The contribution of racism-related stress and adversity to disparities in birth outcomes: evidence and research recommendations

Biological and behavioral pathways from prenatal depression to offspring cardiometabolic risk: Testing the developmental origins of health and disease hypothesis

Given prior literature focused on the Developmental Origins of Health and Disease framework, there is strong rationale to hypothesize that reducing depression in the prenatal period will cause improvements in offspring cardiometabolic health. The current review outlines evidence that prenatal depression is associated with offspring cardiometabolic risk and health behaviors. We review evidence of these associations in humans and in nonhuman animals at multiple developmental periods, from the prenatal period (maternal preeclampsia, gestational diabetes), neonatal period (preterm birth, small size at birth), infancy (rapid weight gain), childhood and adolescence (high blood pressure, impaired glucose-insulin homeostasis, unfavorable lipid profiles, abdominal obesity), and into adulthood (diabetes, cardiovascular disease). In addition to these cardiometabolic outcomes, we focus on health behaviors associated with cardiometabolic risk, such as child eating behaviors, diet, physical activity, and sleep health. Our review focuses on child behaviors (e.g., emotional eating, preference for highly palatable foods, short sleep duration) and parenting behaviors (e.g., pressuring child to eat, modeling of health behaviors). These changes in health behaviors may be detected before changes to cardiometabolic outcomes, which may allow for early identification of and prevention for children at risk for poor adult cardiometabolic outcomes. We also discuss the methods of the ongoing Care Project, which is a randomized clinical trial to test whether reducing prenatal maternal depression improves offspring's cardiometabolic health and health behaviors in preschool. The goal of this review and the Care Project are to inform future research, interventions, and policies that support prenatal mental health and offspring cardiometabolic health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources

Introduction

This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes.

Methods

A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews.

Results

Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies.

Discussion

The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context.

Conclusion

CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.

"There is nothing to protect us from dying": Black women's perceived sense of safety accessing pregnancy and intrapartum care

Pregnancy and childbirth have become a dangerous journey for Black women as harrowing stories of death and near-death experiences resonate within Black communities. While the causes of pregnancy-related morbidity and mortality are well documented, little is known about how Black Canadian women feel protected from undesirable maternal health outcomes when accessing and receiving pregnancy and intrapartum care. This critical qualitative inquiry sheds light on Black women's perceived sense of safety in accessing pregnancy and intrapartum care. Twenty-four in-depth interviews were conducted with Black women who were pregnant or had given birth. Five interconnected themes were generated through thematic analysis: (1) There is a lot of prejudice towards us, (2) We are treated as sick bodies, (3) There is a lot of stereotypes towards us, (4) Our care is lacking in quality, and (5) We feel unsafe in the healthcare system. These themes highlight the perils faced by Black women accessing pregnancy and intrapartum care. The right to safe motherhood and equitable care for Black women should be a national priority in Canada to avert a looming crisis.

Beyond the First Trimester: Social Determinants of Delayed Prenatal Care at a Community Health Center Using the PRAPARE Tool

Social determinants of health have been used to explore associations with pregnancy outcomes and the birth weight of infants; however, research employing individually based social risk measures has not examined associations among underserved populations, including pregnant persons at community health centers. Data were collected from a sample (n = 345) of pregnant persons who sought care at a community health center between January 2019 and December 2020. Social risks of pregnant patients were measured using the PRAPARE tool. First, associations between patients' social risks and trimester in which they initiated care were assessed using ANOVAs, grouping social risk by PRAPARE social determinant domains (persona characteristics, family and home, money and resources, and social and emotional health). ANOVAs were stratified by ethnicity. Next, a multivariate logistic regression examined associations between social measures and seeking care after the first trimester. Patients who sought care in the first trimester reported more financial needs than those who sought care in the second (p = .02) or the third (p = .049). Hispanic patients who sought care in the first trimester reported more monetary needs than those who sought care in the second trimester (p = .048), and non-Hispanic patients who sought care in the first trimester reported greater family and home needs than those who sought care in the second trimester (p = .47). Those who experienced stress were 3.07 times as likely to seek care after the first trimester as those who reported no stress. CHC may reduce social risk among poor and underserved communities by reducing barriers to access to care.

Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial

Background

Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT).

Methods

Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801).

Findings

Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97).

Interpretation

We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation.

Funding

This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).

Experience of discrimination reported during pregnancy and infant's emerging effortful control

Discrimination reported during pregnancy is associated with poorer offspring emotional outcomes. Links with effortful control have yet to be examined. This study investigated whether pregnant individuals' reports of lifetime racial/ethnic discrimination and everyday discrimination (including but not specific to race/ethnicity) reported during pregnancy were associated with offspring emerging effortful control at 6 months of age. Pregnant individuals (N = 174) and their offspring (93 female infants) participated. During pregnancy, participants completed two discrimination measures: (1) lifetime experience of racial/ethnic discrimination, and (2) everyday discrimination (not specific to race/ethnicity). Parents completed the Infant Behavior Questionnaire-Revised when infants were 6 months old to assess orienting/regulation, a measure of emerging effortful control. Analyses were conducted in a subsample with racially/ethnically marginalized participants and then everyday discrimination analyses were repeated in the full sample. For racially/ethnically marginalized participants, greater everyday discrimination (β = -.27, p = .01) but not greater lifetime experience of racial/ethnic discrimination (β = -.21, p = .06) was associated with poorer infant emerging effortful control. In the full sample, greater everyday discrimination was associated with poorer infant emerging effortful control (β = -.24, p = .002). Greater perceived stress, but not depressive symptoms, at 2 months postnatal mediated the association between everyday discrimination and emerging effortful control. Further research should examine additional biological and behavioral mechanisms by which discrimination reported during pregnancy may affect offspring emerging effortful control.

