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Chronic Stress and Low Birth Weight Neonates in a Low-Income Population of Women

From the ¹Northwestern University, Department of Obstetrics and Gynecology, Chicago, Illinois; ²Northwestern University, Institute for Healthcare Studies, Chicago, Illinois; and ³Northwestern University, Department of Pediatrics, Chicago, Illinois.

OBJECTIVE: To estimate whether there is an association between chronic psychosocial stress and low birth weight neonates in low-income women.

METHODS: Between 1999 and 2004, a random sample of women receiving welfare in nine Illinois counties was selected. The women were then interviewed annually. Women who delivered during this period were identified. Self-reported stress that occurred in temporal proximity to the delivery was assessed by 1) external stressors, 2) enhancers of stress, 3) buffers against stress, and 4) perceived stress and was compared between women who delivered low birth weight neonates and women who delivered normal birth weight neonates.

RESULTS: Of the 1,363 women in the study, 294 women (21.6%) became pregnant and delivered during the study period. Of the 294 deliveries, 39 (13.3%) were low birth weight. The only demographic factor associated with a low birth weight delivery was increasing maternal age. However, multiple psychosocial factors, including food insecurity (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4–7.2), a child with chronic illness in the home (OR 3.4, 95% CI 1.5–7.9), increased crowding in the home (OR 2.7, 95% CI 1.3–5.6), unemployment (OR 3.1, 95% CI 1.2–7.9), and poor coping skills (OR 3.8, 95% CI 1.7–8.7), were significantly associated with low birth weight delivery (P < .01 for all comparisons). These significant associations persisted after adjusting for maternal age in multivariable analysis.

CONCLUSION: This study provides evidence that chronic psychosocial stress may be associated with low birth weight neonates in a low-income population of women.

LEVEL OF EVIDENCE: II