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Prenatal Perceived Stress and Adverse Birth Outcomes Among Puerto Rican Women
Kathleen Szegda1,2,3, Elizabeth R Bertone-Johnson1, Penelope Pekow1
11 Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts , Amherst, Massachusetts.
Insights
Prenatal psychosocial stress, particularly in mid-pregnancy, significantly elevates risks for preterm birth and low birthweight in Puerto Rican women. Increased stress during pregnancy also raises the likelihood of having a baby small for gestational age.
Area of Science:
- Perinatal epidemiology
- Reproductive health
- Psychosocial factors in pregnancy
Background:
- Preterm birth and low birthweight are leading causes of infant mortality among Puerto Ricans in the U.S.
- Puerto Rican women represent a high-risk population for adverse birth outcomes.
Purpose of the Study:
- To investigate the association between the timing and pattern of prenatal psychosocial stress and adverse birth outcomes.
- To identify specific stress levels and patterns that increase risks for preterm birth, low birthweight, and small for gestational age (SGA).
Main Methods:
- Prospective cohort study (Proyecto Buena Salud) of 1,267 predominantly Puerto Rican women from 2006-2011.
- Interviews conducted in early, mid-, and late pregnancy to assess perceived stress using the Perceived Stress Scale.
- Evaluated associations between stress levels at different pregnancy stages and birth outcomes: preterm birth, low birthweight, and SGA.
Main Results:
- Elevated mid-pregnancy perceived stress was linked to increased risk of preterm birth (OR=3.50) and low birthweight (OR=3.53).
- A linear trend showed higher stress quartiles correlated with greater risk for these outcomes (ptrend=0.01).
- Increased stress from early to late pregnancy was associated with a higher risk of SGA (OR=1.90).
Conclusions:
- Mid-pregnancy perceived stress is a significant risk factor for preterm birth and low birthweight in this population.
- A pattern of increasing stress throughout pregnancy is associated with an elevated risk of SGA.
- Findings highlight the importance of monitoring and managing prenatal stress in high-risk ethnic groups.
Background:
Preterm birth and low birthweight contribute substantially to the disproportionately high infant mortality rates experienced by Puerto Ricans in the United States. The purpose of this study was to examine whether the timing and pattern of prenatal psychosocial stress increased risk of adverse birth outcomes in this high-risk population.
Materials And Methods:
Proyecto Buena Salud was a prospective cohort study conducted from 2006 to 2011 among predominantly Puerto Rican women. Participants (n = 1,267) were interviewed in early, mid-, and late pregnancy. We evaluated associations between early and mid-pregnancy stress (Perceived Stress Scale) and preterm birth and low birthweight, and stress at each pregnancy time point and small for gestational age (SGA).
Results:
Elevated levels of perceived stress in mid-pregnancy increased risk for preterm birth and low birthweight in adjusted analyses, with a linear trend observed for each increasing quartile of stress (ptrend = 0.01). Women in the highest quartile of stress experienced three times the risk for preterm birth (odds ratio [OR] = 3.50, confidence interval [95% CI]: 1.38-8.87) and low birthweight (OR = 3.53, 95% CI = 1.27-9.86) compared with women in the lowest quartile. Early pregnancy stress was not associated with preterm birth or low birthweight. Increase in stress from early to late pregnancy increased risk for SGA (OR = 1.90, 95% CI = 1.01-3.59); no associations were found between stress at any timepoint and SGA.
Conclusion:
Elevated levels of mid-pregnancy perceived stress increased risk for preterm birth and low birthweight, and an increase in stress over the course of pregnancy increased risk for SGA in a population of predominantly Puerto Rican women.
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