Assessing the impact of stressful life events on small-for-gestational-age births: Data from the Indiana Access project

Stress is thought to contribute to poor pregnancy outcomes; however, results from previous studies have been inconsistent. The objective of this study was to examine the relationship between stressful life events (SLE) and small-for-gestational age (SGA) births in a sample of urban, low-income, predominantly-minority women.

Through the Indiana Access project, 525 women in Indianapolis participated in face-to-face interviews during their post-partum hospitalization. Thirteen validated questions from PRAMS regarding SLE were included in the 162 item interview. Data for 93% of participants (n=493) were matched to birth certificate data for assessment of maternal risk factors (including demographic characteristics, socioeconomic status (SES), behaviors during pregnancy, access to prenatal care) and birth outcomes. The association of four SLE constructs (emotional, financial, partner-related, traumatic) and total number of SLE with SGA births was explored using multiple logistic regression.

Eighty-seven percent of women in the sample reported experiencing at least one SLE; nearly 25% reported 5 or more. Experiencing an increasing number of SLE increased the odds of delivering a SGA baby after adjusting for the mother's race/ethnicity, age, SES, medical history and comorbid conditions, substance use during pregnancy, pregnancy intendedness, and adequacy of prenatal care (OR=1.4; 95% CI=1.1, 2.0). A limitation of this study involving new birth mothers was the exclusion of women who experienced a fetal or infant death or whose baby was in the neonatal intensive care unit.

This study demonstrated a relationship between accumulated prenatal stress and SGA births. Further research on the potential impact of stress during pregnancy is warranted.