Stress in African American pregnancies: Testing the roles of various stress concepts in prediction of birth outcomes

Background: The persistently higher rates of adverse birth outcomes among African American women are a major public health concern. Purpose: The purpose of this study was to explore the relations among psychosocial stress, socioeconomic status, and birth outcomes in African American women. Methods: A prospective survey research design was used to measure stress exposure, subjective responses to stressors, including intrusive effects of life events, and medical and sociodemographic variables in a sample of 178 pregnant African American women. Birth outcomes were obtained from medical charts. Results: Life event exposure was high, but levels of perceived stress and negative emotional responses were low to moderate. Lower income African American women reported significantly greater pregnancy undesirability than higher income African American women. Educational attainment was not related to any of the stress variables, and neither income nor educational attainment was significantly related to birth outcomes. Number of stressful life events significantly predicted 3% additional variance in gestational age after controlling for potential confounders. Psychosocial stress variables altogether accounted for 7% additional variance in gestational age-adjusted birth weight, with event distress and intrusive thoughts concerning severe life events emerging as the significant independent stress predictors. Conclusions: These results contribute to our understanding of the complex etiological processes involved in African American birth outcomes and set the stage for further research into their reproductive health status.