Types, Patterns, and Predictors of Coping with Stress during Pregnancy: Examination of the Revised Prenatal Coping Inventory in a Diverse Sample

Abstract

The present study investigated coping in early, mid-, and late pregnancy in 321 ethnically and socioeconomically diverse women of varying medical risk. The goal was to determine how women cope with stress across pregnancy and to explore the association of coping with maternal characteristics, stress perceptions, disposition, and social support. Factor analysis of the Revised Prenatal Coping Inventory revealed three distinct types of coping: Planning-Preparation, Avoidance, and Spiritual-Positive Coping. Spiritual coping was used most frequently during pregnancy; avoidant coping was used least often. As hypothesized, use of spiritual coping and avoidance differed across pregnancy. Planning was used more consistently across time. Multivariate regression analyses revealed that the strongest predictors of planning were high optimism and pregnancy-specific distress. Avoidance was most strongly predicted by high state anxiety and pregnancy-specific distress. Greater religiosity and optimism were the strongest predictors of spiritual coping. These results add to a body of evidence that women use distinctive and varied strategies to manage stress prenatally. They also suggest that coping is responsive to changing demands across pregnancy and reflective of women's characteristics, perceptions, and social situations.

Full text

Types, patterns, and predictors of coping with stress during
pregnancy: Examination of the Revised Prenatal Coping Inventory
in a diverse sample
JADA G. HAMILTON & MARCI LOBEL
Department of Psychology, Stony Brook University, NY, USA
(Received 20 March 2007; accepted 11 September 2007)
Abstract
The present study investigated coping in early, mid-, and late pregnancy in 321 ethnically and socioeconomically diverse
women of varying medical risk. The goal was to determine how women cope with stress across pregnancy and to explore the
association of coping with maternal characteristics, stress perceptions, disposition, and social support. Factor analysis of the
Revised Prenatal Coping Inventory revealed three distinct types of coping: Planning-Preparation, Avoidance, and Spiritual-
Positive Coping. Spiritual coping was used most frequently during pregnancy; avoidant coping was used least often. As
hypothesized, use of spiritual coping and avoidance differed across pregnancy. Planning was used more consistently across
time. Multivariate regression analyses revealed that the strongest predictors of planning were high optimism and pregnancy-
specific distress. Avoidance was most strongly predicted by high state anxiety and pregnancy-specific distress. Greater
religiosity and optimism were the strongest predictors of spiritual coping. These results add to a body of evidence that women
use distinctive and varied strategies to manage stress prenatally. They also suggest that coping is responsive to changing
demands across pregnancy and reflective of women’s characteristics, perceptions, and social situations.
Keywords: Pregnancy, coping, Prenatal Coping Inventory, stress, planning, preparation, avoidance, prayer
Introduction
Although pregnancy is a time of joyous anticipation
for many women, it can be difficult for some. Changes
in physique, self-identity, and interpersonal relation-
ships may tax a woman’s psychosocial and tangible
resources and the resulting stress can affect maternal
well-being [1]. High prenatal stress also increases the
likelihood of preterm delivery and low birth-weight
[2–4], and is associated with labor analgesia and
unplanned cesarean delivery [5]. Thus, it is vital to
understand how women cope with stress during
pregnancy.
Coping involves cognitive or behavioral attempts to
manage demands that are perceived as taxing or
exceeding one’s resources [6,7]. Both situational and
intrapersonal factors including available resources,
competing demands, and the perceived controllability
of a situation influence how an individual copes with
stress [8–11]. Coping is also associated with disposi-
tion. For example, optimism has been linked with
particular ways of coping in pregnant women [11] and
in other populations [12].
Although some cross-situational stability exists ,
coping is a dynamic process that respon ds to the
changing course of stressful conditions [6,13–15].
Multiple coping strategies may be employed, and
people continuously re-evaluate a situation to deter-
mine whether their coping efforts are succeeding.
