Advancing understanding of health disparities beginning before birth: A multisite study

Modified Project Summary/Abstract Section There are well documented health disparities in preterm birth outcomes, including preterm birth and low birth weight. Few studies have examined how prenatal experiences of stress affect fetal health and development through a process of “biological embedding” measured daily during pregnancy. This study will address three major gaps in the literature to date. First, experiences of stress are often measured globally, missing the cumulative nature of stress exposure on fetal physiological development. Second, it is unclear whether specific partner behaviors (e.g., validation of stressors) and/or coping strategies can buffer effects of stress on maternal physiology, fetal physiology, and birth outcomes. Third, given the novelty of this research program, it is important to integrate qualitative methods that center the experiences of pregnant women during this transformative and vulnerable life stage. The objective of this proposal is to advance understanding of health disparities in pregnant women and infants by (1) enrolling pregnant women during the 2nd and 3rd trimester of pregnancy and assessing daily stress experiences through daily diary assessments (14 consecutive days trimester); (2) measuring maternal and fetal psychophysiology during the third trimester (e.g., heart rate, heart rate variability); (3) assessing newborn neurodevelopment within 48 hours of birth; and (4) exploring buffers and qualitative experiences of stress on women and infants. We will enroll 400 pregnant women from the Atlanta, GA and Durham, NC areas (n=200/site), using established protocols for recruiting and retaining women during this developmental stage. Participating women will complete questionnaires and a 2-week daily diary of stressors in the 2nd and 3rd trimester. In the 3rd trimester, women will complete these measures, a qualitative interview, and two weeks of in-home maternal and fetal physiological measures, which includes an innovative measure of fetal heart rate (HR) and HR variability (HRV). Women will also complete a structured interaction task with their partner; involving discussions of how each cope with stressors. Within 48 hours of birth, infants will complete the NICU Network Neurobehavioral Scale (NNNS) to assess how prenatal exposure to stress may affect newborn birth outcomes. This short-term longitudinal study lays the foundation for further follow-up of infants and women into early childhood and a programmatic line of research devoted to understanding and intervening with mothers and children to reduce the effects of stress on family health and wellbeing.