142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

"Timing impacts how prenatal psychosocial context affects birth outcomes"

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 10:30 AM - 10:50 AM

Donna Schminkey, PhD, MPH, CNM , School of Nursing, University of Virginia, Charlottesville, VA
Timo Von Oertzen, PhD , Department of Psychology, University of Virginia, Charlottesville, VA
Linda Bullock, PhD, RN, FAAN , School of Nursing, University of Virginia, Charlottesville, VA
Background: In the United States approximately one in eight babies is preterm.   Approximately thirty percent of preterm births are attributable to endocrine immune changes that are related to stress processing. During pregnancy, the maturing placenta is an active endocrine and immune organ; however, its’ evolving contributions to stress processing has not been well studied.  This study evaluated Adaptive Reproduction as a theory for understanding how environmental stressors and psychoneurological states impact birth outcomes. Two hypotheses were tested: 1) does the impact of stress, depression, tobacco use and social support on adverse birth outcomes vary across the gestation? And 2) does the experience of perinatal intimate partner violence (IPV) affect the timing of the impact of these variables on birth outcomes?

Methods: Multilevel structural equation modeling was performed on data from BabyBEEP (R01 NR05313), a smoking cessation intervention RCT for low-income pregnant women (N=695). Thirty-four percent of the sample experienced perinatal intimate partner violence.

Results: Both hypotheses were supported by the analysis.  When controlling for the other variables, stress and social support have paradoxical effects at different stages of pregnancy. In women experiencing perinatal IPV, depression, particularly prior to 24 weeks, is associated with both low birthweight and preterm birth.

Conclusion: Adaptive reproduction provides a plausible explanation for why psychoneuroimmune alterations lead to preterm birth and low birthweight.  This explains how community and individual level preconceptional and prenatal interventions aimed at enhancing functional social support and stress resilience improve outcomes and suggests modifications in timing of the interventions for enhanced effects.

Learning Areas:

Basic medical science applied in public health
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related nursing
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss how placental maturation and epigenetics play a part in determining whether a psychosocial stimulus such as stress or social support has a protective or toxic effect on length of gestation and/or birth weight.

Keyword(s): Perinatal Health, Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a certified nurse midwife with 20 years experience in prenatal care and training in advanced quantitative methods including multilevel modeling and structural equation modeling. I am currently coordinating research on the impact of home visiting on the psychosocial health of pregnant adolescents, and on intimate partner violence interventions in pregnancy. Placental cell signaling and epigenetics are particular areas of interest for me.
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.