Thus, coping is likely to change over time [16,17].
For these reasons, when studying coping, it is
important to examine a situation over time, and to
address situationally-specific demands. Generic as-
sessment approaches are likely to provide incomplete
or inaccurate results when examining coping in a
particular situation such as pregnancy. Unfortunately,
much prior research on prenatal coping has employed
generic approaches and has assessed coping at a single
timepoint. These include studies in late pregnan cy of
high-risk women [18,19] and low-income minority
women [20]; studies comparing African American
and Caucasian women in mid-pregnancy [21],
women with or without risk for fetal malformation
Correspondence: Marci Lobel, Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA. Tel: (631) 632-7651.
Fax: (631) 632-7876. E-mail: marci.lobel@stonybrook.edu
Journal of Psychosomatic Obstetrics & Gynecology, June 2008; 29(2): 97–104
ISSN 0167-482X print/ISSN 1743-8942 online Ó 2008 Informa UK Ltd.
DOI: 10.1080/01674820701690624

undergoing ultrasound [22], women with varying
diabetic histories [23], and low-risk American and
Japanese women [24]. These studies suggest that
pregnant women use numerous coping strategies that
are related to maternal characteristics, social situa-
tions, and emotional reactions. Yet the variety of
samples, assessment timepoints, and coping measures
makes it difficult to compare findings or draw firm
conclusions.
Huizink and colleagues [25] improved upon prior
work by assessing coping in nulliparous, low-risk
women during early, mid-, and late pregnancy. Using
the generic 19-item Utrecht Coping List [26], two
factors were identified: emotion-focused coping,
which was used most frequently in early pregnancy,
and problem-focused coping, which was used most
frequently in early and mid-pregnancy. These ways of
coping were predicted by maternal characteristics
including locus of control, educational level, age,
depression, and situation appraisal. Thus, this in-
vestigation helped to clarify the coping process and
some predictors of generic coping strategies used
during pregnancy, but may have failed to capture
aspects of coping unique to the prenatal context.
Yali and Lobel [27] developed a pregnancy-speci fic
coping measure, the 36-item Prenatal Coping In-
ventory (PCI), based on the theoretical framework of
stress and coping elaborated by Lazarus and Folkman
[7]. It includes items adapted from generic coping
measures [9,14] as well as items created from pilot-
testing and prior research on coping in pregnant
women. The PCI was found to be psychometrically
sound, and to have four reliable coping subscales in
medically high-risk women in mid-pregnancy: Pre-
paration, Avoidance, Positive Appra isal, and Prayer.
Of these, prayer was employed most frequently.
Preparation was associated with youn ger maternal
age and with nulliparity; prayer was also associated
with younger age. Yet coping was assessed only once
in this study of a homogenous sample, leaving
unanswered questions about pregnancy-specific cop-
ing during the full course of pregnancy in diverse
women.
The purpose of the present study was to utilize the
Revised Prenatal Coping Inventory (NuPCI), an
adapted and expanded version of the PCI, with a
sample of ethnically and socioeconomically diverse
women of varying medical risk in early, mid-, and late
pregnancy. Coping in a small subsample of these
women was examined previously [28]. We hypothe -
sized that women would cope differently during early,
mid-, and late pregnancy in response to changing
demands and that the use of each type of coping would
be predicted by unique variables including maternal
characteristics, stress perceptions, disposition, and
social support. Consistent with prior coping research
[8,9,11,12], we expected that coping strategies
traditionally classified as adaptive would be associated
with greater optimism and social support, and that
maladaptive ways of coping would be associated with
greater emotion al distress. We could not advance
more specific hypotheses about patterns of prenatal
coping, or about which variables would predict these
ways of coping due to the limited theoretical and
empirical body of prior work.
