Impact of Stressful Life Events on Infant Birth Outcomes: Do Race/Ethnicity and Hypertension in Pregnancy Matter?

Background: Exposure to stressors impacts maternal and infant health. Growing evidence suggests stressful life events (SLEs) are associated with adverse infant birth outcomes. The objective of this study was to determine how SLEs affected infant outcomes (low birth weight [<2500 g], preterm birth, and small for gestational age), and how these effects were influenced by race/ethnicity and hypertensive disorders of pregnancy. Methods: The weighted prevalence of SLEs and adverse infant outcomes were investigated using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2009 to 2020. Adjusted risk ratios were estimated for the effects of SLEs, hypertensive disorders of pregnancy (including hypertension before pregnancy and pregnancy-induced hypertension), and race/ethnicity on infant outcomes using multivariable log-binomial modeling. Results: The dataset included 452,031 women between the ages of 18 and 45. During the year before giving birth, the incidence of self-reported SLEs was between 66% and 72%. Black mothers had more SLEs, significantly increased risk of preterm birth (<37 weeks) and low birth weight. Conclusion: Adverse infant outcomes were more likely among Black mothers participating in PRAMS, perhaps because of a higher number of self-reported SLEs.