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http://hdl.handle.net/11375/17347
Title: | Prenatal Maternal Stress and Preterm Birth: A Life Course Perspective |
Authors: | Kingston, Dawn A. |
Advisor: | Sword, Wendy |
Department: | Nursing |
Keywords: | nursing, stress, preterm, prenatal, maternal, birth |
Publication Date: | Nov-2009 |
Abstract: | BACKGROUND: Prenatal maternal stress has been implicated in having a role in adverse health outcomes across the life span. Despite its potentially pervasive effects and population health significance, research examining the determinants of prenatal maternal stress is limited and inconclusive. One particularly intractable outcome, preterm birth, has shown inconsistent associations with prenatal maternal stress. In addition, few measures of childhood perceived stress and perceived stress in pregnancy exist. OBJECTIVE: The purpose of these papers is to: present the theoretical foundation, conceptualization, and evidence base for the Life Course Stress and Preterm Birth Model; test and refine the Life Course Stress and Preterm Birth Model by evaluating the fit of the proposed model of stressors related to socioeconomic position (SEP) and family environment during childhood and pregnancy, perceived stress in pregnancy, and preterm birth; and conceptualize and measure perceived stress in pregnancy and childhood perceived stress, and to evaluate the validity and reliability of these two measures. METHOD: We used a prospective cohort design to collect data for structural equation analysis. All women who attended pre-birth clinics at two hospitals in different communities in south-western Ontario were invited to participate; women (N = 421) completed questionnaires following their pre-birth clinic visit. RESULTS: The mean gestational age at the time of questionnaire completion was 28.2 (SD = 5.3) weeks. Questionnaire return rate was 74%. Perceived childhood stress was moderately associated with perceived stress in pregnancy(β= .54). Adult subjective SEP had a moderate effect on stress-reduction in pregnancy (β = -.44). The main influence of childhood subjective SEP on prenatal stress was indirect by increasing adult subjective SEP and reducing childhood stress. Family cohesion in childhood and pregnancy had small, direct effects on prenatal stress, but played a greater role in increasing subjective SEP and adult family cohesion and reducing stress in childhood. Findings related to our stress measurement analysis demonstrated that perceived childhood stress and prenatal maternal stress were each conceptualized as a single, latent variable. The childhood perceived stress measure was comprised of one item related to perceived family stress and three global perceived stress items. The construct of perceived stress in pregnancy differed from childhood. Perceived stress in pregnancy encompassed items of perceived financial and family stress and global measures of recent and more distant past perceived stress, suggesting that it reflected chronic stress. Initial analyses provide evidence of reliability and validity in this sample. CONCLUSIONS: Perceived childhood stress had a persistent effect on stress in pregnancy after adjustment for other child and adult factors. Childhood factors played important direct and indirect roles on stress in pregnancy. Adult subjective SEP constituted the main adult contribution. The childhood and pregnancy measures of perceived stress contribute to our understanding of the construct of perceived childhood and prenatal maternal stress and inform the timing and nature of effective prevention and intervention approaches. The Life Course Model of Stress and Preterm Birth can be used as a framework to (a) direct clinical risk assessment, (b) guide research on preconception psychosocial influences on perinatal health, (c) direct perinatal surveillance approaches, (d) influence policy and program development to include determinants of perinatal health across the life course, and (e) inform population health approaches to preconception and prenatal care. |
URI: | http://hdl.handle.net/11375/17347 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Kingston_Dawn_A_2009Nov_PhD.pdf | 13.51 MB | Adobe PDF | View/Open |
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