Racial/ethnic and nativity differences in adversity profiles among middle-aged and older adults

OBJECTIVES

Focusing on the nexus of race/ethnicity and nativity, this study examined profiles of adversity and their mental health implications in five groups of middle-aged and older adults: native-born whites, native-born blacks, native-born Hispanics, foreign-born whites, and foreign-born Hispanics.

METHODS

Data were from the 2018 psychosocial assessment of the HRS (N = 5,223). Latent class analysis (LCA) was employed to identify patterns of eleven adversity indicators and to compare the latent structures and class prevalence across the race/ethnicity and nativity groups. Regressions were used to examine the associations between adversity profiles and depression and life satisfaction, respectively.

RESULTS

Four adversity profiles emerged: low adversity (59.84%), low human capital (15.27%), socially marginalized (15.26%), and neighborhood adversity (9.63%). Regardless of nativity status, white older adults were most likely to have the low adversity profile (74 ∼ 75%). In contrast, all the racial/ethnic minority groups were more likely to have the other three adversity profiles. The adversity experienced by racial/ethnic minorities was further cofounded by their immigration status. Overall, having low adversity was associated with the best mental health outcomes and socially marginalized had the poorest outcomes. Even with the low adversity profile, native-born blacks had significantly more depressive symptoms than native-born whites.

CONCLUSION

Findings revealed heterogeneity in adversity profiles and their mental health implications in disadvantaged aging populations. Tailored programs are needed to address unique needs of different minority populations.

Discrimination and adverse birth outcomes among Latina women: The protective role of social support

OBJECTIVE

Interpersonal discrimination has been associated with adverse birth outcomes among Black populations, but few studies have examined the impact of discrimination among Latinx/Hispanic populations in the United States, especially in conjunction with resources that could be protective. The present study examined (a) if exposure to discrimination is associated with adverse birth outcomes for Latina/Hispanic women and (b) if prenatal social support buffers these links.

METHOD

In two independent prospective studies of Latina/Hispanic women in Southern California (N = 84 and N = 102), the relation between maternal experience of discrimination and birth outcomes (length of gestation and birth weight) was examined. Additionally, social support was tested as a moderator of these relations.

RESULTS

In both Studies 1 and 2, exposures to discrimination predicted adverse birth outcomes. Specifically, lifetime experiences of major discrimination predicted lower birth weight. Additionally, in Study 2, chronic experiences of everyday discrimination were linked to lower birth weight. In Study 1, major discrimination also predicted shorter gestational length. Importantly, in both studies, the presence of prenatal social support buffered associations between discrimination and poorer birth outcomes.

CONCLUSIONS

Findings implicate discrimination as an important risk factor for adverse birth outcomes among women of Latina/Hispanic descent. Further policies, practice, and research on reducing discrimination and enhancing factors that promote resilience such as social support are needed to facilitate healthy births among Latina/Hispanic women, mitigate intergenerational harm of discrimination-related stress, and advance health equity at birth and across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Latinas and Maternal and Child Health: Research, Policy, and Representation

Over the last 50 years, the Latino population in the US has grown and changed. Latinos are the nation's largest minority group and among this group, there is incredible diversity. Much of Latino health research and outcomes have been treated interchangeably with immigrant health, but as the US Latino population evolves so should the focus of Latino health research. We contend that as maternal and child health (MCH) outcomes are an utmost important indicator of a country's health, and as Latinos make up 18% of the US's population, it is imperative that we move past dated research frameworks to a more nuanced understanding of the health of Latina women and children. We summarize how acculturation has been used to describe differences in MCH outcomes, discuss how the umbrella term "Latino" masks subgroups differences, explore Afro-Latinidad in MCH, examine the effects of the sociopolitical climate on the health of families, and demonstrate the limited representation of Latinos in MCH research. We conclude that a deeper understanding of Latino health is necessary to achieve health equity for Latina women and their children.

Developmental Pathways from Prenatal Substance Exposure to Reactive Aggression

Few studies have examined etiological pathways from prenatal substance exposure to adolescent reactive aggression. We tested a conceptual model that included hypothesized pathways from prenatal substance exposure to adolescent aggression via autonomic reactivity and violence exposure from infancy to early school age and maternal harshness across early childhood. The sample included 216 families (106 boys) who primarily self-identified as Black or Mixed Race. Results supported the hypothesized path from violence exposure across early childhood and early school age to school age autonomic reactivity and early adolescent reactive aggression. There was also a significant interaction effect of sympathetic and parasympathetic reactivity on adolescent reactive aggression, with sympathetic arousal and parasympathetic suppression at early school age associated with higher reactive relational and physical aggression in adolescence. Results emphasize the importance of early experiences and autonomic nervous system changes in contributing to the cascade of risk for reactive aggression in early adolescence.