Methods
Overview
Participants were recruited from a university
hospital public prenatal clinic. Trained research
assistants conducted three structured interviews at
M ¼ 16.7 + 4.4, 26.0 + 3.8, and 36.0 + 2.4 weeks
of pregnancy. Sociodemographic information,
pregnancy history, and dispositional variables were
assessed once; coping, distress, and social support
were measured in all three interviews. Obstetric risk
was determined by medical chart abstraction. Multi-
variate statistical analyses were used to determine the
factor structure of the coping measure, and to
examine patterns and predictors of prenatal coping.
Participants
Participants were required to speak English fluently,
to be less than 25 weeks pregnant at recruitment, and
to be a minimum of 18 years old because unique
issues are associated with adolescent pregnancy [29].
We approached 834 eligible women. Of these,
approximately 73% agreed to participate. A total of
321 women completed all study measures. Others
(n ¼ 285) did not complete the study for reasons
including miscarriage, referral to other healthcare
providers, and relocation. No differences were found
between study completers and non-completers, with
two exceptions. Non-c ompleters were 47% non-
white and 22% had household incomes under
$10,000, compared with 34% and 13% of study
completers. For nine study completers, a negligible
amount of data was missing for some sociodemo-
graphic and psychosocial variables. In these in-
stances, mean replacement was used. The sample
was diverse in terms of sociodemographic and
medical cha racteristics (see Table I).
Measures
Coping. The NuPCI is a revised version of the 36-
item PCI [27], modified to be administered by
interview and appropriate for use throughout preg-
nancy. Based on open-ended interviews and piloti ng
with pregnant women, new items, particularly
pertaining to prayer which has been shown to be
the most commonly-used way of coping in pregnancy
[27], were added to the original PCI, producing a
98 J. G. Hamilton & M. Lobel

42-item measure. Respondents report how often they
used different kinds of coping ‘‘to try to manage the
strains and challenges of being pregnant’’ in the past
month on a scale from 0 (never) to 4 (very often).
Sample items inclu de ‘‘imagined how the birth will
go’’, ‘‘wished that you weren’t pregnant’’, and
‘‘prayed that the birth will go well’’.
Socioeconomic status (SES). SES was calc ulated by
standardizing and summing the participant’s and
baby’s father’s employment status, annual household
income, and the participant’s educational level.
Values for employment status were based on the
Hollingshead scal e [30] and ranged from 0 to 9
(0 ¼ lowest). Household income was comprised of
six categories ranging from under $10,000 to more
than $50,000. Educational level included six cate-
gories ran ging from junior high school to graduate
degree completion.
Obstetric risk. The 38-item index was based on the
Problem Oriented Perinatal Risk Assessment System
[31] and has demonstrated value as a predictor of
adverse birth outcomes [32]. Items cover six
categories: unusual features of pregnancy, gynecolo-
gical/obstetrical history, past pregnancy complica-
tions, medical hist ory, family history, and current
pregnancy complaints. Items are scored as present or
absent, and summed. Scores ranged from 0 to 9.
Optimism. Dispositional optimism was measured
with the 12-item Life Orientation Test (LOT) [33].
Items are rated on a five-point scale ranging from 0
(strongly disagree) to 4 (strongly agree), and
summed. Optimism is stable over time (average
test–retest reliability ¼ 0.79). Consistent with past
studies [33], the LOT demonstrated high internal
consistency (a ¼ 0.82).
Religiosity. Participants reported ‘‘how religious or
spiritual’’ they are on a scale from 1 (not at all) to 4
(very much).
State anxiety. The state anxiety subscale of the State-
Trait Personality Inventory (STPI) [34] was used as
one indicator of emotional distress. The 10-item
state anxiety subscale assesses how anxious one feels
at the present moment. Items are rated on a fou r-
point scale ranging from 0 (not at all) to 3 (very
much), and summed. This measure had high internal
consistency at all timepoints (a ¼ 0.89, 0.91, and
0.89).
