Amer J Perinatol 2019; 36(10): 1079-1089
DOI: 10.1055/s-0038-1675618
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status

Madeleine U. Shalowitz
1  Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois
2  Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
Christine Dunkel Schetter
3  Department of Psychology, University College of Los Angeles, Los Angeles, California
Marianne M. Hillemeier
4  Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania
Vernon M. Chinchilli
5  Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Emma K. Adam
6  School of Human Development and Social Policy, Northwestern University, Evanston, Illinois
Calvin J. Hobel
7  Department of Obstetrics, Gynecology, and Pediatrics, Cedars-Sinai Hospital, Los Angeles, California
Sharon Landesman Ramey
8  Department of Psychology, Virginia Technical Carilion School of Medicine and Research Institute, Roanoke, Virginia
9  Department of Psychiatry, Virginia Technical Carilion School of Medicine and Research Institute, Roanoke, Virginia
Maxine Reed Vance
10  Baltimore Healthy Start, Baltimore, Maryland
Patricia O'Campo
11  Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
John M. Thorp Jr
12  Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Teresa E. Seeman
13  Department of Internal Medicine, UCLA Geffen School of Medicine, Los Angeles, California
14  Department of Epidemiology, UCLA School of Public Health, Los Angeles, California
Tonse N. K. Raju
15  Branch of Perinatal Medicine and Neonatology, Eunice Kennedy Shriver National Institute of Child and Human Development, Bethesda, Maryland
Eunice Kennedy Shriver National Institute of Child Human Development Community Child Health Network› Author Affiliations
Funding The CCHN is supported through cooperative agreements with the NICHD (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226–05S1, U HD44245–06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929).
Further Information

Publication History

01 August 2018

20 August 2018

Publication Date:
14 December 2018 (eFirst)


Objective Allostatic load (AL) represents multisystem physiological “wear-and-tear” reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities.

Study Design The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope.

Results Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum.

Conclusion Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Contributing Members

Members of each site are listed below.

 •Baltimore, MD: Baltimore City Healthy Start, Johns Hopkins University

 -Community Principal Investigator: M. Vance

 -Academic Principal Investigator: C. S. Minkovitz; Coinvestigators: P. O'Campo, P. Schafer

 -Project Coordinators: N. Sankofa, K. Walton

 •Lake County, IL: Lake County Health Department and Community Health Center, the North Shore University Health System

 -Community Principal Investigator: K. Wagenaar

 -Academic Principal Investigator: M. Shalowitz

 -Coinvestigators: E. Adam, G. Duncan,* A. Schoua-Glusberg, C. McKinney, T. McDade, C. Simon

 -Project Coordinator: E. Clark-Kauffman

 •Los Angeles, CA: Healthy African American Families, Cedars-Sinai Medical Center, University of California, Los Angeles

 -Community Principal Investigator: L. Jones

 -Academic Principal Investigator: C. Hobel; Co-PIs: C. Dunkel Schetter, M. C. Lu Project Coordinators: F. Jones, D. Serafin, D. Young

 •North Carolina: East Carolina University, NC Division of Public Health, NC Eastern Baby Love Plus Consortium, University of North Carolina, Chapel Hill

 -Community Principal Investigators: S. Evans, J. Ruffin, R. Woolard

 -Academic Principal Investigator: J. Thorp; Co-Is J. DeClerque, C. Dolbier, C. Lorenz

 -Project Coordinators: L. S. Sahadeo, K. Salisbury

 •Washington, DC: Virginia Tech Carilion Research Institute, Virginia Tech, Washington Hospital Center, Developing Families Center

 -Community Principal Investigator: L. Patchen

 -Academic Principal Investigator: S. L. Ramey; Academic Coprincipal Investigator: R.Gaines Lanzi

 -Coinvestigators: L. V. Klerman, M. Miodovnik, C. T. Ramey, L. Randolph

 -Project Coordinator: N. Timraz

 -Community Coordinator: R. German

 -Data Coordination and Analysis Center DCAC (Pennsylvania State University)

 -PI: V. M. Chinchilli

 -Coinvestigators: R, Belue, G. Brown Faulkner,* M, Hillemeier, I. Paul, M. L. Shaffer

 -Project Coordinator: G. Snyder

 -Biostatisticians: E. Lehman, C. Stetter

 -Data Managers: J. Schmidt, K. Cerullo, S. Whisler

 -Programmers: J. Fisher, J, Boyer, M. Payton

 -National Institutes of Health Program Scientists: V. J. Evans and T. N. K. Raju, NICHD; L. Weglicki, National Institute of Nursing Research, Program Officers: M. Spittel* and M. Willinger, NICHD; Y. Bryan,* NINR.

 •Steering Committee Chairs: M. Phillippe (University of Vermont) and E. Fuentes-Afflick* (University of California - San Francisco School of Medicine)

* Indicates those who participated in only the planning phase of the CCHN.


This paper has been designated as a Core Paper of the CCHN, as it reflects major ideas and work considered central to our network. Accordingly, the last designated author is the network itself preceded by the names of those on the writing team who directly prepared this paper listed in the order the team judged best reflects its relative contributions.