Stressful life events during pregnancy adversely affect birth outcomes for American Indian women

BACKGROUND

Racial disparities in birth outcomes have been largely attributed to differences in premature birth, low birthweight and infections. We used the Pregnancy Risk Assessment and Monitoring System (PRAMS) in Oregon and Washington to assess the association of stressful life events with birth outcomes for Northwest American Indian/Alaska Native (AI/AN) women from 2002–2005.

METHODS

PRAMS is a complex survey conducted among a sample of new mothers, stratified by race. Surveys are linked to birth certificate data, enabling the study of birth outcomes. We used responses to the question: “Which of the following stressful events occurred while you were pregnant?” to define eight categories of stressful events in pregnancy. Outcomes included birthweight, prolonged hospitalization or staying in ICU, or neonatal death. Mutivariable logistic regression was performed to account for the complex sample design and assess the association between stressful life events and birth outcomes, controlling for other factors known to be associated with birth outcomes.

RESULTS

A greater proportion of AI/AN women experienced ≥3 stressful events during pregnancy than all other races. The high frequency of stressful events during pregnancy was more likely to be associated with LBW or VLBW, prolonged hospitalization or ICU care, or death for AI/AN neonates compared with other races. AI/AN infants were also more likely than other races to have prolonged hospitalization/ICU care or neonatal death if their mothers had experienced ≥3 stressful events during pregnancy.

CONCLUSIONS

Efforts to prevent excess stress to women during pregnancy, especially AI/AN women, could improve neonatal and infant outcomes.