142nd APHA Annual Meeting and Exposition

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Infant Birth Weight in the United States: The Role of Preconception Stressful Life Events and Poor Health Behaviors

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 11:10 AM - 11:30 AM

Whitney P. Witt, PhD, MPH , Truven Health Analytics, Bethesda, MD
Kara Mandell, MA , Department of Population Health, University of Wisconsin-Madison, Madison, WI
Lauren Wisk, PhD , Department of Population Medicine, Center for Child Health Care Studies, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
Erika Cheng, PhD, MPA , Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital for Children, Boston, MA
Debanjana Chatterjee, MA , Population Health Sciences, University of Wisconsin Madison, Madison, WI
Fathima Wakeel, PhD, MPH , Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
Hyojun Park, MA , Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
Dakota Zarak , of Wisconsin School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI
Audio (mp3) recording Recorded Presentation (mp4)
Background: The goal of this study was to determine the relationships among preconception stressful life events (PSLEs), women’s use of alcohol and tobacco prior to and during pregnancy, and infant birth weight.

Methods: Data were from the Early Childhood Longitudinal Study-Birth Cohort (n=9,350). Survey data determined women’s exposure to any PSLEs (death of a parent, spouse, or previous child, divorce or marital separation, or fertility problems) and alcohol and tobacco use prior to and during pregnancy. Multivariable logistic regression models were used to determine the effect of alcohol and tobacco use and PSLEs on the risk of having a very low (<1,500 grams, VLBW) or low (1,500-2,499 grams, LBW) birth weight infant, adjusting for relevant confounders.

Principal Findings: Women who experienced any PSLE were more likely to give birth to VLBW infants (adjusted odds ratio [AOR]: 1.35; 95% CI: 1.10-1.66) than women who did not experience any PSLE. Compared to women who never smoked, women who used tobacco prior to conception (AOR: 1.31; 95% CI: 1.04-1.66) or during their last trimester (AOR: 1.98; 95% CI: 1.56-2.52) were more likely to give birth to LBW infants, independent of PSLEs.

Conclusions: PSLEs and maternal smoking before and during pregnancy are independent risk factors for having a LBW baby, and may affect infant birth weight through different pathways.  Interventions to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women’s exposure to stress over the life course and prevent poor health behaviors.

Learning Areas:

Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss the relationships between stressful life events prior to conception, alcohol and tobacco use prior to and during pregnancy, and the risk for having a low or very low birth weight infant. Discuss programmatic and policy implications of our findings.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple federally funded grants focusing on the maternal and child health. Among my scientific interests has been the application of the life course approach to understanding the social, behavioral, and psychological factors that contribute to human development and disparities in health and healthcare in women, children, and families.
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: 4149.0: Improving Pregnancy Outcomes: Psychosocial Influences on Birth Outcomes