title: Factors Associated With High Levels of Perceived Prenatal Stress Among Inner-City Women.
abstract: OBJECTIVE
  To explore the factors associated with high rates of perceived prenatal stress among inner-city women.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  We conducted a secondary analysis of data from 603 inner-city women. In our study, 330 participants (54.7%) self-identified as First Nations, Metis, or First Nations/Metis.
  
  
  METHODS
  Prenatal stress was measured with Cohen's Perceived Stress Scale. A social ecological model provided the theoretical framework for the study, and variables representing all levels of the model were selected for study. Data analyses included t tests to compare women with high stress and low/moderate stress, univariable logistic regression analysis to determine the association of selected factors with maternal stress, and multivariable logistic regression analysis to provide adjusted odds ratios and 95% confidence intervals for the factors.
  
  
  RESULTS
  Of the 603 participants, 17.2% (104) reported high levels of perceived stress, and 82.8% (499) reported low/moderate levels. The high-stress group included a significantly greater proportion of First Nations, Metis, or First Nations/Metis women (76.0%) than the low/moderate-stress group (50.3%). Low rates of self-esteem and social support, residential mobility, abuse before/during pregnancy, and experiencing discrimination were significantly associated with high levels of perceived prenatal stress.
  
  
  CONCLUSIONS
  Our findings demonstrated that factors that influence prenatal stress occur at all levels of the social ecological model. The identified factors are amenable to change, and implications for practice include the need for psychosocial risk assessment, alternative forms of prenatal care, relational care, and advocacy initiatives. A greater understanding of the complex factors associated with high rates of perceived prenatal stress can inform the development of effective interventions for inner-city women.
authors.forename: Kendra L
authors.initials: KL
authors.lastname: Rieger
authors.forename: Maureen I
authors.initials: MI
authors.lastname: Heaman
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D011295:Prenatal Care / Q000523:psychology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012647:Self-Assessment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology
keywords: maternal health services; mental health; pregnancy; prenatal care; psychological; risk factors; stress; urban health; vulnerable populations; women's health