JACKSONVILLE, Fla – As we wrap up our coverage of Black maternal deaths, I want to point out this is an everyone problem. In general, more women are dying of maternal causes in the U.S. every year.
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According to the Centers for Disease Control and Prevention, more than 1,200 died in 2021, compared to 861 in 2020 and 754 in 2019.
I had a conversation with Dr. Larae Brown, medical director for UF Health Women’s Specialists North, who brought up how toxic stress contributes to bad outcomes.
Melanie: One area that is being researched is toxic stress. Please explain what is toxic stress?
Brown: If you think about stress, all of us experience stress in life. There are positive stressors, such as performing for a big game or a big concert, that cause us to have a positive response. You get a little adrenaline, but it causes us to perform well. There are other stressors that maybe have a stronger impact, but the impacts are self-limited, so like we discussed the death of a loved one. So you can recover from that with the social support and the constructs that we have within our society to make it through that. But then there’s a third concept called toxic stress. So toxic stress is a chronic, unrelenting, negative impact to a person. It can start as early as childhood, and we now know that those constant chronic stressors can lead to physical manifestations in one’s body and specifically during pregnancy have very dire consequences.
Melanie: What are some examples of toxic stress?
Brown: Toxic stressors can include psychological, sexual, physical, verbal, mental abuse. It can also include exposure to violence, both just seeing violence or being exposed to victims of violence. It can also have to do with systemic racism or injustice or biases.
Melanie: How does this affect your body, especially during pregnancy?
Brown: That can have long-term implications with regards to its effects on your body’s systems, most notably your cardiovascular system. So if you’re constantly in a state of high alert, your blood vessels are going to respond to that over time, predispose you to changes in your heart, predispose you to changes in your blood pressure. So at a vulnerable time in your life, such as pregnancy, or childbirth, some of those long-standing risk factors and their impact on your body systems can have devastating effects that manifest at that time.
Melanie: How do doctors track the effects of toxic stress?
Brown: We rely on some biochemical markers that can also give us some insight into the level of chronic stress that a body has seen and there is a great body of research that is growing. It shows some of those biomarker levels such as cortisol levels, or CRH levels, have been elevated to a point earlier in the age of a minority woman or a patient who has been marginalized, very rural situations or exposure to violence, those can mimic the same values as a person who may not be marginalized and an older age. So essentially, you may get accelerated aging of a patient who has been exposed to toxic stress.
Melanie: How can you battle the effects of toxic stress?
Brown: In those higher-risk patients, you may perform their screening exams at an earlier age. So I definitely believe that preconception care doesn’t just start a year or two before you’re deciding to start your family. This starts very early, even in the teenage or childhood years, with a recognition that the stressors can impact your health and how we can optimize our health care in spite of those things. Also, sharing these things with the medical establishment. That is really ideal to both having early frequent interactions with health care to optimize your health at this point and then the education piece. It is a good thing to not normalize that we always have to fight through everything.
There are resources for women who are pregnant or are considering getting pregnant. Northeast Florida Healthy Start Coalition leads a cooperative community effort to reduce infant mortality and improve the health of children, childbearing women and their families in Northeast Florida.