Racial and ethnic disparities in preterm birth: the role of stressful life events

Am J Obstet Gynecol. 2004 Sep;191(3):691-9. doi: 10.1016/j.ajog.2004.04.018.


Objective: The purpose of this study was to examine racial-ethnic disparities in stressful life events before and during pregnancy and to assess the relationship between stressful life events and racial-ethnic disparities in preterm birth.

Study design: Using data from the Pregnancy Risk Assessment Monitoring System, we conducted a retrospective cohort analysis of a sample of 33,542 women from 19 states who were delivered of a live-born infant in 2000. Principal component analysis was used to group 13 stressful life events into 4 stress constructs: emotional, financial, partner-related, and traumatic. Racial-ethnic disparities in stressful life events were assessed with the use of bivariate and multivariate regression analyses. The contribution of stressful life events to racial-ethnic disparities in preterm birth was evaluated with the use of stepwise regression model and interaction terms.

Results: Black women and American Indian/Alaska Native women reported the highest number of stressful life events in the 12 months before delivery. Compared with non-Hispanic white women, black women were 24% more likely to report emotional stressors, 35% more likely to report financial stressors, 163% more likely to report partner-related stressors, and 83% more likely to report traumatic stressors. The addition of stress constructs to the stepwise regression model minimally affected the association between race-ethnicity and preterm birth, and none of the stress constructs were significantly associated with preterm birth. There were no significant interaction effects between race-ethnicity and stress on preterm birth, except for a modest effect between black race and traumatic stressors.

Conclusion: There are significant racial-ethnic disparities in the experience of stressful life events before and during pregnancy. Stressful life events do not appear to contribute significantly to racial-ethnic disparities in preterm birth.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Asian / statistics & numerical data
  • Black People / statistics & numerical data
  • Emotions
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Surveys
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Indians, North American / statistics & numerical data
  • Infant, Newborn
  • Infant, Premature*
  • Obstetric Labor, Premature / epidemiology*
  • Pregnancy
  • Racial Groups*
  • Regression Analysis
  • Stress, Psychological / complications
  • Stress, Psychological / epidemiology*
  • White People / statistics & numerical data
  • Wounds and Injuries / complications
  • Wounds and Injuries / epidemiology