48 - Novel Classification of Prenatal Stress: Economic vs. Social Stressors in relation to Preconception Care, Intention to Breast Feed, and Birth Outcomes

Publication Number: 4047.48

Elissa Dunlap, Maria Fareri Children's Hospital at Westchester Medical Center, New York, NY, United States; Heather L. Brumberg MD, MPH, New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Sumantra Sarkar, Binghamton University, Binghamton, NY, United States; Sarah M. Sanchez, RWJBH Cooperman Barnabas Medical Center, Livingston, NJ, United States; Caitlyn Kockler, New York Medical College, Lake Lincolndale, NY, United States; Mayeesa Rahman, New York Medical College, Valhalla, NY, United States; Genevieve M. Lewis, New York Medical College, Valhalla, NY, United States; Nathan Beck, Maria Fareri Children's Hospital at Westchester Medical Center, White Plains, NY, United States; Shetal Shah, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States

Background: Perinatal stress is linked with adverse birth outcomes & lower rates of breastfeeding. Previous studies have assessed cumulative stress, income, or education as a proxy for social disadvantage, but few have codified types of stress (social vs economic) in relation to maternal preventative care & birth outcomes.

Objective: To determine whether stress classified into economic or social categories is associated with self-reported intention to breastfeed (ITBF), preconception care screening (PCCS) & birth outcomes [small for gestational age (SGA), preterm birth (PTB), NICU Admission (NICU)].

Design/Methods: Cross sectional (2016-2025), multicenter survey study of mothers (≥18 yrs) of singleton live-born infants combined with birth certificate data. Antenatal outcomes were ITBF & PCCS for diabetes (DM), hypertension (HTN) & family medical history (FMH). Birth outcomes included NICU, SGA, PTB & a composite of these. Self-reported stressors were divided into social (eg. divorce, incarceration) or economic (eg. job insecurity, homelessness, Table 1). Insurance type (Medicaid vs. private) was not included in the economic stress category as it was co-linear with several of the components. Mothers reporting both social & economic stressors were excluded (n=828). Bivariate analysis compared those with social stress vs. economic vs. none in relation to the outcomes. Logistic regression models assessed odds of ITBF & PCCS for DM, HTN & FMH, controlling for clinical factors.

Results: 524 mothers analyzed, 77 had economic stress, 334 had social stress, & 113 had neither. Mothers with economic stress had lower rates of ITBF & PCCS DM & FMH. Birth outcomes were not associated with stress categories. Mothers with economic stress had decreased adjusted odds of PCCS HTN 0.48 [0.24-0.97], PCCS FMH 0.39 [0.20-0.77], & ITBF 0.46 [0.24-0.88] but not PCCS DM compared to those without any stress. Social stressors were not associated with PCCS or ITBF.

Conclusion(s): Economic but not social stress was associated with lower ITBF and PCCS. Further, birth outcomes were not associated with stressor categories, which may be more likely to be affected by clinical factors in our population. We speculate economic stress may have a greater impact on preconception & prenatal health through lack of access to care including preconception & prenatal counselling. Clinicians may consider screening for the components of our economic stressor components to provide additional support for breastfeeding & facilitate preconception health screening.

Table 1
Definition of stressor categories and high-risk pregnancy. Factors were self-reported or collected from infant's birth certificate.

Table 2
Bivariate analysis of clinical/demographic information and outcomes between stress groups.