200808 Using area-based exposures to evaluate the relationship between maternal stress and birth outcomes

Monday, November 9, 2009: 10:47 AM

Stephen Nkansah-Amankra, PhD, MPH , Community Health Program, University of Northern Colorado, Greeley, CO
Kathryn Luchok, PhD , South Carolina Access Initiative, Columbia, SC
James R. Hussey, PhD , Dept. of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
Objective: Studies evaluating the effect of maternal stress on preterm birth (PTB) or low birth weight (LBW) and variations across neighborhood exposures have been inconclusive. The purpose of the study was to examine the relationships among neighborhood exposures, prenatal stress and birth outcomes, and to further explore the modifying effects of neighborhood contexts. Methods: We evaluated this objective by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS), 2000-2003 data linked to the 2000 U.S. census data. We used multilevel logistic regression analysis to estimate the adjusted odds ratio for different models. Results: Maternal stress was significantly associated with increased risks of low birth weight and preterm deliveries. Neighborhood high poverty and low education (upper quartiles) were independently associated with low birth weight but not preterm deliveries and stress appeared as a partial mediator of neighborhood effects on birth outcomes. The interaction models showed that the relationship between stress and LBW or PTB was modified by neighborhood exposures with risks being higher for infants born in disadvantaged neighborhoods. Conclusions: Effects of maternal stress on birth outcomes may be different for mothers living in different neighborhood contexts. Therefore, investigations that fail to examine places of residence would most likely not identify mothers at risk of low birth weight or preterm births. Clinicians seeking to improve birth outcomes need to target both places of residence and specific mediating or moderating factors associated with deprived neighborhoods of mother's residence.

Learning Objectives:
Learning Objectives 1. By the end of this presentation, participants will be able to evaluate the role of neighborhood contexts and maternal-level exposures as determinants of low birth weight or preterm births among respondents participating in South Carolina PRAMS surveys, 2000-2003. 2. At the end of my presentation, participants will be able to identify the most important neighborhood exposures amenable to changes with specific program strategies towards improved health of mothers in the state. 3. At the end of this presentation, participants will be able to describe the most significant stressors related to the neighborhood contexts that may directly jeopardize maternal and child health as well as buffering mechanisms (social support systems) needed to prepare mothers for healthy childbirth.

Keywords: Maternal and Child Health, Low Birthweight

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Assistant Professor with the University of Northern Colorado and this was an independent research conducted by me. I have previously presented at APHA (Maternal and Child Health Section). My paper was adjudged second best in the student section (2008).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.