Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys
- 782 Downloads
We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01–2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.
KeywordsFinancial stress Life event stressor Low birth weight Multilevel analysis Racial disparity
The authors would like to acknowledge with sincere appreciation the Los Angeles Mommy and Baby (LAMB) survey study team (Diana Liu, Marian Eldahaby, Carmen Gutierrez, Yeghishe Nazinyan, Rozana Ceballos, Judith Zarate) for their dedicated work in the design and implementation of the 2007 and 2010 LAMB projects. The authors also wish to thank Ms. Louise Rollin_Alamilo from the Office of Health Assessment and Epidemiology in Los Angeles County Department of Public Health, for computing and sharing the Economic Hardship Index. The LAMB project was made possible by the Health Resources and Services Administration (HRSA) Grant #R40MC06635, the Los Angeles County Productivity and Investment fund, and the Los Angeles County Department of Maternal, Child and Adolescent Health (MCAH) Programs general grants. One author also received funding support from the Epi Scholars Program at Los Angeles County Department of Public Health to work on this project.
Conflict of interest
The authors have no conflicts of interest to disclose.
- 5.Federal Interagency Forum on Child and Family Statistics. Preterm birth and low birthweight [Cited 2013 Aug 10]. http://www.childstats.gov/americaschildren/health1.asp
- 7.McIntosh, L. J., Roumayah, E. N., & Bottoms, S. F. (1995). Perinatal outcome of broken marriage in the inner city. International Journal of Gynecology and Obstetrics, 51(5), 368–375.Google Scholar
- 17.Wadhwa, P. D., Sandman, C. A., Porto, M., Dunkel-Schetter, C., & Garite, T. J. (1993). The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. American Journal of Obstetrics and Gynecology, 169(4), 858–865.CrossRefPubMedGoogle Scholar
- 20.Brown, S. J., Yelland, J. S., Sutherland, G. A., Baghurst, P. A., & Robinson, J. S. (2011). Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care. BMC Public Health, 11, 196.PubMedCentralCrossRefPubMedGoogle Scholar
- 33.Brawarsky, P., Stotland, N. E., Jackson, R. A., Fuentes-Afflick, E., Escobar, G. J., Rubashkin, N., & Haas, J. S. (2005). Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. International Journal of Gynaecology and Obstetrics, 91(2), 125–131.CrossRefPubMedGoogle Scholar
- 35.Institute of Medicine (US). (2011). Committee on Leading Health Indicators for Healthy People 2020. Leading Health Indicators for Healthy People 2020: Letter Report. Washington (DC): National Academies Press (US).Google Scholar
- 37.Nathan, R. P., & Adams, C. F, Jr. (1989). Four perspectives on urban hardship. Political Science Quarterly, 104, 482–508.Google Scholar
- 38.Montiel, L. M., Nathan, R. P., & Wright, D. J. (2004). An update on urban hardship. Albany NY: The Nelson A. Rockefeller Institute of Government.Google Scholar
- 41.The RAND Corporation. The Los Angeles Family and Neighborhood Survey: L.A.FANS-1 Questionnaires. [Cited 2013 Aug 10]. http://lasurvey.rand.org/documentation/questionnaires/
- 42.Institute of Medicine and National Research Council. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): The National Academies Press.Google Scholar
- 47.Oklahoma State Department of Health. (2009). Stressors, social support and pregnancy outcomes among African American and White mothers. PRAMSgram: Oklahoma pregnancy risk assessment monitoring. System, 13, 2.Google Scholar