outcome was significantly associated with higher postpartum AL (OR 1.53 for a 1-unit increase in AL, 95% CI 1.24-1.89). Adding 25(OH)D deficiency as an 11th component to the AL index improved the model fit (Delta (-2LogL) = 3.955, p = 0.047), and improved the Akaike information criterion (180.32 vs. 184.27). Conclusion Women with adverse perinatal outcomes have higher postpartum AL and adding vitamin D deficiency to the AL index strengthens this association.
authors.affiliation: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, 280 West Tower, Los Angeles, CA, 90048, USA. Eynav.accortt@cshs.org.
authors.forename: Eynav Elgavish
authors.initials: EE
authors.lastname: Accortt
authors.affiliation: Cedars-Sinai Biostatistics Core, Research Institute, Clinical & Translational Science Institute (CTSI), Clinical &Translational Research Center (CTRC), Burns and Allen Research Institute, Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.affiliation: Department of Psychology, University of California, 1285a Franz Hall, Los Angeles, CA, 90095-1563, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Dunkel Schetter
authors.affiliation: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8631 West 3rd Street, 1001 East Tower, Los Angeles, CA, 90048, USA. Calvin.Hobel@cshs.org.
authors.forename: Calvin J
authors.initials: CJ
authors.lastname: Hobel
mesh_terms: D000328:Adult; D052636:Allostasis / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D008076:Cholesterol, HDL / Q000032:analysis / Q000097:blood; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood; D007230:Infant, Low Birth Weight / Q000502:physiology; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D002097:C-Reactive Protein; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D006854:Hydrocortisone; C517652:hemoglobin A1c protein, human
keywords: 25(OH)D; Adverse pregnancy or perinatal outcome; Allostatic load; Postpartum health; Vitamin D deficiency