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Variations in Relationships Between Perceived Stress and Birth Outcomes by Immigration Status

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Isabelle Sinclair at Université du Québec à Montréal
Isabelle Sinclair
Myriane St-Pierre
Myriane St-Pierre
Myriane St-Pierre
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Cathy Vaillancourt at Institut National de la Recherche Scientifique
Cathy Vaillancourt
Sonia Gagnon
Sonia Gagnon
Sonia Gagnon
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Abstract and Figures

Introduction Past research shows that stress during pregnancy predicts adverse birth outcomes. These patterns might differ based on immigration status. Our objective was to analyze differences in relationships between perceived stress during pregnancy and birth outcomes by immigration status. Methods We recruited 81 pregnant women in Canada for a prospective longitudinal study of stress during pregnancy and infant development. Participants completed the Perceived Stress Questionnaire at 16–18, 24–26 and 32–34 weeks of pregnancy. Birth records were available for 73 women, including 24 non-immigrants, 18 long-term immigrants (≥ 5 years), and 31 recent immigrants (< 5 years). We used General Linear Models to test relationships between perceived stress and birthweight, birthweight for gestational age Z-scores, and gestational age, and differences based on immigration status. Results Controlling for sociodemographic covariates, we observed interactive relationships between immigration status and perceived stress with birthweight at 16–18 (p = 0.032, partial η² = 0.11) and 24–26 weeks pregnancy (p = 0.012, partial η² = 0.15). Results were similar for birthweight for gestational age Z-scores at 16–18 weeks (p = 0.016, partial η² = 0.13) and 24–26 weeks pregnancy (p = 0.013, partial η² = 0.14). Perceived stress predicted smaller birthweight measurements among long-term immigrants. No relation was found between perceived stress, immigration status and gestational age. Discussion Risk of adverse health outcomes, including birth outcomes, tends to increase with duration of residence among immigrants. Stress during pregnancy might represent one risk factor for adverse birth outcomes among long-term immigrant women. Promoting psychosocial health screening and care among immigrant women, and assuring continued care with acculturation, might improve both maternal and infant health outcomes.
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Vol.:(0123456789)
1 3
Maternal and Child Health Journal (2020) 24:1521–1531
https://doi.org/10.1007/s10995-020-03014-1
Variations inRelationships Between Perceived Stress andBirth
Outcomes byImmigration Status
IsabelleSinclair1· MyrianeSt‑Pierre1· CathyVaillancourt2· SoniaGagnon3· KelseyN.Dancause1
Accepted: 23 September 2020 / Published online: 13 October 2020
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Introduction Past research shows that stress during pregnancy predicts adverse birth outcomes. These patterns might dif-
fer based on immigration status. Our objective was to analyze differences in relationships between perceived stress during
pregnancy and birth outcomes by immigration status.
Methods We recruited 81 pregnant women in Canada for a prospective longitudinal study of stress during pregnancy and
infant development. Participants completed the Perceived Stress Questionnaire at 16–18, 24–26 and 32–34weeks of preg-
nancy. Birth records were available for 73 women, including 24 non-immigrants, 18 long-term immigrants (≥ 5years), and 31
recent immigrants (< 5years). We used General Linear Models to test relationships between perceived stress and birthweight,
birthweight for gestational age Z-scores, and gestational age, and differences based on immigration status.
Results Controlling for sociodemographic covariates, we observed interactive relationships between immigration status
and perceived stress with birthweight at 16–18 (p = 0.032, partial η2 = 0.11) and 24–26weeks pregnancy (p = 0.012, partial
η2 = 0.15). Results were similar for birthweight for gestational age Z-scores at 16–18weeks (p = 0.016, partial η2 = 0.13) and
24–26weeks pregnancy (p = 0.013, partial η2 = 0.14). Perceived stress predicted smaller birthweight measurements among
long-term immigrants. No relation was found between perceived stress, immigration status and gestational age.
Discussion Risk of adverse health outcomes, including birth outcomes, tends to increase with duration of residence among
immigrants. Stress during pregnancy might represent one risk factor for adverse birth outcomes among long-term immigrant
women. Promoting psychosocial health screening and care among immigrant women, and assuring continued care with
acculturation, might improve both maternal and infant health outcomes.
Keywords Stress· Birthweight· Mental health· Migrant· Immigrant· Health disparities
Signicance
What is already known on this subject?
Perceived stress has been associated with adverse birth
outcomes such as low birthweight. Some studies show
that immigrant women have higher risk for both stress and
adverse birth outcomes. This risk tends to increase with time
since immigration.
What this study adds?
Perceived stress might represent one risk factor under-
lying the increasing risk for adverse birth outcomes such
as low birthweight with time since immigration observed
in some studies. This emphasizes the importance of ensur-
ing continued and long-term resources such as psychosocial
health screening and care for pregnant immigrant women.
* Kelsey N. Dancause
kelseydancause@gmail.com
1 Département des Sciences de l’activité physique, Faculté
des sciences, Université du Québec à Montréal (UQAM),
Pavillon des Sciences biologiques (SB), SB-4660, 141,
avenue du Président-Kennedy, Montreal, QCH2X1Y4,
Canada
2 INRS Institut Armand-Frappier Research Centre, Montreal,
QC, Canada
3 Département d’obstétrique-gynécologie, Hôpital du
Sacré-Coeur de Montréal, Université de Montréal, Montreal,
QC, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The pooled prevalence of any perinatal anxiety disorder was 19·6% (range 1·2-53·1; I² 96·8%; τ² 0·01; figure 3). [50][51][52][53]97,100,105,106,110,124,134,136,156,160 Most studies included mixed forced and economic migrants. Only one study included disag gregated data for forced migrants, with a prevalence of 11·5%. ...
The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis
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  • Mar 2023
Background: There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. Methods: In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. Findings: 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. Interpretation: One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. Funding: UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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... The pooled prevalence of any perinatal anxiety disorder was 19·6% (range 1·2-53·1; I² 96·8%; τ² 0·01; figure 3). [50][51][52][53]97,100,105,106,110,124,134,136,156,160 Most studies included mixed forced and economic migrants. Only one study included disag gregated data for forced migrants, with a prevalence of 11·5%. ...
View
... As immigrant women adapt to the US, the stressors associated with acculturation have a negative impact during pregnancy, thus losing some of the protective effects of the previous culture (D 'Anna-Hernandez et al., 2015). A recently published study by Sinclair et al. (2020) demonstrated lower birthweights in long-term immigrants with higher perceived stress. Other studies have reported increases in low birthweight infants and preterm births in Latina women after more restrictive immigration policies, adversely affecting women and their families (Gemmill et al., 2019;Novak et al., 2017). ...
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Relationships between psychological distress and health behaviors among Canadian adults: Differences based on gender, income, education, immigrant status, and ethnicity
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