Multilevel exposure to adversity across the life course and biological implications among urban postpartum women: A cohort study protocol

Anne Elizabeth Glassgow, Claire Flanigan, Anahi A Gante Gaytan, Sage Kim, Aiman Soliman, Rachel Caskey, Almudena Veiga-Lopez, Irina A Buhimschi, Amanda Knepper, Hagar Hallihan, Alicia Arredondo Eve, Sofija Jovanovic Gasovic, Sabrina Akter, Bridget Lawate and Zeynep Madak-Erdogan

PLOS ONE, 2026, vol. 21, issue 5, 1-13

Abstract: Maternal mortality and morbidity in the United States remain substantially higher than in other high-income countries. Evidence suggests that exposure to chronic stress and social and environmental adversity contributes to maternal health risk through interconnected biological, psychological, and structural pathways. While these associations are documented, the molecular mechanisms linking adversity to maternal health outcomes remain poorly defined. This protocol describes a five-year, prospective, explanatory sequential mixed-methods cohort study (N = 200) designed to map how multilevel stress exposures influence biological and clinical outcomes among urban postpartum women. The study integrates geocoded neighborhood-level data, longitudinal electronic health records, and comprehensive interviewer-administered surveys assessing trauma, social support, and mental health. To identify the biological pathways of adversity, we employ multi-omics profiling of peripheral blood mononuclear cells—including DNA methylation, chromatin accessibility, and histone modification—alongside inflammatory and steroid hormone assays. Statistical frameworks, including Exposome-Wide Association Studies and spatial mediation modeling, will evaluate the interplay between socio-ecological stressors and molecular signatures during the postpartum period. Findings will advance understanding of the biological embedding of adversity and inform multilevel interventions to improve maternal health outcomes.

Date: 2026
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0348413 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 48413&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0348413

DOI: 10.1371/journal.pone.0348413

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().