Life satisfaction and preterm birth among urban black women: findings from the Baltimore preterm birth study.

PURPOSE: Preterm birth (PTB) is a major problem in the United States, and black women have greater risk of PTB than white women. The etiology of PTB and the racial disparity in preterm outcomes are poorly understood. Diminished life satisfaction is associated with adult health, but there are no studies of life satisfaction and PTB. In the research reported in this article, the relationship between life satisfaction and PTB among black women was studied. METHODS: Women were enrolled in this prospective study at the time of the first visit to 5 prenatal clinics in Baltimore. Life satisfaction was assessed at the time of the first prenatal visit. Data on PTB were obtained from medical records. RESULTS: The final sample consisted of 922 women. Among women who were somewhat or not at all satisfied with their lives, 16% had preterm births, whereas among women who were very satisfied with their lives, 10.7% had preterm births (unadjusted odds ratio = 1.6; 95% CI 1.1-2.4). The adjusted odds ratio was 1.6 (95% CI 1.00-2.5). CONCLUSIONS: Women who reported being somewhat or not at all satisfied with their lives had a greater risk of PTB than women who reported being very satisfied with their lives.

Maternal health prior to pregnancy and preterm birth among urban, low income black women in Baltimore: the Baltimore Preterm Birth Study.

OBJECTIVES: Black women have increased risk of preterm birth compared to white women, and overall black women are in poorer health than white women. Recent recommendations to reduce preterm birth have focused on preconception health care. We explore the associations between indicators of maternal prepregnancy health with preterm birth among a sample of black women. DESIGN: The current study was prospective. SETTING: Enrollment occurred in prenatal clinics in Baltimore. PARTICIPANTS: Women (N=922) aged > or =18 were enrolled in the study. Data on maternal health, behaviors, and pregnancy outcome were abstracted from clinical records. MAIN OUTCOME MEASURE: Logistic regression was used to evaluate associations between behavioral and health status variables with preterm birth. RESULTS: In bivariate analysis, alcohol use, drug use and chronic diseases were associated with preterm birth. In the logistic regression analysis, drug use and chronic diseases were associated with preterm birth. CONCLUSIONS: These results demonstrate an association between maternal health and behaviors prior to pregnancy with preterm birth among black women. Providing access to health care prior to pregnancy to address behavioral and health risks may improve pregnancy outcomes among low-income black women.

Unintended pregnancy and prenatal behaviors among urban, black women in Baltimore, Maryland: the Baltimore preterm birth study.

PURPOSE: We explored associations between intendedness of pregnancy with maternal prenatal behaviors, including smoking, use of alcohol, use of illicit drugs, and late initiation of prenatal care. METHODS: Pregnant black women ages 18 years or older (N = 913) were enrolled in the study at their first visit to prenatal clinics in Baltimore, Maryland, at which time data were obtained from the women about intendedness of pregnancy. Data on behavioral risks were abstracted from clinical records. Logistic regression was used to adjust analyses for maternal demographic characteristics. RESULTS: Women with unwanted pregnancies were significantly more likely than women with wanted or mistimed pregnancies, or who were unsure about intendedness, to smoke (odds ratio [OR], 2.0; 95% CI, 1.2-3.3), use alcohol (OR, 2.1; 95% CI, 1.1-3.9), and use illicit drugs (OR, 1.8; 95% CI, 1.0-2.9) during pregnancy, and to initiate prenatal care in the third trimester (OR, 5.7; 95% CI, 3.5-9.4). CONCLUSIONS: Unwanted pregnancy is associated with prenatal behaviors that increase the risk of poor pregnancy outcomes. The facilitation of wanted pregnancies and reduction of harmful maternal behaviors may result in improved pregnancy outcomes in the United States.

Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland.

OBJECTIVE: To focus on the relationship between pregnancy-related anxiety and spontaneous preterm birth. Psychosocial factors have been the subject of inquiries about the etiology of preterm birth; a factor of recent interest is maternal prenatal pregnancy-related anxiety (worries and concerns related to the pregnancy). METHODS: From 1991 to 1993, a total of 1820 women completed the study questionnaire during their first prenatal visit to clinics in Baltimore, Maryland. Pregnancy-related anxiety was assessed using six questions from the Prenatal Social Environment Inventory; scores ranged from 0 to 6. Data on pregnancy outcome and clinical and behavioral covariates were obtained from the women's clinical records. RESULTS: After adjustment for covariates (first or second trimester bleeding, drug use, employment, prior poor pregnancy outcome, smoking, low body mass index, maternal education, age, and race), women with higher levels of pregnancy-related anxiety (scores of 5 or 6) had a significantly increased risk of spontaneous preterm birth compared with those with scores of < or =3. CONCLUSIONS: If additional research confirms these results, then this finding may suggest the possibility of intervention to reduce maternal prenatal pregnancy-related worries and concerns, thereby reducing the risk of spontaneous preterm birth.

