Stressful Life Event Experiences of Pregnant Women in the United States: A Latent Class Analysis

Abstract

Objectives: Nearly 65% to 70% of pregnant women in the United States experience one or more stressful life events (SLEs), which can lead to adverse maternal and/or fetal outcomes. This study aimed to identify groups of women with similar patterns of antenatal SLE experiences, and to examine their sociodemographic correlates.

Methods: Data from the 2009 to 2011 Pregnancy Risk Assessment Monitoring System were used and latent class analysis performed (N = 115,704) to identify unobserved class membership. The relative likelihood of membership in each latent class was explored using multinomial logistic regression.

Results: A three-class model was the most appropriate, with the majority (64%) in the low-stress class. The illness/death related-stress class (13%) had a high prevalence of illness (77%) and death (63%) of someone close or a family member, whereas those in the multiple stressors (22%) class endorsed most other SLEs. Unmarried and lowest poverty women were, respectively, more (adjusted odds ratio, 2.36; 95% confidence interval, 2.12-2.62) and less likely (adjusted odds ratio, 0.09; 95% confidence interval, 0.07-0.11) to be in the multiple stressors class. The highest prevalence of severe pregnancy-associated nausea/vomiting, preterm labor, and postpartum depression was in the multiple stress class, followed by illness/death, and low-stress classes.

Conclusions: That one out of every five and one out of every eight women were in the multiple stressors and illness/death related-stress classes, respectively, suggests that antenatal SLEs are common. The greater likelihood of adverse maternal health outcomes in both the illness/death stress and the multiple stressors classes suggests the importance of screening for these SLEs and providing support to pregnant women.