Teaching & Learning Guide for: Psychosocial Perspectives on Pregnancy: Prenatal Maternal Stress and Coping

Authors


Abstract

This guide accompanies the following article: Marci Lobel, Jada G. Hamilton, and Dolores T. Cannella, ‘Psychosocial Perspectives on Pregnancy: Prenatal Maternal Stress and Coping’, Social and Personality Psychology Compass 2/4 (2008): 1600–1623, DOI 10.1111/j.1751-9004.2008.00119.x

Authors’ Introduction

Adverse birth outcomes such as low birthweight and preterm delivery have substantial physical, economic, and emotional consequences that include impaired neurodevelopment, poor health, and increased risk of infant mortality. Thus, efforts to identify factors that contribute to the likelihood of these birth outcomes are of primary importance. Over the last several decades, a consensus has developed that psychosocial factors in pregnancy affect birth outcomes. Much of this research has focused on prenatal maternal stress. Numerous studies demonstrate that women who experience high levels of stress during pregnancy deliver their babies earlier and deliver babies of lower weight. Women subjected to chronic stressors such as racism also have higher rates of adverse birth outcomes. The effects of stress on birth outcomes are explained in part by behaviors such as cigarette smoking and physical inactivity that are more common under stress, and also by physiological processes involving the immune, cardiovascular, metabolic, and neuroendocrine systems. Recent studies also suggest that interpersonal resources such as social support and beneficial traits such as optimism and adaptive coping styles reduce prenatal stress and alleviate its effects on birth outcome. Taken together, existing research indicates that there are complex interactions among the psychosocial conditions that women experience in pregnancy, their emotional, behavioral, physical, and cognitive responses to these conditions, and the physiological processes that affect fetal growth, development, and the timing of delivery. This research exemplifies the important role of psychosocial theory and methodology in tackling the problem of adverse birth outcomes.

Authors Recommend

Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer Publishing Company.

Richard Lazarus’ theoretical approach to stress, emphasizing the role of cognitive appraisal and coping, is arguably the most influential perspective on stress in all of Psychology. In this seminal book, Lazarus and Folkman provide an exhaustive analysis of prevailing theories of stress and coping and a detailed presentation of their theoretical framework. Findings from studies of stress, coping, adaptation, emotions, and health from numerous disciplines are integrated into a comprehensive theory of stress: what it is, how we respond to it, and its effects. The authors also address methodological challenges in studying stress, and some clinical implications related to stress management. This book is a must-read for any student of stress and remains one of the most important volumes ever written on this topic.

Carver, C. S., & Scheier, M. F. (1994). Situational coping and coping dispositions in a stressful transaction. Journal of Personality and Social Psychology, 66(1), 184–195.

By assessing college students’ coping throughout the stressful transaction of a course exam, this classic study investigated associations between dispositional coping styles and situational coping strategies. The researchers also examined associations between people’s emotional responses to the exam and the ways they coped. Findings demonstrate that the demands of a stressful situation unfold over time, and that people respond to such demands through a dynamic process.

Rini, C. K., Dunkel-Schetter, C., Wadhwa, P. D., & Sandman, C. A. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychology, 18(4), 333–345.

This study was one of the first to investigate the impact of pregnant women’s personal resources including optimism, mastery, and self-esteem, on birth outcomes. Associations among prenatal maternal stress, personal resources, sociocultural variables, and birth outcomes including infant birthweight and gestational age were examined in an ethnically-diverse sample. Stress was a direct contributor to length of gestation; resources predicted lower stress and also contributed directly to birthweight. Most of the sociocultural variables such as ethnicity, income, and age, were associated with resources; some were associated with stress.

Lobel, M., DeVincent, C. J., Kaminer, A., & Meyer, B. A. (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19(6), 544–553. doi:10.1037/0278-6133.19.6.544

This study tested the hypothesis that chronic stress during pregnancy is related to underlying dispositions such as optimism and pessimism that contribute to adverse birth outcomes. The authors investigated joint associations of prenatal maternal stress and optimistic disposition with birth outcomes and examined the role of health behaviors in accounting for these associations. As hypothesized, after controlling for stress, optimistic women delivered infants who weighed significantly more. Optimists were also more likely to exercise during pregnancy, and as a result, had lower risk of preterm delivery.

Giscombé, C. L., & Lobel, M. (2005). Explaining disproportionately high rates of adverse birth outcomes among African Americans: The impact of stress, racism, and related factors in pregnancy. Psychological Bulletin, 131(5), 662–683. doi:10.1037/0033-2909.131.5.662

This comprehensive review article analyzes mechanisms that may account for the disproportionately high rates of adverse birth outcomes that occur among African Americans, involving: (1) health behaviors and socioeconomic status, (2) levels of stress in African American women, (3) susceptibility to stress in African Americans, (4) racism, and (5) stress-related physiological processes.

Hamilton, J. G., & Lobel, M. (2008). Types, patterns, and predictors of coping with stress during pregnancy: Examination of the Revised Prenatal Coping Inventory in a diverse sample. Journal of Psychosomatic Obstetrics and Gynecology, 29(2), 97-104. doi:10.1037/a0014778

This study of more than 300 women of diverse backgrounds investigated their use of three distinct ways of coping with stress throughout pregnancy: Planning-Preparation, Avoidance, and Spiritual-Positive Coping. Findings reveal that how women cope with stress varies across pregnancy and that the ways in which women cope are associated with their individual characteristics, perceptions, and social resources.

