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

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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.

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Notes

  1. March of Dimes. Premature babies. Retrieved April 2, 2017 from http://www.marchofdimes.org/baby/premature-babies.aspx.

  2. March of Dimes. Low birth weight. Retrieved April 2, 2017 from http://www.marchofdimes.org/baby/low-birthweight.aspx.

  3. National Center for Health Statistics. Final natality data. Retrieved from http://www.marchofdimes.org/peristats.

  4. Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved April 24, 2017 from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health.

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Authors and Affiliations

  1. Simmons School of Social Work, Simmons College, Boston, MA, USA

    Joanna Almeida & Kristin Erbetta

  2. University of Manchester, Manchester, UK

    Laia Bécares

  3. Perinatal Data Center, March of Dimes Foundation, White Plains, NY, USA

    Vani R. Bettegowda

  4. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA, USA

    Indu B. Ahluwalia

Authors
  1. Joanna Almeida
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  2. Laia Bécares
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  3. Kristin Erbetta
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  4. Vani R. Bettegowda
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  5. Indu B. Ahluwalia
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Corresponding author

Correspondence to Joanna Almeida.

Additional information

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC) or the March of Dimes Foundation.

Appendix

Appendix

Traumatic Life Stressors: (α = 0.46)

A close family member was very sick and had to go into the hospital

I moved to a new address

I was homeless or had to sleep outside, in a car, or in a shelter

My husband, partner, or I went to jail

Someone very close to me had a problem with drinking or drugs

Someone very close to me died

Financial Stressors: (α = 0.49)

My husband or partner lost his job

I lost my job even though I wanted to go on working

I had problems paying the rent, mortgage, or other bills

Relationship Stressors: (α = 0.58)

I got separated or divorced from my husband or partner

I argued with my husband or partner more than usual

My husband or partner said he didn’t want me to be pregnant

During pregnancy did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way?

During the 12 months before pregnancy did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way?

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Almeida, J., Bécares, L., Erbetta, K. et al. Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress. Matern Child Health J 22, 1154–1163 (2018). https://doi.org/10.1007/s10995-018-2500-7

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