Pregnancy-specific distress. To assess distress arising
from stressors unique to pregnancy [1], a revised
version of the Prenatal Distress Questionnaire
(PDQ) was administered [27]. The revised m easure
was designed to be administered by interview in
early, mid-, and late pregnancy. It includes nine
items administered at each interview, plus unique
items added to the mid- and late pregnancy
interviews that are relevant as pregnancy
progresses. Participants indicate the extent to which
they are feeling ‘‘bothered, upset, or worried at this
point’’ about issues including medical care, physical
symptoms, parenting, bodily changes, and the
infant’s health. Responses are on a three-point scale
ranging from 0 (not at all) to 2 (ver y much).
Average pregnancy-specific distress scores were
calculated for each timepoint. Items comprising
the revised PDQ were modestly inter-correlated
(a ¼ 0.62, 0.72, and 0.81 at each timepoint),
reflecting the expected independence of some of
the stressors included.
Table I. Subject characteristics (N ¼ 321).
Age Mean: 27.2 + 5.9
Parity Mean: 1.1 + 1.3
Ethnicity
White 66.4%
Latina or Hispanic 11.5%
African-American or Black 10.6%
Multi-ethnic 9.0%
Asian or Pacific Islander 1.9%
Native American 0.9%
Annual household income Median: $20,000–30,000
Highest level of education
completed
Junior high school 0.9%
10
th
or 11
th
grade 13.4%
High school 38.9%
Associate’s degree or
some college
37.1%
College 7.8%
Graduate degree 1.2%
Marital status
Married or living with a
partner as if married
63.2%
Single 29.0%
Divorced or separated 6.2%
Other 1.2%
Living arrangements
Living with baby’s father 67.0%
Living with family other
than baby’s father
21.2%
Living alone 5.6%
Living with friends 1.2%
Other 5.0%
Mother’s employment status
Not employed 51.7%
Part-time 29.3%
Full-time 19.0%
Father’s employment status
Not employed 13.7%
Part-time 8.7%
Full-time 74.8%
Don’t know 2.8%
Obstetric risk Mean: 2.6 + 1.8
Coping in pregnancy 99

Social support. Social support was measured with an
adapted version of an instrument developed by
Collins et al. [35]. It assesses four types of social
support: material aid, assistance with tasks, advice or
information, and listening while one expresses bel iefs
or feelings. Respondents indicate whether they have
received each type of support in the past week.
Affirmative responses were coded as ‘‘1’’, and
summed to create a measure of total received social
support with values ranging from 0 to 4. For each
type of support received, participants also rated how
satisfied they were on a 1 (not at all) to 4 (very much)
scale. Satisfaction responses were summed and th en
divided by the number of types of support received.
Received support and satisfaction were moderately
correlated in early, m id-, and late pregnancy
(r ¼ 0.52, 0.56, and 0.58, p 5 0.001).
Results
Factor analysis
The NuPCI was examined through exploratory
factor analysis using principal compo nents analysis
with orthogonal rotation. Based on inspection of the
Scree plot and of eigenvalues greater than 1 [36],
three distinct factors were consistently extracted for
each timepoint. The three fac tors accounted for
30.8%, 32.4%, and 34.2% of variance in early, mid-,
and late pregnancy, respectively. Ten items
were eliminated because they (a) failed to load at
least 0.30 on any factor (four items); (b) loaded
inconsistently across timepoints (four items); or
(c) failed to contribute to the reliability of any factor
(two items).
These steps resulted in three coping factors that
were distinct, conceptually interpretable, internally
consistent, and comprised the same items across
time. The first factor, labeled Planning-Preparation,
included 15 items with Cronbach a’s of 0.82, 0.85,
and 0.86 in early, mid-, and late pregnancy,
respectively. The second factor, Avoidance, com-
prised 11 items with Cronbach a’s of 0.77, 0.79, and
0.80. The third factor, Spiritual-Positive Coping,
comprised six items with Cronbach a’s of 0.73, 0.78,
and 0.77. Table II shows items for each factor. The
coping factors were independent of one another at
each timepoint (see Table III).
