Objectives We sought to determine if and to what extent a woman’s exposure to stressful life events prior to conception (PSLEs) were associated with subsequent infant birth weight by using a nationally representative sample of US women. Methods We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study-Birth Cohort in 2001. Weighted regressions estimated the effect of exposure on very low and low birth weight, adjusting for maternal sociodemographic and health factors and stress during pregnancy. Results Twenty percent of women experienced any PSLE. In adjusted analyses, exposed women were 38% more likely to have a very low birth weight infant than nonexposed women. Furthermore, the accumulation of PSLEs was associated with reduced infant birth weight. Conclusions This was the first nationally representative study to our knowledge to investigate the impact of PSLEs on very low and low birth weight in the United States. Interventions aimed to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women’s exposure to stress over the life course and improve the long-term health of children.

Objectives We determined whether and to what extent a woman’s exposure to stressful life events prior to conception (PSLEs) was associated with preterm birth and whether maternal age modified this relationship. Methods We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative sample of US women and children born in 2001, to investigate the impact of PSLEs on preterm birth in the United States. We estimated the effect of exposure on preterm birth with weighted logistic regression, adjusting for maternal sociodemographic and health factors and stress during pregnancy. Results Of the women examined, 10.9% had a preterm birth. In adjusted analyses, women aged 15 to 19 years who experienced any PSLE had over a 4-fold increased risk for having a preterm birth. This association differed on the basis of the timing of the PSLE. Conclusions Findings suggest that adolescence may be a sensitive period for the risk of preterm birth among adolescents exposed to PSLEs. Clinical, programmatic, and policy interventions should address upstream PSLEs, especially for adolescents, to reduce the prevalence of preterm birth and improve maternal and child health.

Objectives This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the United States by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated Cesarean section (C-section). Methods Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n=9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-section. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-section, compared to vaginal delivery. Results 74.2% of women had a vaginal delivery, 11.6% had a non-medically indicated C-section, and 14.2% had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we find salient differences between the risk factors for indicated and non-indicated C-sections. Conclusions Surgical deliveries continue to occur at a high rate in the United States despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.

Objectives Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Methods Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Results Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n=10); three examined stress during both the preconception and pregnancy periods (n=3). Most studies examined the environmental domain (e.g., life events) only (n=9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Conclusions Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.

Purpose Stress during pregnancy is a salient risk factor for adverse obstetric outcomes. Personal capital during pregnancy, defined as internal and social resources that help women cope with or decrease their exposure to stress, may reduce the risk of poor obstetric outcomes. Methods Using data from the 2007 Los Angeles Mommy and Baby (LAMB) survey (N=3,353), we examined the relationships between the balance of stress and personal capital during pregnancy, or the Stress-to-Capital Ratio (SCR), and adverse obstetric outcomes ((i.e., pregnancy complications, preterm birth (PTB), low birthweight (LBW), and small-for-gestational-age (SGA)). Results Women with a higher SCR (i.e. greater stress relative to personal capital during pregnancy) were significantly more likely to experience at least one pregnancy complication, PTB, and lower gestational age, but not LBW or SGA. Accounting for pregnancy complications completely mediated the association between the SCR and PTB. Conclusions Our findings indicate that experiencing greater stress relative to personal capital during pregnancy is associated with an increased risk for pregnancy complications, PTB, and lower gestational age and that pregnancy complications may be a mechanism by which the SCR is related to adverse obstetric outcomes.

Background The lifecourse perspective suggests a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birthweight, and subsequent offspring health, whereby PLSEs are part of a “chains-of-risk” that set children on a certain health pathway. No prior study has examined the link between PSLEs and offspring health in a nationally-representative sample of US mothers and their children. We used longitudinal, nationally-representative data to evaluate the relation between maternal exposure to PSLEs and subsequent measures of infant and toddler health, taking both maternal and obstetric characteristics into account. Methods We examined 6,900 mother-child dyads participating in two waves of the nationally-representative Early Childhood Longitudinal Study-Birth Cohort (n=6,900). Infant and toddler health outcomes assessed at 9 and 24 months included overall health status, special health care needs, and severe health conditions. Adjusted path analyses examined associations between PSLEs, birthweight, and child health outcomes. Results In adjusted analyses, PSLEs increased the risk for very low birthweight (VLBW, <1,500 grams), which, in turn, predicted poor health at both 9 and 24 months of age. Path analyses demonstrated that PSLEs had small indirect effects on children’s subsequent health that operated through VLBW. Conclusion Our analysis suggests a chains-of-risk model in which women’s exposure to PSLEs increases the risk for giving birth to a VLBW infant, which, in turn, adversely affects infant and toddler health. Addressing women’s preconception health may have important downstream benefits for their children, although more research is needed to replicate these findings.

The disproportionate impact of coronavirus disease 2019 (COVID-19) on African American communities necessitates an increased focus on the intersectional roles of racism, stigma, and other social determinants of health in influencing disease and mortality risk. The Weathering Framework is applied to demonstrate the dynamic interrelationships between these factors and to conceptualize COVID-19 as a stressful life event that will have profound health implications over the life course for African Americans. Recommendations for population health research, interventions and policies aimed at reducing COVID-19 incidence and mortality, and mitigation of the long-term impacts of the pandemic on communities of color are discussed.

PURPOSE The purpose of this study was to determine the relationships among preconception stressful life events (PSLEs), women’s alcohol and tobacco use before and during pregnancy, and infant birthweight. METHODS Data were from the Early Childhood Longitudinal Study-Birth Cohort (n=9,350). Data were collected in 2001. Exposure to PSLEs was defined by indications of death of a parent, spouse, or previous live born child; divorce or marital separation; or fertility problems prior to conception. Survey data determined alcohol and tobacco usage during the three months prior to and in the final three months of pregnancy. We used staged multivariable logistic regression to estimate the effects of women’s substance use and PSLEs on the risk of having a very low (<1,500 grams, VLBW) or low (1,500–2,499 grams, LBW) birthweight infant, adjusting for confounders. RESULTS Women who experienced any PSLE were more likely to give birth to VLBW infants (adjusted odds ratio [AOR]: 1.35; 95% confidence interval [CI]: 1.10–1.66) than women who did not experience any PSLE. Compared to women who never smoked, women who smoked prior to conception (AOR: 1.31; 95% CI: 1.04–1.66) or during their last trimester (AOR: 1.98; 95% CI: 1.56–2.52) were more likely to give birth to LBW infants. CONCLUSIONS PSLEs and women’s tobacco use before and during pregnancy are independent risk factors for having a lower birthweight baby. Interventions to improve birth outcomes may need to address women’s health and health behaviors in the preconception period.