Pandemic may increase burden of allostatic load on women during postpartum year
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Women who viewed themselves as lower in socioeconomic status experienced a higher allostatic load 1 year after giving birth, which may lead to worse health outcomes in the future, according to findings published in Health Psychology.
Considering the current pandemic, increased stress from financial, health or other causes may exacerbate this disparity, authors of the study said.
“Data collection for this study occurred between 2008 and 2012, which coincided with the Great Recession,” Christine Guardino, MA, PhD, an assistant professor of psychology at Dickinson College, told Healio. “We found that subjective and objective markers of socioeconomic status predicted higher levels of allostatic load in this sample. Job losses, financial instability, housing insecurity and other disruptions during the COVID-19 pandemic may shape both real and perceived socioeconomic status, which in turn can affect physical and mental health.”
Guardino and Christine Dunkel Schetter, PhD, a professor of psychology and the associate vice chancellor of faculty development at UCLA, used data from the Community Child Health Network to follow 1,168 women during their postpartum year. The researchers conducted home visits at 1, 6 and 12 months after delivery to assess 10 biomarkers of allostatic load, which included participants’ BMI, BP, cholesterol and cortisol levels. To calculate the allostatic load, the researchers assigned one point to each of the biomarkers when levels exceeded clinical cutoffs. Also, the researchers collected information on participants’ household income, years of education completed and perceived social status.
Subjective social status (SSS) scores were reported using the MacArthur Scale of SSS at 6 and 12 months postpartum; on a 10-point scale, scores of one to three were considered low SSS while scores eight to 10 were considered high SSS.
Cohort demographics
Overall, 43% of participants were living at or below the federal poverty level and 27% had incomes between 100% and 200% of the federal poverty level, according to the researchers. Also, participants had completed an average of 13 years of schooling.
About 53% of the women were Black with a mean SSS of 5.26 (95% CI, 5.11-5.4); 23.2% were non-Hispanic white with a mean SSS of 6.15 (95% CI, 5.93-6.37); and 23.2% were Hispanic with a mean SSS of 4.84 (95% CI, 4.62-5.06). About 15% of the cohort reported low SSS and 12% reported high SSS, according to Guardino and Schetter.
Disparities between racial groups were partially due to higher levels of stress and inequalities present in the participants’ neighborhoods, Guardino said. This is consistent with a growing body of research demonstrating that social determinants such as economic stability, educational opportunities and neighborhood environment contribute to health disparities, she added.
Allostatic load associations
The researchers reported that participants had an average of 3.01 markers of allostatic load that were above clinical cutoffs.
“These findings indicate elevated health risk in this sample of women and suggest a need for attention to women’s health after the birth of a child,” Guardino said.
In addition, higher SSS correlated with higher income and more years of education completed, and it was significantly associated with lower allostatic load, according to the researchers. When adjusting for race or ethnicity, SSS remained significantly associated with allostatic load. The association persisted after additional adjustments for relationship status, geographic location, maternal age and weeks since delivery at the time of the biomarker assessment.
The strength of the association between SSS and allostatic load was stronger than the association between income and allostatic load (P = .02), according to Guardino and Schetter. However, the association between SSS and allostatic load may vary by income and education.
“In the U.S., standard medical care after the birth of a child typically focuses almost exclusively on the infant,” Guardino said. “Postpartum health in mothers is rarely emphasized, resulting in a missed opportunity to support women’s health and well-being. This research grew out of our interest in developing a better understanding of the predictors of women’s health in the year after giving birth.”
Exposure to financial strain and other chronic stressors causes “wear and tear” on the body’s systems, which can contribute to a greater allostatic load, she added.
“[Allostatic load] may contribute to adverse outcomes in subsequent pregnancies and shape health outcomes for women across the life span,” Guardino and Schetter wrote.