A prospective study on the influence of stress, social support and coping on birth outcomes and depressive symptomology during pregnancy and the postpartum

The role of psychosocial factors in adverse birth outcomes and postpartum depressed mood remains unclear mainly due to methodological flaws and difficulties conceptualizing and measuring maternal stress. As well, variables such as social support and coping styles during pregnancy which may have an influence on birth outcomes and depressed mood have not received adequate empirical attention. Using a multidimensional approach to measure stress and a prospective design while controlling for demographic and biomedical variables, this study examined the influence of maternal stress, social support and coping styles on labor/delivery complications, infant birth weight and depressed mood pre- and postpartum. Beginning in the third month of pregnancy, data on numerous variables including daily stress (Hassles), state-anxiety (STAI-state), pregnancy-specific stress (PEQ) and depressed mood (DACL) were collected monthly. As well, in each trimester social support and coping strategies (CISS) were assessed, as were lifestyle behaviors such as smoking, caffeine and alcohol intake, and pregnancy progress. Approximately 4-5 weeks following delivery, information on labor, delivery and infant status was collected and the DACL and the Edinburgh Postnatal Depression Scale (EPDS) were administered. The final sample consisted of 80 women with a mean age of 29.19 (range 20-38). The results demonstrated that women who experienced greater stress during pregnancy had a more difficult labor/delivery, even after controlling for parity. Younger maternal age was also linked with intrapartum complications. Perceived prenatal social support emerged as a predictor of infant birth weight. Women who reported less satisfaction with their social support in the second trimester gave birth to infants of lower birthweight. Some evidence for a buffering effect of social support was also shown, as women who reported being less satisfied with their social support in the second trimester and experienced higher levels of depressed mood during pregnancy had infants of lower birthweight. Approximately 16% of the women in this sample experienced depressed mood in the postpartum assessment. Twenty-five percent of the women in this study reported depressed mood only during pregnancy, but not in the postpartum. This study showed that specific psychosocial variables are among the multiple factors involved in the occurrence of the adverse birth outcomes examined. Some support was found for the role of different psychosocial variables on depressed mood during pregnancy compared to the postpartum. Possible etiological mechanisms, clinical recommendations and directions for future research are discussed