The proposed study is a theory-based, prospective, longitudinal investigation of the contributing role of prenatal maternal stress in adverse birth outcomes, particularly low birthweight and preterm delivery. The major aims of the study are to identify behavioral mediators of prenatal stress effects; interactions between stress, sociodemographic variables, and medical risk; and effects of dispositional characteristics on adverse birth outcomes based on stress and coping theory and biopsychosocial models of health and illness. Specific hypotheses will be tested using structural equations modeling procedures. Derived from studies of stress in other populations, the primary hypothesis is that adverse consequences of prenatal stress result in part from their impact on coping and health behavior during pregnancy. Two types of interactive effects are hypothesized. Medical risk and minority racial status are hypothesized to exacerbate the effects of maternal stress on birth outcomes, whereas income and education are expected to attenuate these effects by providing women with cognitive, emotional, and material coping resources. Research in related domains bolsters the final hypothesis that dispositional variables indirectly influence adverse birth outcomes via their effects on prenatal stress response, coping, and health behaviors. Stress will be assessed from multiple indicators of stressors and stress response across the course of pregnancy. The study will be conducted over a five- year period with women who receive prenatal care at the Stony Brook University Hospital. The projected sample of 864 will include overlapping sub-groups of approximately 300 medically high risk subjects, 432 socioeconomically disadvantaged subjects, 168 African-Americans, and 104 Latinas. Data will be collected from three prenatal interviews, one postpartum interview, and medical records. Interviews contain standard measures and measures designed for the study to assess stressors and stress response, dispositional factors, coping, health behaviors, and social support. Information on medical risk and birth outcomes will be abstracted from medical charts.
