260327 Relationship between the maternal Stress to Resiliency Ratio (SRR) and the initiation of prenatal care (PNC): Findings from the 2007 Los Angeles Mommy and Baby (LAMB) study

Tuesday, October 30, 2012

Fathima Wakeel, PhD, MPH , Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
Lauren E. Wisk, BS , Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
Rebekah Gee, MD, MPH, MSHPR , School of Public Health, Louisiana State University, New Orleans, LA
Shin Margaret Chao, PhD, MPH , Maternal, Child, and Adolescent Health, Los Angeles County Department of Public Health, Los Angeles, CA
Whitney P. Witt, PhD, MPH , Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
OBJECTIVE: To examine the association between the maternal stress to resiliency ratio (SRR) and delayed prenatal care (PNC) initiation.

METHODS: We used data from the Los Angeles Mommy and Baby (LAMB) study, a mailed survey based on a multistage clustered design with telephone follow-up for non-respondents. Analyses were based on the responses of 3,148 women who had a live birth in LA County in 2007. The maternal resiliency index comprised personal resources (self-esteem and mastery) and social resources (partner, social network, and neighborhood support) that women drew upon during pregnancy. The stress index consisted of severe life events and perceived stress during pregnancy. The stress index was divided by the resiliency index to create the raw SRR, which was then transformed into a natural log SRR (range -1.5 to 1.5). An SRR>0 signified greater stress relative to resiliency. Logistic regression analyses were used to assess the association between the SRR and delayed PNC.

RESULTS: Among respondents, 10.7% did not initiate PNC during the first trimester. The maternal SRR was significantly associated with delayed PNC (AOR=1.6; 95% CI=1.1, 2.3). Among the reasons commonly cited for delaying PNC, inadequate money and/or insurance to pay for visits was significantly associated with an SRR>0 (AOR=6.5; 95% CI=2.2, 19.3).

CONCLUSIONS: Experiencing greater stress than resiliency during pregnancy is significantly associated with delayed PNC initiation. Financial difficulties may impact the timing of PNC initiation directly or indirectly by increasing one's stress relative to resiliency. Interventions to increase PNC access among low-income and uninsured/underinsured women are warranted.

Learning Areas:
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1) Explain the components of the maternal stress to resiliency ratio; 2) Describe the relationship between the maternal stress to resiliency ratio and delayed prenatal care initiation; 3) Discuss programmatic and policy implications of our findings.

Keywords: Prenatal Care, Stress

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been extensively working with the LAMB study since 2006, and I have presented various findings using the LAMB study data since October 2008. I am also the first author on work regarding the development the maternal stress-to-resiliency ratio (SRR) and its relationships with a number of prenatal, obstetric, and postpartum outcomes.
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.

Back to: 4366.0: Improving Pregnancy Outcomes: Reducing Risk Factors for Mothers and Infants