Maternal and Child Health Journal

, Volume 20, Issue 6, pp 1103–1113 | Cite as

A Multidimensional Approach to Characterizing Psychosocial Health During Pregnancy

  • Pamela J. MaxsonEmail author
  • Sharon E. Edwards
  • Ellis M. Valentiner
  • Marie Lynn Miranda


Objectives Domains of psychosocial health have been separately connected to pregnancy outcomes. This study explores the relationship between five domains of psychosocial health and their joint association with prenatal health and pregnancy outcomes. Methods Women from a prospective cohort study in Durham, North Carolina were clustered based on measures of paternal support, perceived stress, social support, depression, and self-efficacy. Clusters were constructed using the K-means algorithm. We examined associations between psychosocial health and maternal health correlates, pregnancy intention, and pregnancy outcomes using Chi square tests and multivariable models. Results Three psychosocial health profiles were identified, with the first (Resilient; n = 509) characterized by low depression and perceived stress and high interpersonal support, paternal support, and self-efficacy. The second profile (Vulnerable; n = 278) was marked by high depression and perceived stress, and low interpersonal support, paternal support, and self-efficacy. The third profile (Moderate, n = 526) fell between the other profiles on all domains. Health correlates, pregnancy intention, and pregnancy outcomes varied significantly across profiles. Women with the vulnerable profile were more likely to have risky health correlates, have an unintended pregnancy, and deliver preterm. Women with the resilient profile had better birth outcomes and fewer deleterious health correlates, preconception and prenatally. Conclusions We posit that vulnerable psychosocial health, deleterious health correlates, and the stress which often accompanies pregnancy may interact to magnify risk during pregnancy. Identifying and intervening with women experiencing vulnerable psychosocial health may improve outcomes for women and their children.