Patterns of coping
As shown in Table IV, women used each way of
coping to a different extent, F(2, 640) ¼ 289.21,
p 5 0.001. Post-hoc pairwise comparisons corrected
with Tukey’s HSD test (p ¼ 0.05) indicate that
Spiritual-Positive Coping was used most often,
Planning-Preparation was used to a moderate extent,
and Avoidance was used least frequently.
Planning-Preparation was stable over time, F(2,
640) ¼ 1.53, p ¼ 0.22. Avoidance varied over time,
F(2, 640) ¼ 4.78, p ¼ 0.01, as did Spiritual-Positive
Coping, F(2, 640) ¼ 13.47, p 5 0.001. Corrected
post-hoc paired comparisons indicate that women
were more likely to cope by Avoidance in early than
in late pregnancy and that Spiritual-Positive Coping
Table II. Revised Prenatal Coping Inventory (NuPCI) factors.
Item
number
Planning-Preparation
1 Imagined how the birth will go
2 Talked to people about what it is like to raise a child
3 Compared yourself to women having a more
difficult pregnancy
5 Asked doctors or nurses about the birth
11 Thought about what it will be like after the baby comes
12 Planned how you will handle the birth
13 Spent time or talked with someone who just had a baby
14 Made plans to get baby clothes or supplies
17 Gotten advice and understanding from someone about
your pregnancy
19 Spent time with other pregnant women or talked
with them
23 Planned how you or someone else will take care of
the baby
24 Imagined or pretended being the mother of a newborn
34 Talked to family or friends about what it is like to
give birth
39 Felt that having a baby was fulfilling a lifetime dream
or goal
42 Read or watched something about childbirth that
told what it would be like
Avoidance
4 Taken out frustrations on other people
7 Tried to keep your feelings about being pregnant
to yourself
10 Slept in order to escape problems
18 Tried not to think about the birth
20 Told yourself that things could be worse
26 Wished that the birth was over already
27 Tried to make yourself feel better with food
30 Thought about pregnant women who are doing
better than you
31 Tried to stay away from other people
37 Wished that you weren’t pregnant
38 Tried to keep your feelings about the pregnancy from
interfering with things you had to do
Spiritual-Positive Coping
6 Read from the bible or a book of prayers
9 Tried to focus on what is important in life
16 Prayed for strength or courage to get through your
pregnancy
33 Prayed that the birth will go well
36 Prayed that the baby will be healthy
41 Gone to church, synagogue, a mosque, or other place
to pray
Note: Eliminated items included remembering worse times in life
(#8), focusing on positive aspects of pregnancy (#15, #22, and
#35), alcohol use (#21), avoiding stories about childbirth (#25),
planning changes in work (#28), cigarette smoking (#29), exercise
(#32), and drug use (#40).
100 J. G. Hamilton & M. Lobel

Table III. Correlations among major study variables.
