Psychological Stress and Hepcidin: A Potential Link to Preterm Birth

1. Psychological Stress and Hepcidin: A Potential Link to Preterm Birth Mary Dawn Hennessy, RN PhD Department of Women, Children, and Family Health Science University of Illinois at Chicago Carmen Giurgescu, RN PhD WHNP Wayne State University Elizabeta Nemeth, PhD Department of Medicine University of California, Los Angeles

2. Background and Significance • In 2009, 18% of US African American delivered preterm (<37 weeks) • African Americans have increased psychological stress and higher rates of iron deficiency • Conflicting evidence on link between iron deficiency and preterm birth • Inflammation-mediated iron restriction may be a risk factor, but studies have not made distinction

3. Hepcidin: Key Regulator of Iron Spleen Liver hepcidin hepcidin Fpn 20 mg/d 0-5 mg/d Fpn hepcidin Plasma Fe-Tf RBC Fpn 1-2 mg/d 20 mg/d Bone marrow Duodenum

4. Inflammation Iron signal Erythropoietic signal Regulation of hepcidin production Spleen Liver hepcidin hepcidin Fpn Fpn hepcidin Plasma Fe-Tf RBC Fpn Bone marrow Duodenum

5. Aims • Aim 1. Determine if psychological stress and inflammation are correlated with hepcidin levels during pregnancy • Aim 2. Determine if hepcidin levels during pregnancy predict preterm birth

6. Hypotheses • Hypothesis 1. At any time point during pregnancy, increased psychological stress and/or inflammation will be correlated with increasing hepcidin levels • Hypothesis 2. At any time point during pregnancy, increased hepcidin will be predictive of preterm birth

7. Sample • 88 pregnant self-identified African Americans • Predominately low-income from a large Midwest city • At least 18 years of age • Singleton pregnancy • 16-22 weeks gestation

8. Design • Descriptive, longitudinal design • Data collected at • T1 16-22 weeks • T2 26-32 weeks • T3 birth

9. Psychological Stress Measures • Perceived racial discrimination (EOD) • Personal resources • Optimism (LOT) • Self-esteem (RSES) • Coping (PCI) • Emotional stress response • Distress (PGWB) • Anxiety (State Anxiety subscale) • Depression (CES-D)

10. Serum Measures • Inflammation by multiplex bead immunoassays • Interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10 • TNF-α • C-reactive protein • Hepcidin by ELISA

11. Results – Demographic and Clinical Characteristics

12. Results – Psychological Stress, Inflammation and Hepcidin

13. Results – Hepcidin and Preterm Birth

14. Results – Hepcidin Levels and Preterm Birth

15. Results – Hepcidin as a Predictor of Preterm Birth

16. Conclusions • The iron-regulatory hormone hepcidin is increased in pregnant women with elevated psychological stress and inflammation • Hepcidin may be a useful biomarker of inflammation/stress during pregnancy • Hepcidin-mediated iron restriction may increase the risk for preterm birth

17. Future Research • Evaluation of hepcidin throughout pregnancy, as elevated or undetectable hepcidin could be used as an early diagnostic tool and an indicator of inflammation-mediated iron restriction or true iron deficiency

18. Funding Acknowledgements • Midwest Nursing Research Society New Investigator Seed Grant • The University of Illinois at Chicago Dean’s Fund