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Early Births, Poverty Stresses Linked

Chronic, daily strains take toll on pregnancy

WEDNESDAY, May 16 (HealthScout) -- When you're pregnant, having no time or money for those extras in life -- dinner out with friends or a new hair style, for instance -- might affect whether you give birth prematurely.

Especially if you're poor.

"Lacking what might be deemed 'non-essential' may lead to a woman feeling stressed or hopeless, without control or power," says Dawn Misra, an assistant professor of population and family health sciences at Johns Hopkins University's Bloomberg School of Public Health. "These feelings, in turn, increase her risk of delivery preterm."

In fact, feeling stressed and not in control almost doubled the risk of preterm delivery among participants in her study of 735 low-income black women, Misra says.

"Preterm delivery rates have edged up a bit," she says. "Clearly what we're doing now [to prevent this] is not good enough. We need to figure out more about what's causing it and what we can do."

Women now are told to stop smoking, not to use drugs and to get prenatal care, Misra adds. "But it's not that simple."

"In Africa, people know that a girl's health is really important because she's going to be a mother," she says. "But we don't think of it like that. …We don't want to think of all girls as potential mothers, but it might require that aggressive an effort."

"We have to develop a real compelling picture to get people to pay attention," she adds.

Babies born prematurely -- before 37 weeks gestation -- face a higher risk of illness, disability and death than babies carried the full 40 weeks. Preterm birth is the second-leading cause of newborn deaths, according to the Centers for Disease Control and Prevention (CDC).

Using data collected in the early 1990s for a study on drug use and prenatal care among poor, black women, Misra discovered that almost 25 percent of the women delivered prematurely, compared with an 11 percent premature delivery rate in the United States overall. All births in the study were at Johns Hopkins Hospital in Baltimore.

Poverty definitely heightens the risk of giving birth early, Misra says.

"And some of the reason poverty might affect you is through stress," she says.

A higher-income woman who's feeling stressed about something might just take a day off work, Misra says, but a poor woman can't do that. She may skip eating out so she can buy shoes for her kids.

For the participants in the study, the key differences showed up not in whether they had enough basic resources to meet their needs -- heat, housing, furniture, for instance -- but in whether they had some of the extras that can help them feel in control of their lives, she says.

"Time was important, and money was important," Misra says, "but time and money together were really important."

Time to spend alone with a spouse or to take care of the way you look, and money to go out to dinner occasionally or to socialize with friends: Things like these provide a "necessary psychological lift," Misra says. Although they may not be absolutely necessary for survival, "they're things the rest of us take for granted as basic life," she says.

But preterm deliveries rose threefold, the study says, among the women who reported a lack of both time and money for such things. Details appear in a recent issue of the quarterly journal Paediatric and Perinatal Epidemiology.

"Stress might explain why being poor causes these bad pregnancy outcomes," Misra says.

Vajaya Hogan, a CDC epidemiologist who specializes in preterm delivery research, says that's becoming a popular point of view.

"Stress is sort of emerging as one of the most interesting hypotheses to explain [the differences in] health outcomes by race and economic status," Hogan says.

"It's a pretty insidious force," she adds.

Those factors, as well as marital status, "are not really risk factors per se [because] they're just describing characteristics of the population," Hogan says. "But they're pretty strong predictors of somebody who's going to have a preterm delivery."

"But what are some of the underlying causes?" she asks.

"We're seeing more, but not enough, research around this particular issue," she says.

What To Do

For more information on premature births, check out MommyGuide or the BabyZone online.

Or you might want to read previous HealthScout articles on premature births.

SOURCES: Interviews with Dawn Misra, Ph.D., M.H.S., assistant professor of population and family health sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md.; and Vajaya Hogan, Dr.PH, lead epidemiologist, Preterm Delivery Research Group, Centers for Disease Control and Prevention, Atlanta, Ga.; April 2001 Paediatric and Perinatal Epidemiology
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