37 - Associations between Self-Reported Stress, Resilience, and Employment in Early Pregnancy

Publication Number: 4036.37

Leo Velosa, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Brielle Formanowski, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Alicia Laguna-Torres, Childrens Hospital of Philadelphia, Providence, RI, United States; Diana Montoya-Williams, Childre's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Unemployment has been linked to adverse birth outcomes. Although employment is positively associated with insurance and access to healthcare, it can also create stress, especially for low-income pregnant people who face worse working conditions and job strain. Given the role of maternal stress on adverse birth outcomes, maternal resilience to stress and its relationship to employment in pregnancy is important but understudied.

Objective: To explore the relationship between current employment status and self-reported stress and resilience at the onset of pregnancy, stratified by neighborhood disadvantage level.

Design/Methods: This sub-analysis of a prospective longitudinal cohort study of pregnant people in a large Philadelphia healthcare system included participants in their first trimester who reported demographic information, employment status, chronic pregnancy-related stress (Prenatal Social Environment Inventory, PSEI), acute stress (Perceived Stress Scale, PSS), and resilience (the Connor-Davidson Resilience Scale, CD-RISC). Differences in stress and resilience were examined by employment using Chi-square or Fisher's exact test. Associations between employment and categorical survey scores were examined via ordered logistic regression models. Models were first adjusted for participants' zip code childhood opportunity index (COI) given the hypothesized role of area-level social advantage on perinatal stress. Individual-level risk factors were then added to models.

Results: The cohort included 276 racially and ethnically diverse people; 49% were privately insured and 32% were unemployed (Table 1). Among the employed, 6% reported unemployment for over one month in the 12 months prior. There was a near-even split of participants living in high or low COI zip codes. Unemployed people reported higher acute and chronic stress, but also higher resilience (Fig. 1). Unemployed people had significantly higher odds of reporting higher chronic stress levels compared to employed individuals (odds ratio 2.13, 95% CI 1.28 -3.55), even after adjusting for COI (Table 2). Findings became nonsignificant when accounting for individual-level factors. The higher odds of reporting higher acute stress and higher resilience among unemployed compared to employed people were not significant.

Conclusion(s): This cohort of people in early pregnancy showed a higher prevalence of stress, but also higher resilience among those unemployed compared to those employed. Future work will explore how other neighborhood characteristics may impact the effects of employment status on maternal resilience to stress in early pregnancy.

Table 1. Sociodemographic characteristics of pregnant people in study cohort
1 COI was created as a binary variable using COI scores 0-50 for the "Low COI Zip code" category and scores 51-100 for the "High COI Zip Code" category.

Figure 1. Prevalence of maternal stress (chronic and acute) and resilience self-reported by participants in their first trimester, compared by employment status. Numbers represent percentages.
1 Chronic stress in past year: Prenatal Social Environment Inventory (PSEI) score ranges from 0-41; categories were assigned as follows: Low (0-6); Moderate (7-11); High (≥12)
2 Acute Stress in past month: Perceived Stress Scale (PSS) scores range from 0-40; categories were assigned as follows: Low (0-13); Moderate (14-26); High (27-40)
3 The Connor-Davidson Resilience Scale © scores range from 0-100; categories were assigned as follows: Poor ( <60), Normal (60-70); Good (70-80); Excellent (>80).

Table 2. Associations between employment status, resilience, and two types of stress at the onset of pregnancy
1 Chronic stress in past year: Prenatal Social Environment Inventory (PSEI) score ranges from 0-41; categories were assigned as follows: Low (0-6); Moderate (7-11); High (≥12)
2 Acute Stress in past month: Perceived Stress Scale (PSS) scores range from 0-40; categories were assigned as follows: Low (0-13); Moderate (14-26); High (27-40)
3 The Connor-Davidson Resilience Scale © scores range from 0-100; categories were assigned as follows: Poor ( <60), Normal (60-70); Good (70-80); Excellent (>80)
4 OR: Odds Ratio; CI: Confidence Interval
5 Ordered regression models were adjusted for zip code COI
6 Ordered regression models were adjusted for maternal age, race, ethnicity, marital status, and zip code COI