Racial and ethnic disparities in preterm birth: the role of stressful life events.
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.


METHODS
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.


CONCLUSIONS
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.
Lu
Michael C
MC
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, Calif, USA. mclu@ucla.edu
Chen
Belinda
B
D000328:Adult; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D004644:Emotions; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007234:Infant, Premature; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D011247:Pregnancy; D044469:Racial Groups; D012044:Regression Analysis; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology