Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis

Abstract

Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Using path analysis, we examined associations between multiple selfreported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N = 510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2 nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI] = 1.60, 5.85) and 2.67 (95% CI = 1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β = 1.63, 95% CI = 0.29, 3.07; β = 1.48, 95% CI = 0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.

Associations of Maternal Stress, Prenatal Exposure to Per- and Polyfluoroalkyl Substances (PFAS), and Demographic Risk Factors with Birth Outcomes and Offspring Neurodevelopment: An Overview of the ECHO.CA.IL Prospective Birth Cohorts

“…For example, Black women are more likely to experience higher levels of discrimination, poorer neighborhood quality, and more stressful life events relative to white women [ 20 ]. Furthermore, these stressors are risk factors for prenatal depression [ 21 ], which is associated with adverse birth outcomes [ 22 ]. A recent meta-analysis also found that stressors can lead to adverse neurodevelopmental outcomes [ 23 ].…”

Prenatal Exposure to Favorable Social and Environmental Neighborhood Conditions Is Associated with Healthy Pregnancy and Infant Outcomes

“…Maternal health during pregnancy may be one way in which neighborhood conditions become biologically embedded to affect infant outcomes. Several studies have shown that prenatal depression [ 13 ], diet [ 14 , 15 ], smoking [ 16 ], body mass and weight gain [ 17 , 18 , 19 ], and pregnancy morbidities [ 8 ] can influence birth outcomes, with some evidence that these factors may mediate associations between neighborhood conditions and birth outcomes [ 20 , 21 , 22 , 23 ]. However, research evaluating links between neighborhood conditions, maternal health, and birth outcomes has tended to focus on singular aspects of the neighborhood context (e.g., either socioeconomic or environmental conditions) or a single type of mediator (e.g., pregnancy conditions versus depression).…”

Prevalence, associated factors and perinatal outcomes of antepartum depression in Ibadan Nigeria

“…Actually, perceived stress had a dose–response association with APD which suggests causality. The causal relationship between stress and depression has been reported by researchers [ 38 – 41 ]. Perceived stress during pregnancy could result from low socio-economic status, financial distress particularly the difficulty with meeting basic needs such as food and shelter, lack of social and family support, marital dysfunction and conflict [ 41 , 42 ].…”

“…The causal relationship between stress and depression has been reported by researchers [ 38 – 41 ]. Perceived stress during pregnancy could result from low socio-economic status, financial distress particularly the difficulty with meeting basic needs such as food and shelter, lack of social and family support, marital dysfunction and conflict [ 41 , 42 ]. These factors, together with other early life stressors as physical, sexual and psychological maltreatment could contribute to maternal depression during pregnancy [ 42 ].…”