Depressive symptoms and indicators of maternal health status during pregnancy.

OBJECTIVES: Depressive symptoms are common among women, especially those who are of childbearing age or are pregnant. Prior studies have suggested that an increased burden of depressive symptoms is associated with diminished health and functional status, but these studies were primarily of middle-aged and older adults. In the current study, we investigated the relationship between depressive symptoms and health and functional status among pregnant women. METHODS: Women were enrolled in the study at their first prenatal visit to hospital-based clinics and administered an interview that contained the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms and several questions to measure overall health status, limitations in performing moderate activities, and limitations in climbing stairs. RESULTS: The sample included 1163 women. Women with higher levels of depressive symptoms, using cutoff points on the CES-D of either > or =16 (clinically significant) or > or =23 (major depression), had approximately twice the risk of poorer self-reported health and functional status than those with lower scores after adjustment for age, marital status, smoking, education, insurance, trimester, and race. CONCLUSIONS: These results suggest that an increased burden of depressive symptoms during pregnancy is associated with diminished health status and may offer an explanation for the reported association between depressive symptoms and preterm birth.

Prenatal smoking cessation among Black and White women in Eastern North Carolina.

PURPOSE: Limited information is available about Black:White disparities in prenatal smoking cessation, and the results of prior research are inconsistent. We analyzed smoking cessation and factors associated with cessation (attitudes, environment, and nicotine addiction) in a sample of pregnant Black and White women. METHODS: Women were interviewed at the first prenatal visit at two hospital-based clinics. RESULTS: Among former and current smokers, there were no significant differences in the percentage of former smokers between Black (46.8%) and White (43.3%) pregnant women, or in the percentage of "spontaneous quitters" (i.e., those who quit after learning that they were pregnant) for Blacks (36%) and Whites (28%). Both Black and White spontaneous quitters had evidence of occasional relapses to smoking. For Black and White women, smoking more than a pack a day prior to pregnancy was associated with smoking during pregnancy. DISCUSSION: Among current and former smokers, spontaneous cessation was about the same for Black and White women, and about two thirds of women who were smokers when they learned of the pregnancy continued to smoke during pregnancy. Nicotine addiction contributed to continued smoking.

Exercise participation before and during pregnancy among low-income, urban, Black women: the Baltimore Preterm Birth Study.

National data demonstrate that Black women have poorer health status, and greater risk of death from chronic diseases, than their White counterparts. Exercise can help prevent chronic disease, and adult Black women are less likely to engage in exercise than White women. However, few data are available about exercise among pregnant Black women. Pregnant Black women were enrolled in this study at hospital-based prenatal clinics in Baltimore, Maryland. Exercise before and during pregnancy were assessed at the first prenatal visit, along with exposure to stressors, depression, John Henryism Active Coping, and behavioral factors such as smoking. Among the 922 women in the sample, approximately three quarters reported engaging in exercise before pregnancy, and two thirds exercised during pregnancy. Most women engaged in non-strenuous exercise during pregnancy (56%) and exercised for > or = 20 minutes at least three times per week (80%). Exercise participation was significantly associated with higher levels of John Henryism Active Coping and lower levels of depression but was not significantly associated with behavioral factors or exposure to stressors. Prior research, based on older women, may have underestimated exercise participation by young Black women. These results suggest that Black women may decrease exercise participation after pregnancy and as they age. Encouraging Black women to continue to exercise as they age may have promising implications for the prevention of chronic diseases.

Exercise and pregnancy outcome among urban, low-income, black women.

