Factors Associated with Prenatal Health Behaviors among Low-Income, Ethnic Minority Women
Abstract
:1. Introduction
Present Study
2. Methods
2.1. Participants
2.2. Procedures
2.3. Measures
- How has being pregnant affected your eating habits?
- What type of exercise have you performed, if any, during your pregnancy?
- What forms of stress management have you used, if any, during your pregnancy?
2.4. Statistical Analyses
3. Results
3.1. Participants
3.2. Factors Associated with Prenatal Health Behaviors
4. Discussion
4.1. Nutrition
4.2. Exercise
4.3. Stress Management
4.4. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Chia, A.R.; Chen, L.W.; Lai, J.S.; Wong, C.H.; Neelakantan, N.; van Dam, R.M.; Chong, M.F. Maternal dietary patterns and birth outcomes: A systematic review and meta-analysis. Adv. Nutr. 2019, 10, 685–695. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jones, M.A.; Catov, J.M.; Jeyabalan, A.; Whitaker, K.M.; Barone Gibbs, B. Sedentary behaviour and physical activity across pregnancy and birth outcomes. Paediatr. Perinat. Epidemiol. 2021, 35, 341–349. [Google Scholar] [CrossRef]
- Kibret, K.T.; Chojenta, C.; Gresham, E.; Tegegne, T.K.; Loxton, D. Maternal dietary patterns and risk of adverse pregnancy (hypertensive disorders of pregnancy and gestational diabetes mellitus) and birth (preterm birth and low birth weight) outcomes: A systematic review and meta-analysis. Public Health Nutr. 2019, 22, 506–520. [Google Scholar] [CrossRef] [PubMed]
- Littleton, H.L.; Bye, K.; Buck, K.; Amacker, A. Psychosocial stress during pregnancy and perinatal outcomes: A meta-analytic review. J. Psychosom. Obstet. Gynaecol. 2010, 31, 219–228. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians & Gynecologists. Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804. Obstet. Gynecol. 2020, 135, e178–e188. [Google Scholar] [CrossRef] [Green Version]
- Kominiarek, M.A.; Rajan, P. Nutrition recommendations in pregnancy and lactation. Med. Clin. N. Am. 2016, 100, 1199–1215. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- American College of Obstetricians and Gynecologists Committee on Health Care for Undeserved Women. ACOG Committee Opinion No. 343: Psychosocial risk factors: Perinatal screening and intervention. Obstet. Gynecol. 2006, 108, 469–477. [Google Scholar] [CrossRef]
- Abu-Saad, K.; Fraser, D. Maternal nutrition and birth outcomes. Epidemiol. Rev. 2010, 32, 5–25. [Google Scholar] [CrossRef] [Green Version]
- Fink, N.S.; Urech, C.; Cavelti, M.; Alder, J. Relaxation during pregnancy: What are the benefits for mother, fetus, and the newborn? A systematic review of the literature. J. Perinat. Neonatal Nurs. 2012, 26, 296–306. [Google Scholar] [CrossRef]
- Moyer, C.; Reoyo, O.R.; May, L. The Influence of prenatal exercise on offspring health: A review. Clin. Med. Insights. Women’s Health 2016, 9, 37–42. [Google Scholar] [CrossRef]
- Francis, E.C.; Zhang, L.; Witrick, B.; Chen, L. Health behaviors of American pregnant women: A cross-sectional analysis of NHANES 2007–2014. J. Public Health 2021, 43, 131–138. [Google Scholar] [CrossRef]
- Hesketh, K.R.; Evenson, K.R. Prevalence of U.S. pregnant women meeting 2015 ACOG physical activity guidelines. Am. J. Prev. Med. 2016, 51, e87–e89. [Google Scholar] [CrossRef] [Green Version]
- Birdee, G.S.; Kemper, K.J.; Rothman, R.; Gardiner, P. Use of complementary and alternative medicine during pregnancy and the postpartum period: An analysis of the National Health Interview Survey. J. Women’s Health 2014, 23, 824–829. [Google Scholar] [CrossRef] [Green Version]
- Cox, E.Q.; Sowa, N.A.; Meltzer-Brody, S.E.; Gaynes, B.N. The perinatal depression treatment cascade: Baby steps toward improving outcomes. J. Clin. Psychiatry 2016, 77, 1189–1200. [Google Scholar] [CrossRef]
