Skip to main content
SpringerLink
Log in

Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01–2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Valero De Bernabé, J., Soriano, T., Albaladejo, R., Juarranz, M., Calle, M. E., Martínez, D., & Domínguez-Rojas, V. (2004). Risk factors for low birth weight: a review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 116(1), 3–15.

    Article  PubMed  Google Scholar 

  2. Kleinman, J. C., & Kessel, S. S. (1987). Racial differences in low birth weight. Trends and risk factors. New England Journal of Medicine, 317(12), 749–753.

    Article  CAS  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Collins, J. W, Jr, & David, R. J. (2009). Racial disparity in low birth weight and infant mortality. Clinics in Perinatology, 36(1), 63–73.

    Article  PubMed  Google Scholar 

  5. Federal Interagency Forum on Child and Family Statistics. Preterm birth and low birthweight [Cited 2013 Aug 10]. http://www.childstats.gov/americaschildren/health1.asp

  6. Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.

    Article  PubMed  Google Scholar 

  7. McIntosh, L. J., Roumayah, E. N., & Bottoms, S. F. (1995). Perinatal outcome of broken marriage in the inner city. International Journal of Gynecology and Obstetrics, 51(5), 368–375.

    Google Scholar 

  8. Fink, J. C., Schawartz, S. M., Benedetti, T. J., & Stehman, C. O. (1998). Increased risk of adverse maternal and infant outcomes among women with renal disease. Paediatric and Perinatal Epidemiology, 12(3), 277–287.

    Article  CAS  PubMed  Google Scholar 

  9. Sharma, R., Synkewecz, C., Raggio, T., & Mattison, D. R. (1994). Intermediate variables as determinants of adverse pregnancy outcome in high risk inner city populations. Journal of the National Medical Association, 86(11), 857–860.

    PubMed Central  CAS  PubMed  Google Scholar 

  10. Windham, G. C., Hopkings, B., Fenster, L., & Swan, S. H. (2000). Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight. Epidemiology, 11(4), 427–433.

    Article  CAS  PubMed  Google Scholar 

  11. Lazzaroni, F., Bonassi, S., Magnani, M., Calvi, A., Repetto, E., Serra, F., et al. (1993). Moderate maternal drinking and outcome of pregnancy. European Journal of Epidemiology, 9(6), 599–606.

    Article  CAS  PubMed  Google Scholar 

  12. Meng, G., Thompson, M. E., & Hall, G. B. (2013). Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes. International Journal of Health Geographics, 12, 32.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Metcalfe, A., Lail, P., Ghali, W. A., & Sauve, R. S. (2011). The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies. Paediatric and Perinatal Epidemiology, 25(3), 236–245.

    Article  PubMed  Google Scholar 

  14. Newton, R. W., & Hunt, L. P. (1984). Psychosocial stress in pregnancy and its relation to low birthweight. British Medical Journal, 288, 1191–1194.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Stein, A., Campbell, E. A., Day, A., McPherson, K., & Cooper, P. J. (1987). Social adversity, low birthweight, and preterm delivery. British Medical Journal, 295(6593), 291–293.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Mutale, T., Creed, F., Maresh, M., & Hunt, L. (1991). Life events and low birthweight—analysis by infants preterm and small for gestational age. British Journal of Obstetrics and Gynaecology, 98(2), 166–172.

    Article  CAS  PubMed  Google Scholar 

  17. Wadhwa, P. D., Sandman, C. A., Porto, M., Dunkel-Schetter, C., & Garite, T. J. (1993). The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. American Journal of Obstetrics and Gynecology, 169(4), 858–865.

    Article  CAS  PubMed  Google Scholar 

  18. Khashan, A. S., McNamee, R., Abel, K. M., Pedersen, M. G., Webb, R. T., Kenny, L. C., et al. (2008). Reduced infant birthweight consequent upon maternal exposure to severe life events. Psychosomatic Medicine, 70(6), 688–694.

