Abstract
Background: Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Methods: Using path analysis, we examined associations between multiple self-reported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N=510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Results: Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI]=1.60, 5.85) and 2.67 (95% CI=1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β=1.63, 95% CI=0.29, 3.07; β=1.48, 95% CI=0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. Conclusions: In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.
Highlights
Studies have shown that exposure to stressors prior to or during pregnancy may increase the likelihood of adverse birth outcomes, including preterm birth and fetal growth restriction [1,2,3,4]
Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [confidence intervals (CI)] = 1.60, 5.85) and 2.67 increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively
15% of our study population reported caregiving for a family member requiring medical or educational attention, 34% experienced financial strain, and 27% of women indicated that their current pregnancy was unplanned (Table 1)
Summary
Studies have shown that exposure to stressors prior to or during pregnancy may increase the likelihood of adverse birth outcomes, including preterm birth and fetal growth restriction [1,2,3,4]. Individuals who experience stressful life events, such as a family death or trauma, have an increased risk of perceived stress and depression [6, 13, 14]. Individuals in disadvantaged neighborhoods may be more likely to experience violent crime [15], which may be considered a stressful life event and has been linked to adverse pregnancy outcomes [16]. Women in disadvantaged neighborhoods are more likely to experience symptoms of depression [17] and have higher risk of preterm birth [18]
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