Psychosocial health Pregnancy outcomes Prenatal health Cluster analysis 


  1. 1.
    Kramer, M. S., Seguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194–210.CrossRefPubMedGoogle Scholar
  2. 2.
    Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2006). The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstetricia et Gynecologica Scandinavica, 85(3), 277–285.CrossRefPubMedGoogle Scholar
  3. 3.
    Ritter, C., Hobfoll, S. E., Lavin, J., Cameron, R. P., & Hulsizer, M. R. (2000). Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. Health Psychology, 19(6), 576–585.CrossRefPubMedGoogle Scholar
  4. 4.
    Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O. (2000). Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics and Gynecology, 95(4), 487–490.PubMedGoogle Scholar
  5. 5.
    Leiferman, J. (2002). The effect of maternal depressive symptomatology on maternal behaviors associated with child health. Health Education & Behavior, 29(5), 596–607.CrossRefGoogle Scholar
  6. 6.
    Maxson, P. J., Edwards, S. E., Ingram, A., & Miranda, M. L. (2012). Psychosocial differences between smokers and non-smokers during pregnancy. Addictive Behaviors, 37(2), 153–159.CrossRefPubMedGoogle Scholar
  7. 7.
    Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67(10), 1012–1024.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157(1), 14–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: Relationship to poor health behaviors. American Journal of Obstetrics and Gynecology, 160(5 Pt 1), 1107–1111.CrossRefPubMedGoogle Scholar
  10. 10.
    Beck, C. T. (2002). Revision of the postpartum depression predictors inventory. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(4), 394–402.CrossRefPubMedGoogle Scholar
  11. 11.
    Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715–725.CrossRefPubMedGoogle Scholar
  12. 12.
    Borders, A. E., Grobman, W. A., Amsden, L. B., & Holl, J. L. (2007). Chronic stress and low birth weight neonates in a low-income population of women. Obstetrics and Gynecology, 109(2 Pt 1), 331–338.CrossRefPubMedGoogle Scholar
  13. 13.
    Copper, R. L., Goldenberg, R. L., Das, A., Elder, N., Swain, M., Norman, G., et al. (1996). The preterm prediction study: Maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. American Journal of Obstetrics and Gynecology, 175(5), 1286–1292.CrossRefPubMedGoogle Scholar
  14. 14.
    Rini, C. K., Dunkel-Schetter, C., Wadhwa, P. D., & Sandman, C. A. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychology, 18(4), 333–345.CrossRefPubMedGoogle Scholar
  15. 15.
    Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black–white gap in birth outcomes: A life-course approach. Ethnicity and Disease, 20(1 Suppl 2), S2–S76.Google Scholar
  16. 16.
    Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dole, N., Savitz, D. A., Siega-Riz, A. M., Hertz-Picciotto, I., McMahon, M. J., & Buekens, P. (2004). Psychosocial factors and preterm birth among African American and White women in central North Carolina. American Journal of Public Health, 94(8), 1358–1365.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hogue, C. J., & Bremner, J. D. (2005). Stress model for research into preterm delivery among black women. American Journal of Obstetrics and Gynecology, 192(5 Suppl), S47–S55.CrossRefPubMedGoogle Scholar
  19. 19.
    Maciejewski, P. K., Prigerson, H. G., & Mazure, C. M. (2000). Self-efficacy as a mediator between stressful life events and depressive symptoms. Differences based on history of prior depression. British Journal of Psychiatry, 176, 373–378.CrossRefPubMedGoogle Scholar
  20. 20.
    Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38(5), 300.CrossRefPubMedGoogle Scholar
  21. 21.
    Ghosh, J. K., Wilhelm, M. H., Dunkel-Schetter, C., Lombardi, C. A., & Ritz, B. R. (2010). Paternal support and preterm birth, and the moderation of effects of chronic stress: A study in Los Angeles county mothers. Archives of Women’s Mental Health, 13(4), 327–338.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Carlson, M., McLanahan, S., & England, P. (2004). Union formation in fragile families. Demography, 41(2), 237–261.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam (Ed.), The social psychology of health (pp. 31–67). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  24. 24.
    Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.CrossRefPubMedGoogle Scholar
  25. 25.
    Radloff, L. S. (1977). The CES-D Scale. Applied Psychological Measurement, 1(3), 385.CrossRefGoogle Scholar
  26. 26.
    Jerusalem, M., & Schwarzer, R. (1992). Self-efficacy as a resource factor in stress appraisal processes. Self-efficacy: Thought control of action (pp. 195–213). Washington, DC: Hemisphere Publishing Corp.Google Scholar
  27. 27.
    Centers for Disease Control and Prevention. Pregnancy Risk Assessment Monitoring System. (2014). Divison of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Ref Type: Online Source.Google Scholar
  28. 28.
    Elo, I. T., Culhane, J. F., Kohler, I. V., O’Campo, P., Burke, J. G., Messer, L. C., et al. (2009). Neighbourhood deprivation and small-for-gestational-age term births in the United States. Paediatric and Perinatal Epidemiology, 23(1), 87–96.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Asendorpf, J. B., Borkenau, P., Ostendorf, F., & Van Aken, M. A. (2001). Carving personality description at its joints: Confirmation of three replicable personality prototypes for both children and adults. European Journal of Personality, 15(3), 169–198.CrossRefGoogle Scholar
  30. 30.
    Hobel, C. J., Goldstein, A., & Barrett, E. S. (2008). Psychosocial stress and pregnancy outcome. Clinical Obstetrics and Gynecology, 51(2), 333–348.CrossRefPubMedGoogle Scholar
  31. 31.
    Knackstedt, M. K., Hamelmann, E., & Arck, P. C. (2005). Mothers in stress: Consequences for the offspring. American Journal of Reproductive Immunology, 54(2), 63–69.CrossRefPubMedGoogle Scholar
  32. 32.
    Kramer, M. R., & Hogue, C. R. (2009). What causes racial disparities in very preterm birth? A biosocial perspective. Epidemiologic Reviews, 31, 84–98.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7(1), 13–30.CrossRefPubMedGoogle Scholar
  34. 34.
    Savitz, D. A., Kaufman, J. S., Dole, N., Siega-Riz, A. M., Thorp, J. M, Jr, & Kaczor, D. T. (2004). Poverty, education, race, and pregnancy outcome. Ethnicity and Disease, 14(3), 322–329.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Pamela J. Maxson
    • 1
    Email author
  • Sharon E. Edwards
    • 1
  • Ellis M. Valentiner
    • 1
  • Marie Lynn Miranda
    • 1
    • 2
    • 3
  1. 1.Children’s Environmental Health Initiative, School of Natural Resources and EnvironmentUniversity of MichiganAnn ArborUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborUSA
  3. 3.Department of Pediatrics and Communicable DiseasesUniversity of MichiganAnn ArborUSA

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