    Article  PubMed  Google Scholar 

  19. Nkansah-Amankra, S., Luchok, K. J., Hussey, J. R., Watkins, K., & Liu, X. (2010). Effects of maternal stress on low birth weight and preterm birth outcomes across neighborhoods of South Carolina, 2000–2003. Maternal and Child Health Journal, 14(2), 215–226.

    Article  PubMed  Google Scholar 

  20. Brown, S. J., Yelland, J. S., Sutherland, G. A., Baghurst, P. A., & Robinson, J. S. (2011). Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care. BMC Public Health, 11, 196.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Torche, F. (2011). The effect of maternal stress on birth outcomes: Exploiting a natural experiment. Demography, 48(4), 1473–1491.

    Article  PubMed  Google Scholar 

  22. Wainstock, T., Anteby, E., Glasser, S., Shoham-Vardi, I., & Lerner-Geva, L. (2013). The association between prenatal maternal objective stress, perceived stress, preterm birth and low birthweight. The Journal of Maternal-Fetal Medicine, 26(10), 973–977.

    Article  Google Scholar 

  23. Wainstock, T., Anteby, E. Y., Glasser, S., Lerner-Geva, L., & Shoham-Vardi, I. (2014). Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight. International Journal of Gynaecology and Obstetrics, 125(1), 28–32.

    Article  PubMed  Google Scholar 

  24. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11(2), 213–218.

    Article  CAS  PubMed  Google Scholar 

  25. Rinaudo, P. F., & Lamb, J. (2008). Fetal origins of perinatal morbidity and/or adult disease. Seminars in Reproductive Medicine, 26(5), 436–445.

    Article  PubMed  Google Scholar 

  26. Collins, J. W, Jr, Simon, D. M., Jackson, T. A., & Drolet, A. (2006). Advancing maternal age and infant birth weight among urban African Americans: the effect of neighborhood poverty. Ethnicity and Disease, 16(1), 180–186.

    PubMed  Google Scholar 

  27. Buka, S. L., Brennan, R. T., Rich-Edwards, J. W., Raudenbush, S. W., & Earls, F. (2003). Neighborhood support and the birth weight of urban infants. American Journal of Epidemiology, 157, 1–8.

    Article  PubMed  Google Scholar 

  28. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Rosenthal, L., & Lobel, M. (2011). Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women. Social Science and Medicine, 72(6), 977–983.

    Article  PubMed  Google Scholar 

  30. Geronimus, A. T. (1996). Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Social Science and Medicine, 42(4), 589–597.

    Article  CAS  PubMed  Google Scholar 

  31. Dawson, D. A., Grant, B. F., & Ruan, W. J. (2005). The association between stress and drinking: modifying effects of gender and vulnerability. Alcohol and Alcoholism, 40(5), 453–460.

    Article  PubMed  Google Scholar 

  32. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158(8), 1184–1190.

    Article  CAS  PubMed  Google Scholar 

  33. Brawarsky, P., Stotland, N. E., Jackson, R. A., Fuentes-Afflick, E., Escobar, G. J., Rubashkin, N., & Haas, J. S. (2005). Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. International Journal of Gynaecology and Obstetrics, 91(2), 125–131.

    Article  CAS  PubMed  Google Scholar 

  34. Gilbert, B. C., Shulman, H. B., Fischer, L. A., & Rogers, M. M. (1999). The pregnancy risk assessment monitoring system (PRAMS): Methods and 1996 response rates from 11 states. Maternal and Child Health Journal, 3, 199–209.

    Article  CAS  PubMed  Google Scholar 

  35. Institute of Medicine (US). (2011). Committee on Leading Health Indicators for Healthy People 2020. Leading Health Indicators for Healthy People 2020: Letter Report. Washington (DC): National Academies Press (US).

  36. Nathan, R. P., & Adams, C. F, Jr. (1976). Understanding central city hardship. Political Science Quarterly, 91(1), 47–62.

