The aim of this study is to examine physical and psychosocial stressors related to the risk of low birth weight (LBW) in a sample of predominantly low income women in a small city in Alabama. Alabama continues to experience unacceptably high rates of LBW and related problems (infant mortality). In prior research, a variety of factors, including parity, low maternal weight gain, prior experience of poor pregnancy outcomes,, poor prenatal care, as well as other variables, have been used to predict the risk of LBW. Similarly, psychosocial risks, such as stressful life events and depression, have been examined. While many of these variables do explain the risk of LBW in part, there still remain unknown etiologic factors, including a high degree of suspicion with respect to psychosocial factors. In this study, the risk of LBW will be systematically investigated using a model of the psychosocial and physical work strain to which women are exposed in pregnancy, while statistically covarying other known risk factors. Work strain refers to a discrepancy between the demands placed on a woman in her work, and the degree of control she can exercise in responding to those demands. Demands include both psychosocial and physical demands. Work strain has been shown to be a significant risk factor in cardiovascular disease for males; in ethnographic research with pregnant women in the study community, this concept was found to have general applicability both to women, and to the major work sites of women: in paid employment outside of the home, and in work inside the home. Women are variably able to exercise control over the physical and psychosocial demands inherent in these settings, even during pregnancy. It is hypothesized that this kind of work strain is extremely stressful for women and can lead to increased risk of LBW. Additionally, it is hypothesized that access to generalized social support can help to moderate or buffer the work strain to which women are exposed. This model will be investigated prospectively, following women from their initiation of prenatal care through to delivery. A sample of 900 women will be recruited from three clinics providing prenatal care to low income women in the study community. These women will be interviewed in each trimester regarding the level of work strain and available social support. Possible covariates will be collected through interviews and chart reviews. The contribution of these factors to the risk of LBW (determined by chart audit) will be assessed using multiple logistic regression.
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