Factors related to reduced social support for pregnant African American women

Background

African American women are at disproportionate risk for adverse pregnancy outcomes as compared to other racial-ethnic groups. While psychosocial risks may contribute to this disparity, social support has been shown to be a protective factor for improving pregnancy outcomes for women at risk. Identification of risks which result in loss of social social support over the course of pregnancy, might allow initiation of appropriate preventive interventions to improve maternal and infant outcomes.

Purpose

To identify factors associated with decrease in social support over the perinatal period for low income African American women.

Methods

As part of the NIH-DC Initiative to Reduce Infant Mortality in Minority Populations, low income, African American women in prenatal care at 6 clinic sites in Washington, DC (N=1044) were screened for smoking, environmental tobacco smoke exposure, depression and intimate partner violence. As part of an RCT, women who screened with any of the targeted risks were randomized to usual care or they were offered individual counseling tailored to their specific risks. Maintaining and increasing support from others was a goal for each of the risk intervention components. The counseling was conducted at the time of the woman's prenatal clinic visits. Measures of risk factors, demographics, partner relationship, and social support were gathered at baseline, end of third trimester, and postpartum. Factors associated with decrease in reported social support over the perinatal period were analyzed.

Results:

A substantial proportion of these low income minority women reported a decrease in social support over the course of pregnancy: 40% at the end of the third trimester and 31% at postpartum. At the end of the third trimester, comparison by group assignment shows that a greater percentage of women in usual care reported a decrease in social support as compared to the women in the intervention (44% vs. 36%) (OR=1.36, 95% CI 1.00-1.83). At postpartum, women who used alcohol during pregnancy were more likely to report decreased social support than those who did not drink (39% vs. 29%) (OR=1.61,CI 1.14-2.27). No differences were found for education, age, employment, number of children, drug use, depression or intimate partner violence.

Conclusions:

Although social support may serve as a protective factor for improving pregnancy outcome for those at psychosocial risk, many women experience loss of social support during pregnancy. Participating in a counseling intervention during prenatal care may help to preserve the social support network for women at risk. Health providers need to be aware that women using alcohol during pregnancy, not only place their infant at risk for alcohol exposure, but also risk increasing their isolation from available social supports.

Funded by NICHD and NCMHHD