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Matern Child Health J. 2018 Aug;22(8):1154-1163. doi: 10.1007/s10995-018-2500-7.

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress.

Author information

1
Simmons School of Social Work, Simmons College, Boston, MA, USA. Joanna.almeida@simmons.edu.
2
University of Manchester, Manchester, UK.
3
Simmons School of Social Work, Simmons College, Boston, MA, USA.
4
Perinatal Data Center, March of Dimes Foundation, White Plains, NY, USA.
5
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA, USA.

Abstract

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.

KEYWORDS:

Adverse birth outcomes; Low birth weight; Preterm birth; Psychosocial stressors; Racial/ethnic inequities

PMID:
29442278
DOI:
10.1007/s10995-018-2500-7
[Indexed for MEDLINE]

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