At the forefront of psychoneuroimmunology in pregnancy: Implications for racial disparities in birth outcomes PART 1: Behavioral risks factors

Abstract

Birth prior to full term is a substantial public health issue. In the US, ˜400,000 babies per year are born preterm (<37 weeks), while>1 million are early term (37-386/7 weeks). Birth prior to full term confers risk both immediate and long term, including neonatal intensive care, decrements in school performance, and increased mortality risk from infancy through young adulthood. Risk for low birth weight and preterm birth are 1.5-2 times greater among African Americans versus Whites. Psychosocial stress related to being a member of a discriminated racial minority group contributes substantially to these racial disparities. Providing promising targets for intervention, depressed mood, anxiety, and poor sleep are each linked with exposure to chronic stress, including racial discrimination. A rigorous transdisciplinary approach addressing these gaps holds great promise for clinical impact in addressing racial disparities as well as ameliorating effects of stress on perinatal health more broadly. As will be reviewed in a companion paper, the mechanistic roles of physiological sequelae to stress - including neuroendocrine, inflammatory regulation, biological aging, and the microbiome - also require delineation.

Keywords: Anxiety; Birth outcomes; Depression; Pregnancy; Psychoneuroimmunology; Racial disparities; Sleep; Stress.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Figures

Figure 1:. Behavioral and Biological Pathways to Shortened Gestation.

Racial discrimination and other objective stressors are psychosocial exposures that increase the risk for shortened gestation. These are not necessarily clinically modifiable at the individual level. However, as reviewed herein, psychological factors (mood/anxiety disorders, sleep) present promising targets for identifying risk and targeting intervention. In a companion paper, the role of biological sequelae (neuroendocrine function, immune function, cellular aging, microbiome) will be described. These may directly impact delivery length, contributing to spontaneous occurrence of shortened gestation. In addition, these pathways can contribute to medically-indicated shortened gestation by increasing risk for clinical conditions including pre-eclampsia and gestational diabetes. Pathways bolded in red print are emphasized in the current review.