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. 2018 Nov:216:114-123.
doi: 10.1016/j.socscimed.2018.08.010. Epub 2018 Oct 9.

Racial discrimination and leukocyte glucocorticoid sensitivity: Implications for birth timing

Shannon L Gillespie  1 , Cindy M Anderson  2
Affiliations

Racial discrimination and leukocyte glucocorticoid sensitivity: Implications for birth timing

Shannon L Gillespie et al. Soc Sci Med. 2018 Nov.

Abstract

Rationale: Psychological stress-induced cortisol elevations appear to contribute to preterm birth. Yet, some studies suggest that the biological ramifications of racial discrimination-associated stress are unique and may involve development of decreased glucocorticoid sensitivity despite normalized cortisol levels.

Objective: In this study, we examined the effects of racial discrimination on maternal cortisol output, leukocyte glucocorticoid sensitivity, and the degree of correspondence between cortisol levels and birth timing in an African American cohort.

Method: A generally healthy prospective cohort was enrolled at 28-32 weeks gestation (n = 91). The Experiences of Discrimination scale was administered, whole blood collected, and plasma cortisol levels, cytokine levels, and leukocyte counts quantified for examination of patterns of endogenous feedback.

Results: Racial discrimination in the mid-tertile was associated with greater maternal cortisol levels than the bottom tertile among women reporting internalizing responses (b* = 0.68, p = 0.001). Decreased leukocyte glucocorticoid sensitivity was witnessed at greater frequencies of experiences of racial discrimination, as evidenced by decreased correspondence between maternal cortisol levels and plasma IL-8 levels, monocyte counts, and lymphocyte counts (p values ≤ 0.043). The association between maternal cortisol levels and birth timing differed by discrimination tertile (p values ≤ 0.005), with greater cortisol levels predictive of earlier birth among women without (b* = -0.59, p < 0.001) but not with racial discrimination (ps ≥ 0.497).

Conclusion: We provide novel evidence of decreased glucocorticoid sensitivity at increasing frequency of exposure to racial discrimination. Our findings suggest that the biology of preterm birth may depend upon racial discriminatory exposures, favoring pathways dependent upon glucocorticoid-induced increases in leukocyte tissue surveillance versus glucocorticoid resistance-associated inflammatory aberrations at increasing levels of exposure. Precision approaches to prenatal care are sorely needed to combat preterm birth, particularly among African American women, with efforts dependent upon further research examining the pathways contributing to the syndrome dependent upon the totality of an individual's exposures.

Keywords: Cortisol; Cytokines; Discrimination; Disparity; Glucocorticoids; Pregnancy; Psychological; Stress.

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Conflict of interest statement

Author Declaration

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property.

We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals or human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript.

We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He/she is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from the publisher.

Figures

Fig. 1.
Fig. 1.. Plasma cortisol and interleukin-8 levels by discrimination tertile.
Estimated marginal effects for the prediction of IL-8 levels according to cortisol levels. African American women in the first tertile showed a significant positive association (b* = 0.36, p = 0.030) as compared to non-significant negative associations among women in the second and third tertiles (p values ≥ 0.110).
Fig. 2.
Fig. 2.. Plasma cortisol levels and monocyte count by discrimination tertile.
Estimated marginal effects for the prediction of monocyte count according to cortisol levels. African American women in the first tertile showed a non-significant negative association (b* = −0.24, p = 0.149) as compared to non-significant positive associations among women in the second and third tertiles (p values ≥ 0.141).
Fig. 3.
Fig. 3.. Plasma cortisol levels and lymphocyte count by discrimination tertile.
Estimated marginal effects for the prediction of lymphocyte count according to cortisol levels. African American women in the first tertile showed a significant negative association (b* = −0.35, p = 0.033) as compared to a non-significant positive association among women in the second tertiles (b* = 0.13, p = 0.455) and non-significant negative association among women in the third tertile (b* = −0.37, p = 0.099).
Fig 4.
Fig 4.. Plasma cortisol levels and birth timing by discrimination tertile.
Estimated marginal effects for the prediction of birth timing according to cortisol levels. African American women in the first tertile showed a significant negative association (b* = −0.59, p < 0.001) as compared to non-significant positive associations among women in the second and third tertile (p values ≥ 0.497).
See this image and copyright information in PMC

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