The proposed research is a prospective, epidemiologic study of the relationship between life stress and preterm birth among low-income, urban black women. The purpose of this study is to define the risk of preterm birth associated with pre- and post-conception life changes and their perceived adequacy of emotional support during pregnancy, while controlling for the effects of other physical, demographic, and health behavior variables. Drawing from a population who experiences approximately 18% term birth, this ongoing investigation has collected data from 600 women. Questionnaires were completed about the timing, nature, and numbers of pre- and post-conception life changes and women were interviewed about the perceived adequacy. sources, and satisfaction with emotional support during pregnancy. All women delivered at the same urban, teaching hospital. Women were identified and recruited for study at registration at one of two local prenatal clinics. Interviews were conducted during early and mid pregnancy, and once after delivery. Women with limited or no prenatal care were recruited and interviewed at delivery. Demographic, obstetrical, health behavior, and delivery data were collected through a hospital data base, and will be linked to interview data for study analysis. Using standard parametric and categorical statistical methods, the proposed study will specifically explore if pre-conception life change predicts post-conception life change and other mediating risk factors for preterm birth, and if those risks change in the presence of various levels of emotional support. Another aim is to test for differences in negative health behavior and pregnancy complications in each trimester of pregnancy among women reporting varying combinations of life change and emotional support. Through careful design and large sample size this investigation addresses some of the methodological weaknesses of previous research. The study of effects of timing and severity of life change on a single birth outcome provides insight to the potential causal relationship between life stress and pregnancy outcome. In addition, this study provides information on women who because of race, poverty level income, and inadequate prenatal care are at significant risk for early delivery.
