Stressful life events and hypertensive disorders of pregnancy: The role of maternal and fetal inflammation.

INTRODUCTION

Psychosocial stress is associated with increased risk for hypertensive disorders of pregnancy (HDP), and inflammation may be a key pathway mediating this association. However, few studies have examined maternal-fetal inflammation during mid-pregnancy.

METHODS

We leveraged data from two unique study populations, a study of women undergoing elective pregnancy terminations in San Francisco (SF), California (N = 96) and a prospective birth cohort in Atlanta, Georgia (N = 441). In both populations, experiences of stressful life events (SLEs) were assessed via questionnaire and inflammatory cytokines (IFN-γ, IL-10, IL-6 and TNF-α) were measured in maternal serum. In the SF cohort, we measured an expanded panel of 20 inflammation biomarkers in mid-pregnancy maternal serum, cord serum, and placental tissue. We used linear regression to assess associations between SLEs and maternal cytokine levels. In the SF cohort, we estimated associations with the expanded panel of maternal, cord, and placental cytokines. Within the Atlanta cohort, we examined associations between SLEs, maternal cytokines, and odds of developing HDP.

RESULTS

In the SF cohort, 1-3 SLEs was associated with elevated levels of maternal IL-7, TNF-α, TNF-R1 and cord CCL3 and CCL17 (e.g., β = 0.92, 95% confidence interval [CI] = 0.17, 1.66 for cord CCL3) compared to those who did not experience any SLEs. In the Atlanta cohort, increasing concentration of the anti-inflammatory cytokine IL-10 was associated with reduced odds of developing a HDP (odds ratio = 0.55, 95% CI = 0.32, 0.91).

DISCUSSION: Results suggest SLEs are associated with fetal inflammation during mid-pregnancy and anti-inflammatory cytokines may be protective for HDP.