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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

Spring 2014

First Advisor

Lisa Chasan-Taber

Subject Categories

Epidemiology | Maternal and Child Health

Abstract

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women.

The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy alcohol, and smoking were positively associated with high early pregnancy stress. Greater number of adults in the household was positively associated with high mid-pregnancy stress; while Spanish language preference and annual household income were inversely associated with high mid-pregnancy stress. Likewise, income was inversely associated with high late pregnancy stress.

The second project examined the association between perceived stress and glucose intolerance among 1,115 pregnant Hispanic women from Proyecto Buena Salud. Stress during early and mid-pregnancy was measured using perceived stress scale. Medical records were abstracted for blood glucose values. In multivariable logistic regression models, increase in stress from early-mid pregnancy was positively associated with risk of gestational diabetes.

The third project examined the association between anxiety and depression and risk of tooth loss and use of oral health services among 402 pregnant participants in the 2010 Behavioral Risk Factor Surveillance System, a state-based telephone survey among the non-institutionalized U.S. adult population. Using multivariable logistic regression, we found that lifetime diagnosed anxiety was positively associated with tooth loss and non-use of oral health services in the past year. We found no association between depression and oral health.

To summarize, this dissertation adds to the limited research on psychosocial factors and their associated impacts on the health of pregnant women. Evaluation of correlates of stress may be useful in identifying women at high risk for prenatal stress, particularly Hispanic women. Early identification of modifiable psychosocial risk factors may provide an opportunity for prevention of glucose intolerance and oral disease during pregnancy.

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