Racial and ethnic disparities in preterm birth: The role of stressful life events☆

Abstract 

Objective

The purpose of this study was to examine racial-ethnic disparities in stressful life events before and during pregnancy and to assess the relationship between stressful life events and racial-ethnic disparities in preterm birth.

Study design

Using data from the Pregnancy Risk Assessment Monitoring System, we conducted a retrospective cohort analysis of a sample of 33,542 women from 19 states who were delivered of a live-born infant in 2000. Principal component analysis was used to group 13 stressful life events into 4 stress constructs: emotional, financial, partner-related, and traumatic. Racial-ethnic disparities in stressful life events were assessed with the use of bivariate and multivariate regression analyses. The contribution of stressful life events to racial-ethnic disparities in preterm birth was evaluated with the use of stepwise regression model and interaction terms.

Results

Black women and American Indian/Alaska Native women reported the highest number of stressful life events in the 12 months before delivery. Compared with non-Hispanic white women, black women were 24% more likely to report emotional stressors, 35% more likely to report financial stressors, 163% more likely to report partner-related stressors, and 83% more likely to report traumatic stressors. The addition of stress constructs to the stepwise regression model minimally affected the association between race-ethnicity and preterm birth, and none of the stress constructs were significantly associated with preterm birth. There were no significant interaction effects between race-ethnicity and stress on preterm birth, except for a modest effect between black race and traumatic stressors.

Conclusion

There are significant racial-ethnic disparities in the experience of stressful life events before and during pregnancy. Stressful life events do not appear to contribute significantly to racial-ethnic disparities in preterm birth.

Keywords:  Preterm birth, Racial-ethnic disparity, Stressful life event