Abstract
Objective
Both psychosocial stress and gestational weight gain are independently associated with adverse maternal and fetal outcomes. Studies of the association between psychosocial stress and gestational weight gain (GWG) have yielded mixed results. The objective of this study was to evaluate the association between psychosocial stress and GWG in a large population-based cohort.
Methods
Data from the nationally representative Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 questionnaire 2012–2015 was utilized. Maternal psychosocial stress was assessed through response to questions designed to examine four domains of psychosocial stress (i.e., traumatic, financial, emotional, partner-related) three months prior to or during pregnancy. GWG was categorized using pre-pregnancy BMI and total GWG into inadequate, adequate, or excessive according to the Institute of Medicine’s GWG guidelines. Multinomial logistic regression was used to evaluate the association between psychosocial stressors and adequacy of GWG. Analyses took into account complex survey design.
Results
All respondents who delivered ≥ 37 weeks gestation with GWG information available were included in the analysis (n = 119,183). After adjusting for confounders, patients who reported financial stress were more likely to experience excessive versus adequate GWG (RRR 1.09 [95%CI: 1.02–1.17]). Exposure to any of the stressor groups did not significantly increase the risk of inadequate GWG.
Conclusions
This large, population-based study revealed that among pregnant people in the US, exposure to financial stress is associated with higher risk of excessive GWG. Understanding the role stress plays in GWG will help to inform initiatives targeting this important aspect of prenatal care.
Significance
Excessive gestational weight gain (GWG) has been linked to postpartum weight retention and long-term adverse maternal and child health outcomes. Multiple studies have shown an association between psychosocial stress and adverse fetal outcomes. Risks of inadequate weight gain include low birthweight and failure to initiate breast-feeding whereas the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring.
AbstractSection What this study adds?The 2012–2015 Pregnancy Risk Assessment Monitoring System (PRAMS) provides unique nationally representative data in which birth outcomes and maternal weight are linked to psychosocial stressors. Our study is the largest of its kind examining the link between stress and GWG and reveals that exposure to financial stress is associated with higher risk of excessive GWG in the US.
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Data Availability
This data is available from the PRAMS working group by data request.
Code Availability
STATA (v14.2) - Contact corresponding author.
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Acknowledgements
The authors would like to acknowledge the contributions of the National PRAMS working group, the CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health and the following PRAMS sites for their role in conducting PRAMS surveillance and allowing the use of their data: PRAMS Alabama, PRAMS Alaska, PRAMS Arkansas, PRAMS Delaware, PRAMS Georgia, PRAMS Hawaii, PRAMS Illinois, PRAMS Iowa, PRAMS Louisiana, PRAMS Maine, PRAMS Maryland, PRAMS Massachusetts, PRAMS Michigan, PRAMS Minnesota, PRAMS Missouri, PRAMS Nebraska, PRAMS New Hampshire, PRAMS New Jersey, PRAMS New Mexico, PRAMS New York City, PRAMS New York State, PRAMS Ohio, PRAMS Oregon, PRAMS Pennsylvania, PRAMS Rhode Island, PRAMS Tennessee, PRAMS Utah, PRAMS Vermont, PRAMS Virginia, PRAMS Washington, PRAMS West Virginia, PRAMS Wisconsin, amd PRAMS Wyoming.
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Study conception and design: SML, SGB, YG, CDD; Data cleaning & Analysis: GCE; Interpretation of results: SML, YG, CDD; Manuscript and Figure preparation: SML, SL,YG, CDD, GCE. All of the authors reviewed the results and approved the final version of the manuscript.
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The authors have no conflict of interest to discloseEthics approval: This Research was approved by the PRAMS Working group review board. It is considered IRB exempt because data was provided without any unique identifiers.
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Mehta-Lee, S.S., Echevarria, G.C., Brubaker, S.G. et al. The Association between Psychosocial Stressors and Gestational Weight Gain: Analysis of the National Pregnancy Risk Assessment Monitoring System (PRAMS) Results from 2012 to 2015. Matern Child Health J (2024). https://doi.org/10.1007/s10995-024-03923-5
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DOI: https://doi.org/10.1007/s10995-024-03923-5