- Blumenshine, P.; Egerter, S.; Barclay, C.J.; Cubbin, C.; Braveman, P.A. Socioeconomic disparities in adverse birth outcomes: A systematic review. Am. J. Prev. Med. 2010, 39, 263–272. [Google Scholar] [CrossRef] [PubMed]
- Evenson, K.R.; Wen, F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999–2006. Prev. Med. 2010, 50, 123–128. [Google Scholar] [CrossRef] [PubMed]
- Fox, M.; Entringer, S.; Buss, C.; DeHaene, J.; Wadhwa, P.D. Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: A fetal programming perspective. Am. J. Public Health 2015, 105 (Suppl. 3), S409–S423. [Google Scholar] [CrossRef] [PubMed]
- Hill, A.M.; Nunnery, D.L.; Ammerman, A.; Dharod, J.M. Racial/ethnic differences in diet quality and eating habits among WIC pregnant women: Implications for policy and practice. Am. J. Health Promot. 2020, 34, 169–176. [Google Scholar] [CrossRef] [PubMed]
- Larrabee Sonderlund, A.; Schoenthaler, A.; Thilsing, T. The Association between maternal experiences of interpersonal discrimination and adverse birth outcomes: A systematic review of the evidence. Int. J. Environ. Res. Public Health 2021, 18, 1465. [Google Scholar] [CrossRef]
- Park, C.L.; Iacocca, M.O. A stress and coping perspective on health behaviors: Theoretical and methodological considerations. Anxiety Stress Coping 2014, 27, 123–137. [Google Scholar] [CrossRef]
- Alhusen, J.L.; Ayres, L.; DePriest, K. Effects of maternal mental health on engagement in favorable health practices during pregnancy. J. Midwifery Women’s Health 2016, 61, 210–216. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Auerbach, M.V.; Lobel, M.; Cannella, D.T. Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy. J. Psychosom. Obstet. Gynaecol. 2014, 35, 76–83. [Google Scholar] [CrossRef] [PubMed]
- Cannella, B.L.; Yarcheski, A.; Mahon, N.E. Meta-analyses of predictors of health practices in pregnant women. West. J. Nurs. Res. 2018, 40, 425–446. [Google Scholar] [CrossRef] [PubMed]
- Harris, A.; Chilukuri, N.; West, M.; Henderson, J.; Lawson, S.; Polk, S.; Levine, D.; Bennett, W.L. Obesity-related dietary behaviors among racially and ethnically diverse pregnant and postpartum women. J. Pregnancy 2016, 2016, 9832167. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pasha, H.; Faramarzi, M.; Chehrazi, M.; Bakouei, F.; Gholinia, H.; Abdollahi, S.; Shafierizi, S. Health-promotion and health-harming behaviours in pregnant women: Role of coping strategies, anxiety, and depression. J. Obstet. Gynaecol. 2021, 42, 410–415. [Google Scholar] [CrossRef]
- U.S. Census Bureau. Selected Economic Characteristics. 2010–2014 American Community Survey 5-Year Estimates. 2014. Available online: https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2014/5-year.html (accessed on 23 February 2018).
- Yali, A.M.; Lobel, M. Stress-resistance resources and coping in pregnancy. Anxiety Stress Coping 2002, 15, 289–309. [Google Scholar] [CrossRef]
- Baker, D.; Taylor, H. The relationship between condition-specific morbidity, social support and material deprivation in pregnancy and early motherhood. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood. Soc. Sci. Med. 1997, 45, 1325–1336. [Google Scholar] [CrossRef]
- Cohen, S.; Williamson, G. Perceived stress in a probability sample of the United States. In The Social Psychology of Health: Claremont Symposium on Applied Social Psychology; Spacapam, S., Oskamp, S., Eds.; Sage: Newbury Park, CA, USA, 1988. [Google Scholar]
- DiPietro, J.A.; Christensen, A.L.; Costigan, K.A. The pregnancy experience scale-brief version. J. Psychosom. Obstet. Gynaecol. 2008, 29, 262–267. [Google Scholar] [CrossRef] [Green Version]
- Cole, J.C.; Rabin, A.S.; Smith, T.L.; Kaufman, A.S. Development and validation of a Rasch-derived CES-D short form. Psychol. Assess. 2004, 16, 360–372. [Google Scholar] [CrossRef]
