Orr S T, James S A, Miller C A, Barakat B, Daikoku N, Pupkin M, Engstrom K, Huggins G
School of Hygiene and Public Health, Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD 21205, USA.
Am J Prev Med. 1996 Nov-Dec;12(6):459-66.
Low birthweight is a major determinant of infant mortality, as well as a contributor to infant and childhood morbidity. A key issue is how to reduce the incidence of low birthweight in the United States. One emerging factor is exposure to psychosocial stressors. In this research, we evaluated the association between exposure to psychosocial stressors and low birthweight in a population of urban, low-income pregnant women.
Over 2,000 pregnant women 18 years of age and older were enrolled in this prospective study and recruited at their first prenatal care visit. We obtained information on maternal exposure to stressors. After the pregnancy, we abstracted clinical records of each woman enrolled in the study. Logistic regression was used to estimate the adjusted odds ratio for the association between stressor group membership and low birthweight, controlling for the effects of confounding factors.
In logistic regression analyses stratified by race, for African-American women, the following variables were significantly associated with low birthweight: smoking, hypertension, low prepregnancy weight, hospitalization during pregnancy, previous preterm birth, and exposure to stressors. For Caucasian women, significant predictors were: smoking, drug use, hospitalization during pregnancy, hypertension, and previous preterm birth. Exposure to stressors was also significantly associated with many clinical and behavioral risks for low birthweight.
Our results suggest two potential mechanisms for an association between stressors and low birthweight. Exposure to stressors may be indirectly associated with low birthweight through a relationship with clinical and behavioral risks for low birthweight. Exposure to psychosocial stressors may also be directly associated with risk of low birthweight among African-American women.
低出生体重是婴儿死亡率的主要决定因素，也是婴儿及儿童发病的一个原因。一个关键问题是如何降低美国低出生体重的发生率。一个新出现的因素是接触心理社会压力源。在本研究中，我们评估了城市低收入孕妇群体中接触心理社会压力源与低出生体重之间的关联。
2000多名18岁及以上的孕妇参与了这项前瞻性研究，她们在首次产前检查时被招募。我们获取了孕妇接触压力源的信息。妊娠结束后，我们提取了参与研究的每位女性的临床记录。使用逻辑回归来估计压力源分组与低出生体重之间关联的调整优势比，同时控制混杂因素的影响。
在按种族分层的逻辑回归分析中，对于非裔美国女性，以下变量与低出生体重显著相关：吸烟、高血压、孕前体重低、孕期住院、既往早产以及接触压力源。对于白人女性，显著的预测因素有：吸烟、药物使用、孕期住院、高血压以及既往早产。接触压力源也与许多低出生体重的临床和行为风险显著相关。
我们的结果提示了压力源与低出生体重之间关联的两种潜在机制。接触压力源可能通过与低出生体重的临床和行为风险的关系而与低出生体重间接相关。接触心理社会压力源也可能与非裔美国女性低出生体重的风险直接相关。
