RESUMO
Latinas experience high levels of stress in pregnancy, however few studies have investigated how acculturation affects pregnancy mental health among Latinas. The goal of this study was to determine if acculturation was associated with pregnancy stress among pregnant, predominantly Puerto Rican women. Participants (n = 1426) were enrolled in Proyecto Buena Salud, a prospective cohort study of Latinas. Acculturation on a bi-dimensional scale that allows for identification with both Latina and continental US cultures (i.e., bi-cultural vs. high or low acculturation) was measured in early pregnancy via the Psychological Acculturation Scale (PAS), language preference, and generation in the US. Stress was measured in early and mid/late pregnancy using Cohen's 14-item Perceived Stress Scale. After adjustment for risk factors, women with bicultural acculturation had significantly lower stress in overall pregnancy (ß = - 2.15, 95% CI - 3.5, - 0.81) and in mid/late pregnancy (ß = - 2.35, 95% CI - 3.92, - 0.77) as compared to women with low acculturation. There were no significant associations between proxies of acculturation (i.e., language preference and generation) and stress. Bicultural psychological acculturation was associated with lower stress in pregnancy, while proxies of acculturation were not. Bi-dimensional measures of psychological acculturation should be considered in future studies of maternal mental health.
Assuntos
Aculturação , Cuidado Pré-Natal/psicologia , Estresse Psicológico/etnologia , Adolescente , Adulto , Feminino , Hispânico ou Latino , Humanos , Entrevistas como Assunto , Modelos Lineares , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Pesquisa Qualitativa , Adulto JovemRESUMO
BACKGROUND: Preterm birth and low birthweight contribute substantially to the disproportionately high infant mortality rates experienced by Puerto Ricans in the United States. The purpose of this study was to examine whether the timing and pattern of prenatal psychosocial stress increased risk of adverse birth outcomes in this high-risk population. MATERIALS AND METHODS: Proyecto Buena Salud was a prospective cohort study conducted from 2006 to 2011 among predominantly Puerto Rican women. Participants (n = 1,267) were interviewed in early, mid-, and late pregnancy. We evaluated associations between early and mid-pregnancy stress (Perceived Stress Scale) and preterm birth and low birthweight, and stress at each pregnancy time point and small for gestational age (SGA). RESULTS: Elevated levels of perceived stress in mid-pregnancy increased risk for preterm birth and low birthweight in adjusted analyses, with a linear trend observed for each increasing quartile of stress (ptrend = 0.01). Women in the highest quartile of stress experienced three times the risk for preterm birth (odds ratio [OR] = 3.50, confidence interval [95% CI]: 1.38-8.87) and low birthweight (OR = 3.53, 95% CI = 1.27-9.86) compared with women in the lowest quartile. Early pregnancy stress was not associated with preterm birth or low birthweight. Increase in stress from early to late pregnancy increased risk for SGA (OR = 1.90, 95% CI = 1.01-3.59); no associations were found between stress at any timepoint and SGA. CONCLUSION: Elevated levels of mid-pregnancy perceived stress increased risk for preterm birth and low birthweight, and an increase in stress over the course of pregnancy increased risk for SGA in a population of predominantly Puerto Rican women.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Resultado da Gravidez/etnologia , Nascimento Prematuro/etnologia , Estresse Psicológico/etnologia , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Estresse Psicológico/psicologia , Estados Unidos/epidemiologiaRESUMO
Objectives To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a population who experiences disparities in adverse birth outcomes and one of the highest infant mortality rates in the United States. Methods Proyecto Buena Salud (PBS) was a prospective cohort study conducted from 2006 to 2011 at a large tertiary care center in Western Massachusetts. Caribbean Islander (i.e., Puerto Rican and Dominican Republic) women were interviewed in early, mid and late pregnancy. Among 1262 participants, associations between depression, assessed using the Edinburgh Postnatal Depression Scale, and risk of preterm birth and small-for-gestational age (SGA) were evaluated. Results Women with at least probable minor depression [odds ratio (OR) = 1.77 (95% confidence interval (CI) = 1.02, 3.07)] or probable major depression [OR = 1.82 (95% CI = 1.01, 3.25)] in mid-pregnancy had an increased risk of SGA compared to non-depressed women in adjusted analyses. Borderline significant associations were observed between increasing levels of depressive symptom scores in early and mid-pregnancy [OR = 1.05 (95% CI = 1.00, 1.11) and OR = 1.04 (95% CI = 1.00, 1.09), respectively] and each additional trimester of exposure to probable major depression across mid- to late pregnancy [OR = 1.66 (95% CI = 1.00, 2.74)] and SGA. Late pregnancy depression was not associated with SGA; depression during pregnancy was not associated with preterm birth. Conclusions for Practice In this population of predominantly Puerto Rican women, mid-pregnancy depression increased risk for SGA. Findings can inform culturally appropriate, targeted interventions to identify and treat pregnant women with depression.