- Danhauer, S.C.; Oliveira, B.; Myll, J.; Berra, K.; Haskell, W. Successful dietary changes in a cardiovascular risk reduction intervention are differentially predicted by biopsychosocial characteristics. Prev. Med. 2004, 39, 783–790. [Google Scholar] [CrossRef]
- Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A.G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav. Res. Methods 2009, 41, 1149–1160. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; Lawrence Erlbaum Associates: Hillsdale, NJ, USA, 1988. [Google Scholar]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Henry, C.J.; Kaur, B.; Quek, R. Are Asian foods as “fattening” as western-styled fast foods? Eur. J. Clin. Nutr. 2020, 74, 348–350. [Google Scholar] [CrossRef] [PubMed]
- Epel, E.; Lapidus, R.; McEwen, B.; Brownell, K. Stress may add bite to appetite in women: A laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology 2001, 26, 37–49. [Google Scholar] [CrossRef] [PubMed]
- Doron, J.; Trouillet, R.; Maneveau, A.; Ninot, G.; Neveu, D. Coping profiles, perceived stress and health-related behaviors: A cluster analysis approach. Health Promot. Int. 2015, 30, 88–100. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Guardino, C.M.; Schetter, C.D. Coping during pregnancy: A systematic review and recommendations. Health Psychol. Rev. 2014, 8, 70–94. [Google Scholar] [CrossRef] [Green Version]
- Groth, S.W.; Morrison-Beedy, D. Low-income, pregnant, African American women’s views on physical activity and diet. J. Midwifery Women’s Health 2013, 58, 195–202. [Google Scholar] [CrossRef] [Green Version]
- Lee, D.T.; Ngai, I.S.; Ng, M.M.; Lok, I.H.; Yip, A.S.; Chung, T.K. Antenatal taboos among Chinese women in Hong Kong. Midwifery 2009, 25, 104–113. [Google Scholar] [CrossRef]
- Urizar, G.G.; Hurtz, S.Q.; Ahn, D.K.; King, A.C.; Albright, C.L.; Atienza, A.A. Influence of maternal stress on successful participation in a physical activity intervention: The IMPACT Project. Women Health 2005, 42, 63–82. [Google Scholar] [CrossRef]
- Vermeesch, A.L.; Stommel, M. Physical activity and acculturation among U.S. Latinas of childbearing age. West. J. Nurs. Res. 2014, 36, 495–511. [Google Scholar] [CrossRef]
- Lobel, M.; Cannella, D.L.; Graham, J.E.; DeVincent, C.; Schneider, J.; Meyer, B.A. Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychol. 2008, 27, 604–615. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Suarez-Cano, G. Racial and Ethnic Differences in Perceived Stress, Social Support, and Stress Management. Master’s Thesis, University of Cincinnati, Cincinnati, OH, USA, 2018. OhioLINK Electronic Theses and Dissertations Center. Available online: http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522335867241361 (accessed on 27 July 2021).
- Upchurch, D.M.; Wexler Rainisch, B.K. Racial and ethnic profiles of complementary and alternative medicine use among young adults in the United States: Findings from the National Longitudinal Study of Adolescent Health. J. Evid.-Based Complement. Altern. Med. 2012, 17, 172–179. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Siu, A.L.; US Preventive Services Task Force (USPSTF); Bibbins-Domingo, K.; Grossman, D.C.; Baumann, L.C.; Davidson, K.W.; Ebell, M.; García, F.A.; Gillman, M.; Herzstein, J.; et al. Screening for depression in adults: US preventive services task force recommendation statement. JAMA 2016, 315, 380–387. [Google Scholar] [CrossRef] [PubMed]
- Urizar, G.G., Jr.; Yim, I.S.; Rodriguez, A.; Schetter, C.D. The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women. Psychoneuroendocrinology 2019, 104, 174–184. [Google Scholar] [CrossRef] [PubMed]