Few studies have focused on the association between maternal exercise and outcomes of pregnancy among low-income, Black women. The analysis reported here examines the associations between exercise before and during pregnancy and pregnancy outcomes of preterm birth and low birth weight among a sample of urban, low-income, Black women. Women (N=922) were enrolled in this prospective cohort study during their first prenatal visit at five hospital-based prenatal clinics located in Baltimore City, Maryland, from 1993 to 1995. A questionnaire was used to ask women about their participation in strenuous and non-strenuous exercise before and during pregnancy. Nearly two thirds of the women reported participating in exercise during pregnancy; most women participated in non-strenuous exercise (56%). The risks of both low birth weight (12.2%) and preterm birth (13.7%) were not significantly different whether women reported exercising or not, either before or during pregnancy. For women who were considered high risk because of chronic diseases or previous poor pregnancy outcome, stratified analysis indicated no significant difference in preterm birth or low birth weight between those who exercised and those who did not. Our analysis failed to identify any association between exercise and pregnancy outcomes among low-income, urban, Black women.

Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern north Carolina.

PURPOSE: Black women have an increased risk for preterm birth compared with white women, and prior research indicated that maternal prenatal depressive symptoms are associated with increased risk for preterm outcomes among black women. Race-related differences in prenatal depression could be of etiologic significance in understanding racial disparities in preterm birth. Our study focused on Center for Epidemiologic Studies' Depression Scale (CES-D) scores of pregnant black and white women. METHODS: Women were administered the CES-D at the time of their first visit to hospital-based prenatal clinics. Two cutoff scores for the CES-D were used: 16 or higher, which indicates "significant" depressive symptoms, and 23 or higher, which indicates major depressive disorder. RESULTS: For the sample of 1163 women, mean CES-D scores were significantly higher among black (17.4) than white (13.7) women. Of black women, 49% had CES-D scores higher than 15 compared with 33.5% of white women. Also, 27.5% of black women had scores higher than 22 compared with 16% of white women. After adjustment for maternal age, marital status, and education, odds ratios for race for both CES-D cutoff scores were approximately 1.5. CONCLUSIONS: Results of this study indicate that black women have greater rates of prenatal depression than white women.

Factors associated with prenatal smoking among black women in eastern North Carolina.

OBJECTIVES: The objective of this research was to explore prenatal smoking behaviors among Black women attending prenatal clinics. Despite the racial disparities in poor pregnancy outcomes, and the well-known association of smoking with harmful outcomes, little research has been conducted about prenatal smoking among Black women. METHODS: Women were enrolled in the study and interviewed at the time of the first prenatal visit. The interview contained items to assess prenatal smoking and cessation, depressive symptoms, demographic factors, and beliefs about smoking. Reports of smoking cessation were verified using urinary cotinine. RESULTS: The sample consisted of 811 Black women. Fourteen percent of the women were self-reported smokers, 12.6% reported cessation and 73% were nonsmokers. Twenty percent of the self-reported quitters had elevated cotinine; when these women were reclassified, 17% of the women were smokers. Factors associated with smoking in logistic regression analysis included elevated maternal depressive symptoms (OR = 1.7, 95% CI: 1.1-2.6), maternal age 20 years or older (OR = 1.94; 95% CI: 1.1, 3.3), less than a high school education (OR = 2.2; 95% CI: 1.2, 3.8), unmarried/not living with a partner (OR = 1.9; 95% CI: 1.0, 3.6), and allowing smoking in the home (OR = 5.5; 95% CI: 3.4, 8.6). CONCLUSIONS: The prevalence of maternal prenatal smoking was much higher among women in this sample than has been previously reported. The rate of nondisclosure of smoking among self-reported quitters was also high. Maternal behavioral (allowing smoking in the home) and psychosocial factors (depressive symptoms) were associated with prenatal smoking.

Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland.

The purpose of this study was to examine the relation between maternal depressive symptoms and spontaneous preterm birth. From 1991 to 1993, pregnant, African-American women were prospectively enrolled at four hospital-based clinics in Baltimore, Maryland, that serve low-income areas of the city. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms. Multiple logistic regression analysis estimated the independent contribution of maternal depressive symptoms to spontaneous preterm birth, controlling for behavioral, clinical, and demographic variables. Among the 1,399 women in the sample, 117 (8.4%) had a spontaneous preterm delivery. Spontaneous preterm birth occurred among 12.7% of those with a CES-D score in the upper 10th percentile and among 8.0% of those with a lower score (relative risk = 1.59). The adjusted odds ratio for an elevated CES-D score was 1.96 (95% confidence interval: 1.04, 3.72); hence, maternal depressive symptoms in this sample of African-American women were independently associated with spontaneous preterm birth. Effective treatment of depression in pregnant women could ultimately result in a reduction of spontaneous preterm births.