Understanding the Association of Biomedical, Psychosocial and Behavioral Risks with Adverse Pregnancy Outcomes Among African-Americans in Washington, DC

Abstract

Objectives This study investigates the relationship between diabetes, hypertension, preeclampsia, and Body Mass Index (BMI) -- the most common and interrelated medical conditions occurring during pregnancy; sociodemographic and behavioral risk factors; and adverse pregnancy outcomes in high-risk urban African American women in Washington, DC. Methods Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: 1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes, 2) identify the relative importance of various predictors of adverse pregnancy outcomes, and 3) characterize women at the highest risk of poor pregnancy outcomes. Results Overall, the strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; and employment was the first splitter for miscarriage. Conclusions Preconceptional factors play a very important role in pregnancy outcomes. For many of these women, the risks that they bring into the pregnancy were more likely to impact their pregnancy outcome than events during pregnancy.

The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review

“…This finding is in line with the literature that explores Black race as one of the most predictive factors for PTB. [54][55][56] In 14 studies, women were assessed on psychological measures more than once and repeated perinatal screening suggests an appreciation that mental health status during pregnancy is not static. It can be argued that measuring depression in early pregnancy may not be an accurate predictor because the development of subsequent depression might go undetected.…”

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

“…[1][2][3][4][5][6] The majority of research has found that between 3% and 9% of women experience abuse during pregnancy, 7,8 though there are well established risk factors that are associated with higher rates of abuse, including young age, single relationship status, minority race/ethnicity, and poverty. 9,10 Indeed, studies conducted among samples of low-income, predominantly single women have noted higher prevalence with rates up to 50%.…”

“I am the worst pregnant woman ever”: A mixed-method study of the nature of psychological distress during pregnancy

“…Specifically, the association of ethnicity to PTB was mediated through lower levels of personal resources, language barriers, economic difficulties, separation from friends and family, racial and neighbourhood discrimination for migrants (Coussons-Read et al, 2012;Rini et al, 1999;Ruiz et al, 2012), which all present an important area for future investigations. This finding is in line with the literature that explores Black race as one of the most predictive factors for PTB (Giurgescu, McFarlin, Lomax, Craddock, & Albrecht, 2011;Graham, Frank, Zyzanski, Kitson, & Reeb, 1992;Kiely et al, 2011). In 14 studies, women were assessed on psychological measures more than once and repeated perinatal screening suggests an appreciation that mental health status during pregnancy is not static.…”