Work-Related Stress and Birth Outcomes: A Longitudinal Study Using Ecological Momentary Assessment

The health and well-being of children is a key indicator of the health of a nation. Key measures of children’s health include infant mortality, and infants born preterm, at low birth weight, and small-for-gestational age. The Black-White disparity in infant mortality is a persistent public health problem in the United States. Previous work has investigated exposure to key psychosocial stressors such as stressful life events, financial stressors, and racial discrimination to elucidate Black-White disparities in adverse birth outcomes. However, few studies have examined the relationship between work-related stress and adverse birth outcomes. We used data from the NIH-funded Postpartum Mothers Mobile Study to examine (1) stress and sources of stress during the second and third trimester of pregnancy, (2) the relationship between work-related stress and small-for-gestational age births, and (3) by race (Black and White participants) in a diverse study population. This study used novel research methodology such as ecological momentary assessment (EMA) and smart phone technology to explore the study aims. EMA data collection methods capture participant’s exposures, experiences, and behaviors as they occur in real-time and in their natural setting. We found racial differences in self-reported stress and sources of stress during pregnancy in a diverse population across sociodemographic characteristics. Black participants indicated more high levels of stress compared to White participants. However, White participants indicated more lower to moderate levels of stress than Black participants during pregnancy. Black participants reported financial issues, too many things to do at once, and housing issues as sources of stress. Conversely, White participants were more likely to report work-related, too many things to do at once, and baby or other children as sources of stress during pregnancy. There was no significant relationship between work-related stress and small-for-gestational age births. Our study extends previous work examining stress during pregnancy using EMA as a primary data collection method. Study findings suggest that there are racial differences in exposure to stress during pregnancy. Additionally, these findings also have implications for policy action and public health interventions