ArticleObstetrics and gynecology2026
Allostatic Load Mediates Associations Between Race and Ethnicity and Hypertensive Disorders of Pregnancy.
Article in Obstetrics and gynecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- The cost of chronic strain: Sleep disruption, allostatic load, and the impact on adverse pregnancy outcomes.Pregnancy (Hoboken, N.J.) · 2026Article
- Adverse Pregnancy Outcomes and Health-Related Social Needs Among Parous Women.JAMA network open · 2026Article
- Maternal Stress and Ethnic Disparities in Pre-Eclampsia: The Significance of a Migrant Perspective.Journal of clinical medicine · 2026Article
- Unpacking Preterm Birth: How Granular Epidemiologic Analyses Can Inform Interventions.Paediatric and perinatal epidemiology · 2026Article
- The role of allostatic load in adverse pregnancy outcomes: a multisystem, developmental perspective.Frontiers in global women's health · 2025Review
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Authors and funding
12 authors.
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Abstract
objectiveTo evaluate whether chronic stress exposure, measured by allostatic load (a biological measure of chronic stress embodiment, including stressors exacerbated by structural inequities [eg, structural racism]) and patient-reported perceived stress in the first trimester of pregnancy, mediates the association between self-identified race and ethnicity and hypertensive disorders of pregnancy (HDP).
methodsThis was a secondary analysis of data from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a large prospective cohort study. We evaluated self-identified race and ethnicity as an independent variable (non-Hispanic Black, Hispanic, Asian, non-Hispanic White), and our outcome of interest was HDP (ie, gestational hypertension, preeclampsia or eclampsia). Allostatic load was operationalized with regression- and count-based approaches. Perceived stress was collected with the Cohen perceived stress scale. We investigated allostatic load and perceived stress and used causal mediation analyses with a counterfactual approach to evaluate whether they mediated the association between self-identified race and ethnicity and HDP, adjusting for age and tobacco use. Mediation analyses were conducted for each minoritized racial and ethnic group compared with non-Hispanic White participants.
resultsThe sample included 645 participants who developed HDP and 2,438 participants without HDP or other adverse pregnancy outcome. Allostatic load and perceived stress varied by race and ethnicity; HDP varied by allostatic load but not perceived stress. Allostatic load was a partial mediator exclusively in the comparison of non-Hispanic Black and non-Hispanic White participants (0.027, 95% CI, 0.013-0.040, P <.001; 28.9%). Perceived stress was not a significant mediator.
conclusionFirst-trimester allostatic load mediated the association between self-identified race and ethnicity and HDP for non-Hispanic Black and non-Hispanic White participants. This mediation effect was not observed in other racial and ethnic comparisons. These results demonstrate a physiologic pathway through which racism may contribute to adverse pregnancy outcomes and suggest that interventions targeting allostatic load reduction could help address racial and ethnic disparities in HDP.
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