Does Degree and Type of Adverse Life Events Impact Birth Outcomes?

Author Type(s)

Resident/Fellow

Document Type

Article

Publication Date

2022

DOI

10.1136/jim-2022-ERM.247

Journal Title

Journal of Investigative Medicine

Department

Pediatrics

Comments

Purpose of Study Social determinants of health are known to affect both maternal and infant health. However, little is known regarding the degree and specific type of adverse life events in relation to birth outcomes. The objective of our study is to identify whether there are associations between degree and type of maternal adverse life events (ALE) and birth outcomes, in comparison to mothers with no ALE (NoS) Methods Used This is an analysis (2016-2020) of survey data of parents (≥18 years) of singleton live-born infants. Outcomes including NICU admission (NICU), small for gestational age (SGA), preterm birth (PTB, <37 weeks) and composite of the 3 outcomes were obtained from birth certificates and analyzed by self-reported maternal sociodemographic factors. Mothers were assessed for degree of stress by total number of positive answers to 14 questions related to ALE. The ALE were classified into social stress (SS; eg marital discord, incarceration) or economic stress (ES; eg job insecurity, homelessness). If both ES & SS ALE were selected, they were excluded from type of ALE analysis. Covariates included: maternal race, age, education, lifestyle behaviors such as exercise & substance use, high-risk pregnancy conditions, mode of delivery & antenatal steroids. Summary of Results 1102 mothers were analyzed, of which 277 mothers reported 1 ALE, 148 reported 2 ALE and 170 reported ≥ 3ALE. 507 reported NoS. 389 were SS, 47 were ES and 507 reported neither SS or ES (NoS). Mothers with higher ALE differed by race & were less likely to be foreign born & more likely to use substances (p's<0.05). Educated mothers were less likely to have SS. Substance using mothers were more likely to have SS and less likely to have ES, compared to NoS (p's<0.05). In adjusted analysis, higher ALE score was associated with NICU (1.12, 95% CI {1.02-1.25}) & composite (1.11, 95% CI {1.01-1.22}). ES mothers had higher odds of delivering SGA infants (OR 4.37, 95% CI {1.45-13.09}) & composite (2.30, 95% CI {1.09-4.82}), compared to NoS mothers. SS mothers had similar odds of adverse birth outcomes as NoS mothers. Odds of preterm birth compared to NoS mothers were not different in adjusted analysis for degree and type of ALE. Conclusions Compared with NoS mothers, infants born to mothers with higher ALE were more likely to require NICU admission & economically stressed mothers were more likely to deliver SGA infants. We suggest that providers should consider assessing amount and type of ALE to provide targeted support and optimize birth outcomes.

Purpose of Study Social determinants of health are known to affect both maternal and infant health. However, little is known regarding the degree and specific type of adverse life events in relation to birth outcomes. The objective of our study is to identify whether there are associations between degree and type of maternal adverse life events (ALE) and birth outcomes, in comparison to mothers with no ALE (NoS) Methods Used This is an analysis (2016-2020) of survey data of parents (≥18 years) of singleton live-born infants. Outcomes including NICU admission (NICU), small for gestational age (SGA), preterm birth (PTB, <37 weeks) and composite of the 3 outcomes were obtained from birth certificates and analyzed by self-reported maternal sociodemographic factors. Mothers were assessed for degree of stress by total number of positive answers to 14 questions related to ALE. The ALE were classified into social stress (SS; eg marital discord, incarceration) or economic stress (ES; eg job insecurity, homelessness). If both ES & SS ALE were selected, they were excluded from type of ALE analysis. Covariates included: maternal race, age, education, lifestyle behaviors such as exercise & substance use, high-risk pregnancy conditions, mode of delivery & antenatal steroids. Summary of Results 1102 mothers were analyzed, of which 277 mothers reported 1 ALE, 148 reported 2 ALE and 170 reported ≥ 3ALE. 507 reported NoS. 389 were SS, 47 were ES and 507 reported neither SS or ES (NoS). Mothers with higher ALE differed by race & were less likely to be foreign born & more likely to use substances (p's<0.05). Educated mothers were less likely to have SS. Substance using mothers were more likely to have SS and less likely to have ES, compared to NoS (p's<0.05). In adjusted analysis, higher ALE score was associated with NICU (1.12, 95% CI {1.02-1.25}) & composite (1.11, 95% CI {1.01-1.22}). ES mothers had higher odds of delivering SGA infants (OR 4.37, 95% CI {1.45-13.09}) & composite (2.30, 95% CI {1.09-4.82}), compared to NoS mothers. SS mothers had similar odds of adverse birth outcomes as NoS mothers. Odds of preterm birth compared to NoS mothers were not different in adjusted analysis for degree and type of ALE. Conclusions Compared with NoS mothers, infants born to mothers with higher ALE were more likely to require NICU admission & economically stressed mothers were more likely to deliver SGA infants. We suggest that providers should consider assessing amount and type of ALE to provide targeted support and optimize birth outcomes.

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