Stress and Health in American Indian Pregnancies

Project Summary/Abstract Cardiovascular disease is the leading cause of mortality among American Indian populations, and cardiovascular-related premature mortality among this population is worsening. Between 2000 and 2015, cardiovascular disease mortality rates among American Indian individuals aged 25-49 years increased by up to 2.1%, yet declined or plateaued among similarly aged individuals in other racial/ethnic groups in the U.S. The American Heart Association recently called for intergenerational examinations of consequences of chronic stress, such as childhood adversity and trauma, on cardiovascular risk factors among infants and children. American Indian populations have been exposed to historic trauma through violence, forced relocation and forced acculturation. Additionally, American Indian populations are exposed to higher levels of Adverse Childhood Experiences (ACEs) than other racial/ethnic groups in the United States. Infant growth is a recognized risk factor for cardiovascular disease in adulthood, yet the relationship between maternal adverse childhood experiences and infant growth among American Indian populations is unexamined. Investigation of the effect of chronic stress on maternal hypothalamic-pituitary-adrenal axis function and maternal and obstetric outcomes is important, as these mechanisms may lie on the pathway between chronic stress and infant growth. The Stress and Health in American Indian Pregnancies (SHAIP) study aligns with the goals of the Indigenous Trauma and Resiliency Research Center by partnering with American Indian communities in culturally relevant research. The SHAIP study will enroll 375 pregnant American Indian women from 3 tribal communities in North Dakota, collecting detailed biologic, medical, and social data 1 time during pregnancy, at birth, at 6 months postpartum and at 12 months postpartum. In Aim 1, we will assess the association between maternal ACEs and maternal hair cortisol concentration during pregnancy. In Aim 2, we will test the hypothesis that maternal hair cortisol concentration mediates the association between maternal ACEs and maternal and obstetric outcomes. Lastly, in Aim 3, we will examine multiple mediators of the relationship between maternal ACEs and infant growth. This proposed research project will allow me to examine, for the first time, potential pathways between maternal ACEs and infant growth. Potentially modifiable mediators like breastfeeding and maternal health may inform culturally informed interventions targeting American Indian populations in North Dakota. Achieving the Specific Aims of this project will enable me to establish myself as a leading scholar in the intergenerational transmission of maternal ACEs and cardiometabolic risk factors among infants.