Maternal Stress, Neighborhood Safety, and Pregnancy Outcomes: Findings from the 2010 Los Angeles Mommy and Baby (LAMB) Survey

Objective: Assess the relationship between perceived neighborhood safety, maternal stress, and pregnancy complications.  

Methods:We analyzed data from the 2010 Los Angeles Mommy and Baby Survey, a mailed survey that utilizes a stratified sampling design with telephone follow-up for non-respondents.  A biennial population-based surveillance project modeled after the Pregnancy Risk Assessment Monitoring Study, LAMB asked women to report on stressful events in pregnancy, perceived neighborhood safety, and any pregnancy complications (including gestational diabetes or high blood pressure, early labor, severe nausea, and infections). Cluster analysis grouped 13 stressful life events into 4 constructs: emotional, financial, partner-related, and traumatic stress. Contributions of stress and neighborhood safety to pregnancy complications were evaluated through logistic regression analysis that controlled for maternal age, education, race, marital status, and prenatal care coverage.

Results:Among 6,085 respondents, 37.8% reported stress in two or more stress domains, denoting high stress; 43.6% reported very poor to fair neighborhood safety during pregnancy, and 66.2% reported pregnancy complication(s). Adjusting for confounders, women with high stress were 1.7 times more likely to have a pregnancy complication (95% CI: 1.4-2.0) compared to women with no/low stress. Women rating their neighborhood as unsafe had a higher likelihood of pregnancy complications (aOR=1.2; 95% CI: 1.0-1.5). White mothers were less likely to report pregnancy complications compared to African American mothers (aOR = 0.7; 95% CI: 0.6-0.9).  

Conclusions: Stressful events and low neighborhood safety in pregnancy are associated with adverse pregnancy outcomes. Programmatic and policy interventions to increase maternal resiliency resources among pregnant women are warranted.