Variables 1 2 3 456789101112131415161718192021222324252627
1. PP-E –
2. A-E .11 –
3. SPC-E .41*** .11* –
4. PP-M .70*** .13* .37*** –
5. A-M .16*** .73*** .14* .17** –
6. SPC-M .36*** .07 .75*** .40*** .13* –
7. PP-L .67*** .16** .32*** .80*** .23*** .36*** –
8. A-L .12* .74*** .13* .12* .80*** .17** .20*** –
9. SPC-L .29*** .09 .73*** .33*** .16** .83*** .41*** .21*** –
10. SES 7.01 7.07 7.08 .04 7.07 7.07 .02 7.11 7.12* –
11. Parity 7.29*** 7.03 .13* 7
.28*** 7.03 .10 7.27*** .03 .14* 7.05 –
12. Risk 7.16** .13* .03 7.13* .08 7.03 7.14** .10 7.02 7.19*** .26*** –
13. Optimism .09 7.33*** .21*** .14* 7.32 *** .18*** .15** 7.32*** .19*** .12 * .12* 7.10 –
14. Religiosity .14* 7.03 .48*** .15** 7.01 .51*** .18*** .02 .49*** .03 .21*** .00 .23*** –
15. Anxiety.-E .13* .49*** .02 .09 .39*** 7.03 .14* .43*** 7.00 7.05 7.12* .12*
7.40*** 7.15** –
16. PSD-E .27*** .54*** .08 .22*** .45*** .05 .25*** .47*** .08 7.08 7.14** .13* 7.32*** 7.00 .49*** –
17. Anxiety-M .10 .43*** 7.03 .07 .46*** 7.03 .11 .44*** 7.01 7.06 7.06 .15** 7.34*** 7.08 .54*** .43*** –
18. PSD-M .22*** .48*** .15** .23*** .53*** .09 .25*** .47*** .13* 7.12* 7.13* .15** 7.33*** .02 .44*** .64*** .52*** –
19. Anxiety-L .08 .47*** 7.03 .07 .44*** .03 .15** .52***
.05 7.10 7.04 .11 7.34*** 7.07 .49*** .43*** .56*** .46*** –
20. PSD-L .26*** .46*** .07 .25*** .51*** .09 .35*** .52*** .15** 7.03 7.16** .06 7.29*** .10 .45*** .62*** .51*** .70*** .53*** –
21. Rec. SS-E .24*** .21*** .17** .26*** .20*** .10 .27*** .18*** .08 7.09 7.03 .06 7.12* .15** .17** .23*** .15** .21*** .15** .23*** –
22. Satis. SS-E .07 7.04 .11* .13* 7.04 .10 .16** 7.08 .14*
7.06 .06 .01 .09 .22*** 7.01 7.00 7.01 .00 7.04 7.02 .52*** –
23. Rec. SS-M .20*** .23*** .06 .28*** .20*** .11 .30*** .21*** .09 .01 7.11* .02 7.01 .14* .22*** .18** .27*** .23*** .16** .25*** .54*** .31*** –
24. Satis. SS-M .05 .00 .02 .13* 7.06 .07 .10 7.07 .03 .05 .03 .02 .10 .14* .02 7.00 .05 7.00 7.04 .01 .33*** .34*** .56*** –
25. Rec. SS-L .24*** .19*** .11* .30*** .20*** .11 .37*** .21*** .17** 7.11 7.06 7.01 7.01 .17** .21*** .16**
.17** .24*** .24** .28*** .49*** .31*** .61*** .30*** –
26. Satis. SS-L .18*** .04 .13* .24*** .05 .14* .26*** .02 .19*** 7.06 7.03 .01 .11* .18*** .06 .02 7.01 .05 .00 .06 .34*** .40*** .38*** .38*** .58*** –
27. Age 7.19*** 7.04 .12* 7.19*** 7.07 .16** 7.16** 7.02 .14* .10 .50*** .13* .13* .35*** 7.14* 7.10 7.15** 7.11 7.06 7.04 7.06 .04 7.16** 7.03 7.05 7.01 –
M + SD 2.05 +
.68
1.34 +
.69
2.41 +
.80
2.09 +
.70
1.28 +
.65
2.36 +
.82
2.05 +
.72
1.26 +
.65
2.25 +
.83
12.69 +
4.17
1.11 +
1.26
2.59 +
1.78
26.39 +
5.24
2.60 +
.93
10.08 +
6.90
.74 +
.40
8.18 +
6.55
.61 +
.33
8.35 +
6.35
.58 +
.33
2.36 +
1.23
3.16 +
1.12
2.26 +
1.33
3.08 +
1.25
2.22 +
1.35
3.08 +
1.32
27.16 +
5.87
*p 5 0.05; **p 5 0.01; ***p 5 0.001; PP ¼ Planning-Preparation; A ¼ Avoidance; SPC ¼ Spiritual-Positive Coping; E ¼ Early Pregnancy; M ¼ Mid-Pregnancy; L ¼ Late Pregnancy; PSD ¼ Pregnancy-Specific
Distress; SS ¼ Social Support.