Lobel, M., Cannella, D. L., Graham, J. E., DeVincent, C., Schneider, J., & Meyer, B. A. (2008). Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology, 27(5), 604–615. doi:10.1037/a0013242

This study focused on stress arising from pregnancy-specific issues and examined its association with low birthweight and preterm delivery as well as the extent to which these associations are explained by pregnant women’s health behaviors. Compared with other types of stress, pregnancy-specific stress uniquely contributed to preterm delivery, and through its association with smoking, predicted low birthweight. The authors describe several reasons why pregnancy-specific stress may be a stronger contributor to adverse birth outcomes than general or non-specific stress.

Online Materials

Managing stress during pregnancy

http://www.marchofdimes.com/39679_42475.asp

This video by the March of Dimes provides practical tips to manage stress and maintain wellness during pregnancy.

Moms in motion: Pregnant women need exercise

http://www.webmd.com/video/moms-exercise

This video discusses the benefits of physical activity in pregnant women and explains that it is one of the most important things that pregnant women can do to protect the health of their baby.

Exercise encouraged during pregnancy

http://www.cbsnews.com/stories/2009/07/17/uttm/americanbaby/main5166982.shtml

This is an interview with Kate Kelly, Managing Editor of American Baby Magazine, that was broadcast on CBS’s Up to the Minute. Kelly discusses the benefits of physical activity for pregnant women as well as the types of activities most suitable for pregnant women.

Stress and pregnancy don’t mix

http://archives.cnn.com/2000/HEALTH/women/02/15/pregnancy.stress.wmd/

This website describes the types of stress that are harmful for pregnant women, effects of stress on birth outcomes and other longstanding effects, and ways for pregnant women to manage stress effectively.

Stress during pregnancy: A dozen techniques for coping with stress

http://womenshealth.about.com/cs/pregnancy/a/mispregstress.htm

Provides an extensive list of ways that pregnant women can cope with stress by altering the situations that are stressful for them, or learning how to manage and alleviate emotional reactions.

Simple stress busters

http://elizabethedwardsen.com/portfolio-elizabeth-edwardsen-maine-freelance-write/5-simple-stress-busters/

Five easy techniques to reduce physical and psychological symptoms of stress are described, including relaxation, stretching, and positive ways of thinking.

Soothing music reduces stress, anxiety and depression during pregnancy says study

http://www.medicalnewstoday.com/articles/124336.php

Describes results of a study showing that pregnant women who listened to relaxing music 30 minutes per day experienced a reduction of stress, anxiety, and depressed mood after 2 weeks. Results suggest that listening to music may be a low-cost, safe, and easy way to reduce emotional distress during pregnancy.

Sample Syllabus

This article could be used in a semester-long class examining current conceptual and methodological issues or challenges in stress and coping research.

Sample Course Topics

Conceptualizing and Measuring Stress

Stress and Health

Stress and Cognition

Social Aspects of Stress

Coping with Stress

Stress, Coping, and Gender

Stress-Protective Factors

This article could also be used as part of a course examining psychological aspects of women’s health.

Sample Course Topics

Health Behaviors in Women

Stress, Coping, and Women’s Physical Health

Reproductive Health: Menstruation to Menopause

Preventing Sexually Transmitted Infections

Contraception and Birth Control

Unwanted Pregnancy

(In)fertility, Pregnancy, and Childbirth

Focus Questions

  • 1 What additional individual traits, characteristics, or resources may help women to manage pregnancy-related stress or to reduce its effects? Conversely, what factors might make women more vulnerable to distress or to its effects during pregnancy?
  • 2 What are the challenges in determining whether various coping strategies are ‘adaptive’ or ‘maladaptive?’
  • 3 Longitudinal studies targeting diverse samples and incorporating a number of psychosocial and physiological measures could help to clarify some of the questions raised by this article. What specific questions would you address? What variables would you measure, and in whom? What are some of the practical or theoretical challenges associated with conducting such research?

Project Idea

Stress and Coping Measurement (class exercise to be completed in groups or individually)

This exercise is designed to help students understand the differences between generic and situationally-specific stress and coping measures. Begin by distributing a generic measure of stress to your students, such as the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). In addition to having them read over each item, you may want to encourage your students to complete the measure and calculate their own scores. Next, distribute a pregnancy-specific measure of stress, such as the Revised Prenatal Distress Questionnaire (Lobel et al., 2008). Ask your students to examine these items, and consider any similarities or differences between the two measures. Then, distribute a general measure of coping behaviors, such as the Brief COPE (Carver, 1997). Ask your students to brainstorm about unique ways of coping that a woman may adopt during pregnancy, and then ask them to share these ideas with the class. Finally, distribute a pregnancy-specific measure of coping, such as the Revised Prenatal Coping Inventory (Hamilton & Lobel, 2008). Conclude with several discussion questions for the class: Were students’ suggested ways of coping similar to those included in the pregnancy-specific measure? Are all ways of coping healthy or beneficial? What may be the advantages of using a generic measure of stress or coping in a research study? What are the advantages of using a situationally-specific measure?

Project References

Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

Hamilton, J. G., & Lobel, M. (2008). Types, patterns, and predictors of coping with stress during pregnancy: Examination of the Revised Prenatal Coping Inventory in a diverse sample. Journal of Psychosomatic Obstetrics and Gynecology, 29(2), 97–104. doi:10.1037/a0014778

Lobel, M., Cannella, D. L., Graham, J. E., DeVincent, C. J., Schneider, J., & Meyer, B. A. (2008). Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology, 27(5), 604–615. doi:10.1037/a0013242

Ancillary