Status and Influencing Factors of Allostatic Load in Pregnant Women at Different Trimesters

Abstract

Background As an objective index to evaluate chronic stress, allostatic load (AL) is associated with adverse pregnancy outcomes. At present, there are few longitudinal studies to analyze the influencing factors of AL among pregnant women. Objective To investigate the status of AL and its influencing factors in pregnant women at different trimesters. Methods This study was designed as a prospective study. Questionnaire survey, physical examination and laboratory examination were administered to 152 women in the first (≤14 weeks), second (23-27 weeks) and third (30-34 weeks) trimesters of pregnancy collected in the obstetrics outpatient clinics of the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital from November 2021 to November 2022 by using convenience sampling method. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess the depression during pregnancy. Referring to previous studies, the relevant assessment indexes of metabolic system, cardiovascular system, and immune system were used to calculate the total score of AL, and AL≥3 score was used as a criterion for determining high AL level at different trimesters of pregnancy. Multivariate Logistic regression analysis was used to explore the influencing factors of AL in the first, second and third trimesters. Results Among 152 pregnant women, the mean total AL score was (2.06±1.68), (2.07±1.84) and (2.07±1.68) in the first, second and third trimesters; 52 (34.2%), 54 (35.5%) and 50 (32.9%) women were in high level of AL (total score of AL≥3) in the first, second and third trimesters. The results of multivariate Logistic regression analysis showed that occupations {business service employees〔OR=0.229, 95%CI (0.062, 0.845), P=0.027〕, office staff〔OR=0.164, 95%CI (0.051, 0.528), P=0.002〕, professional and technical personnel〔OR=0.278, 95%CI (0.099, 0.784), P=0.015〕}, unemployment〔OR=5.516, 95%CI (1.044, 29.144), P=0.044〕and depression〔OR=6.241, 95%CI (1.403, 27.757), P=0.016〕were the influencing factors of AL in the first trimester. Age〔OR=1.098, 95%CI (1.002, 1.202), P=0.045〕and AL in the first trimester〔OR=9.965, 95%CI (4.402, 22.561), P<0.001〕were the influencing factors of AL in the second trimester. Sleep duration in the third trimester〔≥9 h/d: OR=0.176, 95%CI (0.044, 0.703), P=0.014〕, AL in the first trimester〔OR=4.697, 95%CI (1.852, 11.908), P<0.001〕and AL in the second trimester〔OR=9.426, 95%CI (3.728, 23.834), P<0.001〕 were the influencing factors of AL in the third trimester. Conclusion More than 30% of women are at high levels of AL at different trimesters and the influencing factors of AL at different trimesters are different. Occupation, unemployment status, and depression are the influencing factors of AL in the first trimester; age and AL in the first trimester are the influencing factors of AL in the second trimester; sleep duration in the third trimester and AL in the first and second trimesters are the influencing factors of AL in the third trimester.

Keywords

• pregnancy|chronic stress|allostatic load|psychological distress|biomarkers|root cause analysis