was more common in early and mid-pregnanc y than
in late pregnancy.
Predictors of coping
Table III shows bivariate correlations and descriptive
statistics for the potential predictors of coping at each
timepoint. A series of simultaneous multiple regres-
sion analys es were conducted predicting each way of
coping in early, mid-, and late pregnancy. The full set
of predictors accounted for most variance in Avoid-
ance (see Table V).
Associations between specific predictors and cop-
ing factors are displayed in Table VI. Each analysis
was examined for multicollinearity [36]; none was
found except in early pregnancy where there was
evidence of multicollinearity between religiosity and
optimism. Results involving these variables at this
timepoint should be interpreted cautiously. Plan-
ning-Preparation was predic ted most powerfully at
each timepoint by higher optimism and pregnancy-
specific distress. Higher state anxiety and pregnancy-
specific distress were the strongest predictors of
Avoidance throughout pregnancy. Religiosity
and optimism most strongly pred icted the use of
Spiritual-Positive Coping at each timepoint.
Discussion
These results establish the existence of three distinct
types of coping in pregnancy: Planning-Preparation,
Avoidance, and Spiritual-Positive Coping. Spiritual
coping was most frequently used and avoidance was
used least often to manage prenatal stress. As
hypothesized, coping also varied over the course of
pregnancy. This finding fits the perspective of coping
as a dynamic process, changing in response to
situational and contextual demands [6]. For exam-
ple, spiritual coping was most common in early and
mid-pregnancy. Such coping may be utilized when
women are primarily concerned with unpredictable
issues such as miscarriage. Avoidant coping also
decreased as pregnancy progressed, perhaps because
it becomes difficult for women to ignore their
physical changes and the inevitable experience of
birth as pregnancy advances. By comparison, women
Table IV. Descriptive statistics for coping factors during early,
mid-, and late pregnancy.
Coping factor
Early
pregnancy
M + SD
Mid-
pregnancy
M + SD
Late
pregnancy
M + SD
Spiritual-Positive
Coping
2.41 + .80 2.36 + .82 2.25 + .83
Planning-Preparation 2.05 + .68 2.09 + .70 2.05 + .72
Avoidance 1.34 + .69 1.28 + .65 1.26 + .65
Response scale range is 0–4.
Table V. Variance in the use of coping factors accounted for by the
entire set of predictor variables.
Coping factors
Early
pregnancy
Mid-
pregnancy
Late
pregnancy
R
2
FR
2
FR
2
F
Avoidance .36 19.29 .34 17.56 .37 19.81
Planning-Preparation .23 10.79 .21 9.62 .32 15.80
Spiritual-Positive
Coping
.27 12.92 .27 12.63 .28 13.24
Adjusted R
2
is reported due to the large number of predictor
variables.
All F values significant at p 5 0.001.
Table VI. Predictors of NuPCI factors during early, mid-, and late
pregnancy.
Factors and
predictor variables
b values
Early
pregnancy
Mid-
pregnancy
Late
pregnancy
Planning-Preparation
SES – – –
Obstetric Risk 7.13 – –
Optimism .21 .20 .24
Religiosity .17 .15 .12
State Anxiety – – –
Pregnancy-Specific
Distress
.24 .25 .30
Received Social Support .20 .18 .20
Satisfaction with
Social Support
–––
Maternal Age – – –
Parity 7.21 7.21 7.19
Avoidance
SES – – –
Obstetric Risk – – –
Optimism 7.10 7.13 7.13
Religiosity – – –
State Anxiety .26 .21 .29
Pregnancy-Specific
Distress
.36 .36 .33
Received Social Support .12 .14 –
Satisfaction with
Social Support
– 7.13 –
Maternal Age – – –
Parity – – .13
Spiritual-Positive Coping
SES – – 7.14
Obstetric Risk – – –
Optimism .20 .11 .14
Religiosity .46 .48 .44
State Anxiety .12 – –
Pregnancy-Specific
Distress
– .12 .13
Received Social Support .12 – –
Satisfaction with
Social Support
–––
Maternal Age – – –
Parity – – –
All b values shown are significant at or below the p ¼ 0.05 level.