    Article  Google Scholar 

  37. Nathan, R. P., & Adams, C. F, Jr. (1989). Four perspectives on urban hardship. Political Science Quarterly, 104, 482–508.

    Google Scholar 

  38. Montiel, L. M., Nathan, R. P., & Wright, D. J. (2004). An update on urban hardship. Albany NY: The Nelson A. Rockefeller Institute of Government.

    Google Scholar 

  39. Cochrane, R., & Robertson, A. (1973). The life events inventory: A measure of the relative severity of psycho-social stressors. Journal of Psychosomatic Research, 17(2), 135–140.

    Article  CAS  PubMed  Google Scholar 

  40. Newton, R. W., Webster, P. A., Binu, P. S., Maskrey, N., & Phillips, A. B. (1979). Psychosocial stress in pregnancy and its relation to the onset of premature labour. British Medical Journal, 2(6187), 411–413.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. The RAND Corporation. The Los Angeles Family and Neighborhood Survey: L.A.FANS-1 Questionnaires. [Cited 2013 Aug 10]. http://lasurvey.rand.org/documentation/questionnaires/

  42. Institute of Medicine and National Research Council. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): The National Academies Press.

    Google Scholar 

  43. Greenland, S., & Mickey, R. M. (1989). The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology, 129(1), 125–137.

    PubMed  Google Scholar 

  44. Tofighi, D., & MacKinnon, D. P. (2011). RMediation: An R package for mediation analysis confidence intervals. Behavior Research Methods, 43, 692–700.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Lockwood, C. J. (1999). Stress-associated preterm delivery: The role of corticotropin-releasing hormone. American Journal of Obstetrics and Gynecology, 180(1 Pt 3), S264–S266.

    Article  CAS  PubMed  Google Scholar 

  46. Omer, H. (1986). Possible psychophysiologic mechanisms in premature labor. Psychosomatics, 27, 580–584.

    Article  CAS  PubMed  Google Scholar 

  47. Oklahoma State Department of Health. (2009). Stressors, social support and pregnancy outcomes among African American and White mothers. PRAMSgram: Oklahoma pregnancy risk assessment monitoring. System, 13, 2.

    Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge with sincere appreciation the Los Angeles Mommy and Baby (LAMB) survey study team (Diana Liu, Marian Eldahaby, Carmen Gutierrez, Yeghishe Nazinyan, Rozana Ceballos, Judith Zarate) for their dedicated work in the design and implementation of the 2007 and 2010 LAMB projects. The authors also wish to thank Ms. Louise Rollin_Alamilo from the Office of Health Assessment and Epidemiology in Los Angeles County Department of Public Health, for computing and sharing the Economic Hardship Index. The LAMB project was made possible by the Health Resources and Services Administration (HRSA) Grant #R40MC06635, the Los Angeles County Productivity and Investment fund, and the Los Angeles County Department of Maternal, Child and Adolescent Health (MCAH) Programs general grants. One author also received funding support from the Epi Scholars Program at Los Angeles County Department of Public Health to work on this project.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Yale School of Public Health, New Haven, CT, USA

    Yuan Zhao, Trace Kershaw & Adrienne S. Ettinger

  2. Los Angeles County Department of Public Health, Maternal, Child and Adolescent Health Programs, Los Angeles, CA, USA

    Yuan Zhao, Chandra Higgins & Shin M. Chao

  3. Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA

    Trace Kershaw

  4. Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, New Haven, CT, USA

    Adrienne S. Ettinger

  5. Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA

    Michael C. Lu

Authors
  1. Yuan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trace Kershaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adrienne S. Ettinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chandra Higgins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael C. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shin M. Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuan Zhao.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, Y., Kershaw, T., Ettinger, A.S. et al. Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys. Matern Child Health J 19, 2195–2205 (2015). https://doi.org/10.1007/s10995-015-1734-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-015-1734-x

Keywords

Search

Navigation