RESUMO
OBJECTIVES: To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness. STUDY DESIGN: Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life. RESULTS: The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness. CONCLUSIONS: In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.
Assuntos
Doenças do Recém-Nascido/etiologia , Infecções/etiologia , Período Pós-Parto , Complicações na Gravidez/psicologia , Estresse Psicológico/complicações , Adolescente , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Infecções/epidemiologia , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estresse Psicológico/psicologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: To evaluate the associations between 3 prenatal stress exposures and rapid infant weight gain. STUDY DESIGN: Participants were 162 maternal-child dyads drawn from a nonrandomized controlled trial evaluating a prenatal intervention for reducing women's stress and excessive gestational weight gain and subsequent longitudinal observational study of offspring outcomes. Participants were predominantly low-income and racial or ethnic minorities, and mothers were overweight or obese prepregnancy. Primary exposures were objective stress exposures (number of stressful life events) and subjective distress (maternal perceived stress and depressive symptoms) during pregnancy. The primary outcome was rapid infant weight gain from birth to 6 months, assessed via birth records and in-person anthropometry measurements. RESULTS: In total, 28% of the sample (N = 40) met criteria for rapid infant weight gain. In adjusted models, exposure to prenatal stressful life events was associated with increased odds of rapid infant weight gain (OR 1.40, 95% CI 1.07-1.83, P = .014). Neither prenatal perceived stress (OR 0.47, 95% CI 0.16-1.37, P = .17) nor depressive symptoms (OR 0.89, 95% CI 0.76-1.03, P = .13) were significantly associated with rapid infant weight gain. CONCLUSIONS: Each additional stressful life event a woman experienced during pregnancy was associated with 40% greater odds of rapid infant weight gain. Future research should evaluate whether prenatal interventions that focus on reducing exposure to stressful events prevent rapid infant weight gain.
Assuntos
Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estresse Psicológico/epidemiologia , Aumento de Peso , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Fatores de TempoRESUMO
BACKGROUND: A positive association of socioeconomic position and health is well established in high-income countries. In poorer nations, however, higher income individuals often have more cardiovascular risk factors (including obesity) than do those with less income. Our study goal was to estimate the effects of receiving a living wage (340% higher income) on short-term changes in consumption and cardiovascular risk factors among low-wage workers in a middle-income country. METHODS: This cross-sectional study matched workers at an apparel factory (n=105) in the Dominican Republic with those at a similar factory (n=99) nearby, 15 months after the intervention factory introduced a substantially higher living wage. Statistical matching on non-time varying individual characteristics (childhood health, childhood living conditions, work experience, demographic factors) strengthened causal inference. Primary outcomes were blood pressure (systolic and diastolic), pulse rate, body mass index and waist circumference. Secondary outcomes were dietary consumption and spending on services, consumables and durable goods. RESULTS: Receiving the living wage was associated with increased consumption of protein, dairy, soda and juice and sugars, but not with cardiovascular risk factors. Intervention factory workers spent more on grocery items and household durable goods. CONCLUSIONS: While having a higher income in a middle-income country might be expected to increase obesity and its associated health risks, the current study found no short-term negative associations. There may be possible longer-term negative health consequences of increases in consumption of soda, juice and sugars, however. It is important to consider complementary interventions to support healthy dietary intake in areas with increasing wages.
Assuntos
Doenças Cardiovasculares/epidemiologia , Dieta/estatística & dados numéricos , Saúde Ocupacional , Setor Privado , Salários e Benefícios , Adulto , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Fatores SocioeconômicosRESUMO
This study examines the shape of social class gradients for substance use among Mexican adolescents. Substance use and objective and subjective indicators of social class were assessed in house-to-house surveys conducted with 7614 Mexican adolescents in 2004. The sample was designed to be representative of the poorest urban communities in seven Mexican states. The prevalence of current smoking was 16.8%, alcohol consumption was 30.2%, and drug use was 4.6%. Multiple logistic regressions are used to estimate the associations of objective indicators of socioeconomic status (SES) and subjective social status (SSS)-at both community and societal levels-and smoking, alcohol and drug use. Adolescents who perceived themselves as higher in social status in reference to their local community reported more smoking and drinking. Our findings were similar when we used objective measures of SES, such as maternal education and total monthly household expenditures per person. In contrast, adolescents who perceived that they had high social standing in reference to Mexican society as a whole were less likely to report being current smokers and drinkers. We found no significant association between social status and drug use. Research into how adolescents perceive themselves in reference to their peer communities may help strengthen programs and policies aimed at promoting health in vulnerable adolescent populations.
Assuntos
Comportamento do Adolescente/psicologia , Classe Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Escolaridade , Características da Família , Feminino , Humanos , Masculino , México/epidemiologia , Áreas de Pobreza , Fumar/economia , Fumar/epidemiologia , Fumar/psicologia , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Saúde da População Urbana/estatística & dados numéricosRESUMO
OBJECTIVE: The purpose of this study was to examine the association between depressive symptoms and salivary cortisol responses to stress in a high-risk population of very poor Mexican women. METHODS: Adult women (N = 1109) between the ages of 18 and 44 years (mean age, 29) were identified in a house-to-house survey in low-income areas (income <20th percentile nationally) of urban Mexico. An interview containing the Spanish version of the Center for Epidemiologic Studies--Depression Scale (CES-D) was administered to all women. The naturalistic stressor was defined as the unexpected arrival of a team of researchers at the participants' homes followed by an in-depth interview and physical assessment, with saliva samples taken at time of arrival (baseline), 25 minutes, and 50 minutes after arrival. RESULTS: The mean CES-D score was 19.42 (range, 0-53). Results of hierarchical linear modeling analyses revealed no effect of depressive symptoms on baseline salivary cortisol levels. However, a significant depressive symptom by time interaction revealed that women with elevations in depressive symptoms (CES-D scores = 35) failed to exhibit a cortisol response to the stressor. In contrast, in women with lower CES-D scores, cortisol levels significantly increased in response to the stressor. CONCLUSION: Consistent with research on individuals with major depressive disorder, results of this study demonstrate that women with very high levels of depressive symptoms exhibit blunted cortisol responses to a naturalistic psychological stressor. Results also contribute to previous research by generalizing findings to a high risk, underserved population of women.