A Multidimensional Approach to Characterizing Psychosocial Health During Pregnancy.
Objectives Domains of psychosocial health have been separately connected to pregnancy outcomes. This study explores the relationship between five domains of psychosocial health and their joint association with prenatal health and pregnancy outcomes. Methods Women from a prospective cohort study in Durham, North Carolina were clustered based on measures of paternal support, perceived stress, social support, depression, and self-efficacy. Clusters were constructed using the K-means algorithm. We examined associations between psychosocial health and maternal health correlates, pregnancy intention, and pregnancy outcomes using Chi square tests and multivariable models. Results Three psychosocial health profiles were identified, with the first (Resilient; n = 509) characterized by low depression and perceived stress and high interpersonal support, paternal support, and self-efficacy. The second profile (Vulnerable; n = 278) was marked by high depression and perceived stress, and low interpersonal support, paternal support, and self-efficacy. The third profile (Moderate, n = 526) fell between the other profiles on all domains. Health correlates, pregnancy intention, and pregnancy outcomes varied significantly across profiles. Women with the vulnerable profile were more likely to have risky health correlates, have an unintended pregnancy, and deliver preterm. Women with the resilient profile had better birth outcomes and fewer deleterious health correlates, preconception and prenatally. Conclusions We posit that vulnerable psychosocial health, deleterious health correlates, and the stress which often accompanies pregnancy may interact to magnify risk during pregnancy. Identifying and intervening with women experiencing vulnerable psychosocial health may improve outcomes for women and their children.
Children's Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, 440 Church Street, Ann Arbor, MI, 48109, USA. pm12@duke.edu.
Pamela J
PJ
Maxson
Children's Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, 440 Church Street, Ann Arbor, MI, 48109, USA.
Sharon E
SE
Edwards
Children's Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, 440 Church Street, Ann Arbor, MI, 48109, USA.
Ellis M
EM
Valentiner
Children's Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, 440 Church Street, Ann Arbor, MI, 48109, USA.|Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.|Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Marie Lynn
ML
Miranda
D000328:Adult; D016000:Cluster Analysis; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015438:Health Behavior; D006801:Humans; D033182:Intention; D009657:North Carolina; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D011256:Pregnancy Outcome / Q000523:psychology*; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011275:Pregnancy, Unwanted / Q000523:psychology; D037841:Pregnant People / Q000523:psychology*; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology
Cluster analysis; Pregnancy outcomes; Prenatal health; Psychosocial health