Abstract
BACKGROUND/AIMS: Chronic stress may lead to a dysfunctional inflammatory response, producing adverse health conditions such as cardiovascular disease (CVD). Increased C-reactive protein (CRP), a marker of systemic inflammation, is associated with prematurity and psychosocial stress during pregnancy. Residents in disadvantaged neighborhoods and with decreased socioeconomic status (SES) have higher social strain and experience more chronic stress. However, the relationship between social strain and inflammatory markers in pregnant women is unknown. African American’s demonstrate more inflammation than other racial groups. The purpose of this study was to determine if there was an association between social strain (socioeconomic and neighborhood stress) and CRP among pregnant African American women. METHODS: This descriptive-correlational study was conducted between February 2009 and June 2010 with 203 African American women in the 2nd trimester of pregnancy. Social strain was measured using: MacArthur Scale of Subjective Social Status (self-reported) and the Messer Index of Neighborhood Deprivation (census-level). CRP was measured using standard methods. Body Mass Index (BMI), a possible confounder in the social strain/CRP relationship, was calculated using self-reported height and pre-pregnancy weight. Linear regression models were fit to estimate the association of social strain (i.e., neighborhood deprivation and subjective social status) with log adjusted CRP. RESULTS: Participants were young (M=26.2; SD=6.0), mostly high school graduates (M=13 years SD=1.72), predominantly low-income (M=31,781) and obese (mean BMI=30.1). The mean log adjusted CRP was 1.15; SD=0.98 suggesting a moderate risk. Neighborhood deprivation scores ranged from −1.1 to 3.3 with a mean of 0.82 ±0.99, suggesting relatively deprived neighborhoods. The mean SSS score was 5.4 (SD =2.0) suggesting that participants felt equal in social status to their community. Neither neighborhood deprivation nor SSS was associated with CRP (p=0.686 and p=0.778) after adjusting for age, education, income, and BMI. Women with higher pre-pregnancy BMI were more likely to have higher CRP levels (p<0.0001). CONCLUSIONS: BMI confounded the social strain/CRP relationship. Increased BMI is associated with decreased SES and neighborhoods where energy-dense foods predominate. Future research should examine other neighborhood factors that increase BMI, psychosocial factors which could mediate the stress inflammation pathway as well as examining other inflammation markers among disadvantaged groups.