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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Lisa Chasan-Taber

Second Advisor

Elizabeth Bertone-Johnson

Third Advisor

Penelope Pekow

Fourth Advisor

Sally Powers

Subject Categories

Epidemiology | Maternal and Child Health | Other Mental and Social Health | Women's Health


Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) in a population of predominantly Puerto Rican women that participated in Proyecto Buena Salud (PBS), a prospective cohort study. In adjusted analyses, mid-pregnancy perceived stress was positively associated with low birth weight and both early and mid-pregnancy stress was positively associated with preterm birth. In addition, an increase in perceived stress during pregnancy was positively associated with SGA in adjusted analyses. Findings from this study suggest that timing and patterns of exposure to stress are important to consider in screening and prevention efforts. The second study examined associations between depression during pregnancy and preterm birth, low birth weight and SGA among PBS participants. Early and mid-pregnancy depression was positively associated with SGA in adjusted analyses. Increasing duration of exposure to major depression during pregnancy was also found to increase risk for SGA. No associations were observed between depression and preterm birth or low birth weight. Findings suggest that depression screening and intervention in early pregnancy is important to reduce risk for SGA. The third study evaluated the association between physical activity and depression during pregnancy in PBS participants. Few associations were observed in prospective analyses. Contrary to expectations, total physical activity was positively associated with depression in some adjusted analyses, likely because the majority of physical activity among participants was non-voluntary (e.g. household/caregiving) and potentially stressful. Findings suggest a protective effect of early pregnancy physical activity on mid-pregnancy depression among women that did not have depression in early pregnancy, though more research is needed to confirm these findings.