Short-term, retrospective, cross-sectional studies set in western countries have discovered a pattern of pregnancy disruption associated with stressful events. Incidences of spontaneous abortions, stillbirths, low birth weights and premature delivery have all been quantitatively associated with increased maternal stress. Little is known, however, about how disparities in the social status of non-western women can impact pregnancy outcomes and resultant infant health. The objective of the proposed research is to determine the association of social status and chronic psychosocial stress on spontaneous abortion, gestation length and neonate body size. This longitudinal, prospective, biocultural study measures psychosocial stress in women prior to conception, through pregnancy and concludes with a postpartum follow-up on the health of their infants. Early pregnancy loss will be determined using fertility monitors and urine based pregnancy tests. Two interrelated indicators of psychosocial stress, Epstein-Barr virus (EBV) antibody concentration and status incongruence, will be used to assess the effects of stress on pregnancy outcomes of 108 women on the American Samoan island of Tutuila. Fingertip dried blood spots are collected from mothers prior to and throughout the course of their pregnancy and analyzed for EBV and C-reaction protein levels (CRP). CRP levels detect infection and are then used to control EBV levels. Combined with interviews and maternal and infant anthropometrics, these techniques make it possible to identify the impact of psychosocial stress on all stages of pregnancy and to assess the role of maternal stress on health outcomes of infants.
These data provide an opportunity to assess pregnancy outcomes in terms of psychosocial stress over the course of gestation and information regarding a specific type of psychosocial stress on pregnancy. Data from this study provides insight into pregnancy loss, the least well understood component of reproduction. Additionally, the co-PI is participating in community outreach and education programs for girls and women in Tutuilla.
Introduction and Intellectual Merit The objective of this research is to determine the relationship between chronic maternal psychosocial stress on spontaneous abortion, gestation length and neonate body size. In order to achieve this goal, we conducted a biocultural, longitudinal, prospective study of pregnancy outcomes in 184 women experiencing significant shifts in cultural identity in American Samoa. Two interrelated indicators of psychosocial stress, Epstein-Barr virus (EBV) antibody concentration and status incongruence, were paired with monthly stress questionnaires and the perceived stress scale to assess the effects of stress on pregnancy outcomes. EBV antibody concentrations represent a broad, non-specific response to psychosocial stressors. Status congruence is related to a woman’s status within the community and her ability to resolve traditional and nontraditional markers of status. The monthly stress questionnaire provides a culturally specific measure of stress while the perceived stress scale provides a global measure of psychosocial stress. The study followed women from their first prenatal care appointment through to their pregnancy’s natural conclusion to help clarify the effects of psychosocial stress on pregnancy outcomes. Pregnancy outcomes will be assessed in terms of spontaneous abortions, preterm births (≤ 36 weeks) and neonate size for gestational age in full term births. This study aims to add to our knowledge of the factors associated with pregnancy loss, premature delivery and infants born small-for-gestational-age in a non-western population of women. Fieldwork was conducted from October 2010 to June 2012 on the American Samoan island of Tutuila. Research permission was gained from the Department of Health in American Samoa (OHRP Federalwide Assurance #: 00001749) and the University of Colorado (OHRP Federalwide Assurance #: 00003492). Preliminary Results The key focus of this study, the impact of maternal psychosocial stress (measured by EBV antibody levels and status incongruence on pregnancy outcomes is still under analysis. However, preliminary analysis of the relationship between stress measures indicate that there is a weak relationship between the monthly stress questionnaire and the perceived stress scale (p≤0.001, r2=0.129). There is no relationship between status congruence and the monthly stress questionnaire or perceived stress scale. Analysis of EBV antibody levels and pregnancy outcomes is currently in process. While in American Samoa we conducted a complementary study that included an inclusive medical chart review of women of Polynesian decent who delivered between October 2010 and October 2011. These women were identified from the Labor and Delivery Ward Log Book and follow-up data were collected from the patient charts. These data focused on maternal characteristics, prenatal care utilization, medical interventions and neonate outcomes. A total of 970 women were included in this supplemental study. Preliminary results indicate that married women sought prenatal care earlier, attended more prenatal care appointments and were more likely to have adequate prenatal care compared to unmarried women. Although married women were less likely to receive an episiotomy or have an operative vaginal delivery, there was no difference in induction rates or type of delivery. The longer gestations and neonates that were heavier with greater heel to crown length, the differences were small and unlikely to be biologically significant. These results suggest that the Samoan tradition of shared family resources and extensive family support beyond the marriage helps reduce the social and financial inequalities that negatively impact pregnancy outcomes in unmarried women in other cultural contexts. Broader Impacts Preliminary results from this study have been disseminated to the community where this data was collected and to the relevant scientific community. While in Samoa our research was featured multiple times on the territory’s main radio station and newspaper. These pieces focused on the purpose of our research and preliminary findings. In addition we presented an in-service for the staff of the American Samoan Department of Health that focused on the impact of psychosocial stress on gestation length and pregnancy outcomes in Samoan women. In 2011 we collaborated with a Samoan doctor to present at a Samoa centered conference at the National University in Apia, Independent Samoa.