Bolded b values are significant at or below the p ¼ 0.01 level.
102 J. G. Hamilton & M. Lobel

coped through preparation at a constant level across
pregnancy, which may reflect their need to plan and
gather information throughout this entire period.
As predicted, a variety of psychosocial factors and
maternal characteristics were associated with the
ways that women coped with stress. Some of these
associations corroborate findings from studies of
other populations, some do not. For example,
preparation was predicted by high er optimism, which
has been shown previously in non-pregnant samples
[12]. Optimi sm also predicted spiritual coping.
Contrary to our prediction, social support was
related to both adaptive and maladaptive forms of
coping. Such departures from findings in other
populations suggest that the unique circumstances
of pregnancy may result in distinct influences and
consequences of coping in this context, and illustrate
the importance of using situationally-specific mea-
sures to investigate prenatal coping. The pregnancy-
specific measure of coping used in this investigation
successfully identified discrete, stable, and concep-
tually interpretable ways of coping over the course of
pregnancy in a diverse sample. The NuPCI also
appears to be sensitive to individual, interpersonal,
and situational influences that may affect prenatal
coping, as evidenced by its association with disposi-
tional, social, and emotional variables in this study.
It is important to emphasize that these analyses
involve a large number of variables and the findings are
correlational. Notably, all of the coping strategies were
correlated with greater distress, consistent with the
expectation that distress is a predictor, rather than an
outcome, of coping. This assumption seems especially
likely for adaptive ways of coping. Yet, for maladaptive
coping such as avoidance, the association with emo-
tional distress may be bidirectional or in reverse.
Future investigations may clarify these associations.
Additional research is also needed to examine the
adaptiveness of prenatal coping strategies across
situations and individuals, using multiple criteria to
define what is adaptive. Daily process studies and
examinations of within-person effects may provide
such information [37]. Factors such as the perceived
controllability of a stressor can affect whether a specific
strategy produces an advantageous or deleterious
outcome [6]. For example, while avoidant coping is
typically associated with negative emotional outcomes
[13,28,38], there are instances, such as when a stressor
cannot be actively controlled, in which avoidant coping
provides some emotional benefit [39]. These issues
highlight the complexity of designing interventions to
improve prenatal coping.
Considering the damaging and far-reaching effects
of prenatal stress on fetal, infant, and child health
[40], it is imp erative to understand how women
respond to stress in pregnancy. The present findings
offer an important foundation and a valuable
measurement tool for further research to examine
coping during pregnancy, and its impact on the
health and well-being of women and their offspring.
Acknowledgments
The present study was funded by NIH grant
R29NR03443 to Marci Lobel. We thank Camille
Wortman for commenting on a draft of this article.
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Current knowledge on this subject
– Individual traits, social relationships, and emotional
reactions to stress affect the ways that people cope wi th
stress.
– T he few existing studies of coping with stress in
pregnancy have predominantly used generic coping
measures that are not tailored to the prenatal experi-
ence.
– Methodological limitations of previous studies hamper
conclusions about prenatal coping.
What this study adds
– The Revised Prenatal Coping Inventory (NuPCI)
successfully identified three discrete, stable, and con-
ceptually interpretable ways of coping over the course of
pregnancy in a diverse sample of women.
– Prenatal coping is dynamic: The extent to which
women used specific ways of coping varied across early,
mid-, and late pregnancy.
– The NuPCI is sensitive to factors that may influence
prenatal coping, as evidenced by its association with
dispositional, social, and emotional variables in this
study.
104 J. G. Hamilton & M. Lobel