Examining the inter-correlated effects of low income, life stress, and race on birth outcomes: A representative state study

Abstract

Programming of the stress response system during gestation has lifelong effects that put the infant at risk for multiple stress-related pathologies. Populations most vulnerable to prenatal stress are African-Americans and individuals of low socioeconomic status. The Pregnancy Risk Assessment Monitoring System (PRAMS) research project, a collaboration between the Centers for Disease Control and Prevention and individual state health departments, was employed for this study. Tennessee data from 2009 were compiled from individual birth certificates and PRAMS questionnaire responses to examine the influence of maternal stressors, race and low income on birth outcomes. The number of stressors was only a significant predictor of having an infant small for gestational age when moderated by Medicaid status. Medicaid status was a positive predictor of both problematic birth and preterm delivery, but did not predict small or large for gestational age. The relationship between race and birth outcomes overall was moderated by age, with young African-American mothers less likely than European-Americans and older African-American mothers to have adverse birth outcomes.

Different levels of associations between medical co-morbidities and preterm birth outcomes among racial/ethnic women enrolled in Medicaid 2014–2015: retrospective analysis

“…In addition, the dataset did not provide socioeconomic information such as marital status, employment status, or education level. We may assume that women enrolled in Medicaid are likely to share certain sets of socioeconomic characteristics, such as low-income status [12,13,18,19]. However, future research should include ways to categorize pregnant women enrolled in Medicaid, considering risky behaviors, daily lifestyle, and social support elements.…”

“…As race/ethnicity is interwoven with multiple social, economic, and cultural issues, however, the precise cause of this disparity is not clearly known. Social determinants of health, such as maternal educational level, family income, housing situation, partner support as well as community factors can also play an important role in accounting for these disparities in preterm birth outcomes [1,[12][13][14][15].…”

“…Enrollment in Medicaid, which covers nearly half of all births in the United States, is itself an independent predictor of preterm delivery [12,13,[16][17][18][19]. Medicaid beneficiaries share common characteristics, such as lower income and health literacy, among other risk factors, which in turn impact their overall health, lifestyle, and access to and utilization of prenatal health services and birth outcomes [12,13,16,18]. The percentage of Medicaid-enrolled pregnant women who received more than 80% of the expected number of prenatal visits ranged from 1 to 85% with considerable geographic variation across states [10,20].…”

Examining the Association Between Parental Socioeconomic Status and Preterm Birth Using Multidomain Social Determinants Scale in a Tertiary Care Center in Saudi Arabia

“…Previous studies were conducted to investigate the effect of SES on prematurity. Some of these studies showed an association, while others did not [ 5 - 7 ]. These contrasting results may be explained by the differences in predictors and measurements used in each study.…”

The influence of mindfulness and social support on stress reactivity during pregnancy

“…Although pregnancy can be a joyous moment in a woman's life, it may also induce a great amount of stress, leading to a number of negative health consequences for mothers and their infants. For instance, recent systematic reviews and meta‐analyses have shown pregnancy‐specific stressors (e.g., concerns about baby's health) and other stressors during this time period (e.g., finances and lack of support) to be significant predictors of maternal depressive symptoms (Yim, Tanner Stapleton, Guardino, Hahn‐Holbrook, & Dunkel‐Schetter, ), premature births, low birthweight, and long‐term problems in infant emotional and behavioural development (Bussières et al, ; Graignic‐Philippe, Dayan, Chokron, Jacquet, & Tordjman, ), with low‐income women being at greater risk for these adverse health outcomes (Lefmann, Combs‐Orme, & Orme, ; Reynolds, Labad, Buss, Ghaemmaghami, & Räikkönen, ). To better understand how prenatal stress impacts health, studies that examine women's responses to stressors during pregnancy are needed.…”