Exploring Maternal Stressors and Their Relationship to Racial Disparities in Adverse Birth Outcomes in Maryland

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Author/Creator ORCID

Date

2019-10-24

Department

Public Health and Policy

Program

Doctor of Public Health

Citation of Original Publication

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Abstract

Low birth weight and preterm birth are among the leading causes for infant mortality in the nation. Historically, infant mortality rates in Maryland have been higher than the overall rate in America due to high rates among the black population. Previous research indicates that maternal stress affects birth outcomes and may contribute to the disparity between black and white birth outcomes in the United States. The objective of this research is to examine maternal stressors experienced shortly before and during pregnancy and their relationship to disparities in low birth weight and preterm birth between Non-Hispanic black and Non-Hispanic white women in the state of Maryland. A retrospective cross-sectional analysis was conducted using Maryland Pregnancy Risk Assessment and Monitoring (PRAMS) data from 2004-2013. Bivariate and multivariate logistic regression analyses were performed to assess associations between adverse birth outcomes and stressful life events, maternal characteristics, and health behaviors by race/ethnicity. Using stressful life events, stress is operationalized in four ways: number of stressful life events, stress domain (emotional, financial, partner-related, and traumatic), number of stress domains, and weighted stress score (1995 Life Change Unit values). In this sample, black women had over 1.5 times the rate of preterm birth and had over twice the rate of low birth weight compared to white women. Black women experienced more stress for all four operationalized stress measures than white women. Black women reported 62% more total number of stressors than white women did and had a mean life change unit score that was nearly 59 points higher than white women. Most stress measures were not significantly associated with preterm birth or low birth weight for both black and white women and race did not modify this relationship. Results may suggest that, although operationalized in four different ways, stressful life events may not adequately measure maternal stress and its relationship to preterm birth and low birth weight. Subsequent studies should aim to use a cumulative stress measure and account for personality traits and coping styles to understand the impact of stress over the life course on adverse birth outcomes.