Mediators of adverse birth outcomes among socially disadvantaged women

J Womens Health (Larchmt). 2012 Jun;21(6):634-42. doi: 10.1089/jwh.2011.2766. Epub 2011 Dec 13.


Background: Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes.

Methods: Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data.

Results: Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy.

Conclusions: The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Gestational Age
  • Health Behavior / ethnology*
  • Healthcare Disparities*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Middle Aged
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnant Women / ethnology
  • Pregnant Women / psychology*
  • Prenatal Care / psychology
  • Prenatal Care / standards
  • Prenatal Care / statistics & numerical data*
  • Prospective Studies
  • Social Class*
  • Stress, Psychological / epidemiology
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Surveys and Questionnaires
  • United States / epidemiology
  • Vulnerable Populations* / ethnology
  • Vulnerable Populations* / psychology