Total Sample n = 100 | African American n = 39 | Foreign-Born Latinas n = 30 | U.S.-Born Latinas n = 15 | Asian American/Pacific Islander n = 6 | Non-Hispanic White n = 10 | |
---|---|---|---|---|---|---|
Demographic | ||||||
Age [M (SD)] ** | 25.8 (± 6.0) | 23.8 (± 5.6) | 28.7 (± 5.7) * | 22.2 (± 3.4) | 27.3 (± 5.1) | 28.0 (± 7.6) * |
Gestational Age [M (SD)] | 17.0 (± 4.8) | 16.9 (± 5.0) | 16.9 (± 4.6) | 18.2 (± 4.2) | 16.5 (± 6.0) | 17.7 (± 5.4) |
BMI [M (SD)] * | 27.7 (± 5.9) | 27.5 (± 5.9) | 29.4 (± 6.0) ** | 29.8 (± 6.5) ** | 24.4 (± 3.2) | 23.2 (± 2.8) |
Number of Children [M (SD)] ** | 1.1 (± 1.5) | 1.0 (± 1.5) | 1.9 (± 1.7) ** | 0.5 (± 0.8) | 0.5 (± 0.8) | 0.4 (± 0.7) |
Married/Living Together (%) *** | 49.0 | 14.3 *** | 76.7 | 53.3 | 66.7 | 70.0 |
High-school education or less (%) ** | 61.0 | 64.1 | 83.3 | 53.3 | 16.7 ** | 20.0 ** |
Annual family combined income < USD 25,000 (%) *** | 75.0 | 87.2 | 93.3 | 60.0 | 33.3 *** | 20.0 *** |
Psychosocial Characteristics | ||||||
Planning [M (SD)] *** | 22.8 (± 6.6) | 25.8 (± 5.0) | 18.5 (± 6.7) ** | 23.6 (± 7.2) | 21.7 (± 5.6) | 23.0 (± 4.8) |
Avoidance [M (SD)] | 14.5 (± 4.3) | 14.6 (± 4.8) | 14.4 (± 3.8) | 14.3 (± 4.9) | 15.3 (± 4.7) | 14.1 (± 4.0) |
Social Support [M (SD)] | 32.5 (± 6.9) | 31.6 (± 7.1) | 33.0 (± 5.9) | 33.2 (± 7.7) | 32.8 (± 7.2) | 33.1 (± 8.0) |
Stress [M (SD)] | 5.2 (± 3.2) | 5.2 (± 3.5) | 5.2 (± 2.4) | 5.4 (± 3.8) | 5.7 (± 4.0) | 5.0 (± 2.9) |
Frequency Pregnancy Stress [M (SD)] * | 0.8 (± 0.6) | 0.7 (± 0.4) | 1.0 (± 0.8) * | 0.7 (± 0.4) | 0.7 (± 0.3) | 0.7 (± 0.3) |
Intensity Pregnancy Stress [M (SD)] | 0.7 (± 0.3) | 0.7 (± 0.3) | 0.7 (± 0.3) | 0.6 (± 0.3) | 0.7 (± 0.2) | 0.8 (± 0.2) |
Depression [M (SD)] | 9.2 (± 6.2) | 10.6 (± 7.1) | 9.3 (± 5.5) | 6.6 (± 5.4) | 7.8 (± 3.9) | 7.7 (± 5.1) |
High-Fat Foods | Fruits and Vegetables | Exercise | Stress Management | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Variables | R2 | Standard β | Standard Error | R2 | Standard β | Standard Error | R2 | Standard β | Standard Error | R2 | Standard β | Standard Error |
0.29 *** | 0.11 | 0.25 ** | 0.19 * | |||||||||
Age | −0.32 ** | 0.01 | −0.03 | 0.02 | −0.06 | 2.24 | 0.28 ** | 2.5 | ||||
Income | 0.07 | 0.04 | 0.18 | 0.05 | 0.26 * | 5.9 | 0.16 | 8.45 | ||||
Ethnicity | −0.25 * | 0.09 | 0.01 | 0.09 | 0.23 * | 12.53 | −0.22 * | 17.31 | ||||
Planning | 0.08 | 0.02 | −0.04 | 0.02 | 0.36 ** | 1.91 | −0.21 | 2.92 | ||||
Avoidance | 0.39 ** | 0.02 | 0.04 | 0.02 | 0.06 | 3.3 | 0.30 * | 4.36 | ||||
Social Support | 0.01 | 0.01 | 0.15 | 0.02 | 0.11 | 2.14 | −0.15 | 2.78 | ||||
Stress | 0.32 * | 0.04 | −0.09 | 0.04 | −0.03 | 5.6 | 0.09 | 7.45 | ||||
Frequency Pregnancy Stress | −0.02 | 0.16 | −0.02 | 0.17 | −0.05 | 23.86 | 0.03 | 31.33 | ||||
Intensity Pregnancy Stress | 0.05 | 0.38 | 0.07 | 0.41 | −0.24 * | 57.9 | 0.05 | 74.79 | ||||
Depression | −0.07 | 0.02 | −0.05 | 0.02 | 0.24 | 3 | −0.23 | 3.77 |
Main Theme | N * | Definition | Sample Quote |
---|---|---|---|
Subtheme | |||
How have your eating habits changed? | |||
New food cravings | 121 | Participants mentioned new cravings during pregnancy that they did not have previously. | “I never bought ice cream until now. I probably haven’t bought ice cream in five years.” |
No change | 21 | Participants mentioned having no changes in eating habits or cravings. | “Well, it [pregnancy] has not affected me because it is the same. I continue eating the same.” |
How has pregnancy affected your exercise? | |||
Decreased exercise | 33 | Participants mentioned a decrease in the amount of exercise they engaged in during pregnancy. | “I used to be able to do a lot of stuff, and after giving birth, I kind of really can’t do it anymore.” |
Increased exercise | 8 | Participants mentioned an increase in the amount of exercise they engaged in during pregnancy. | “I’ve stepped up swimming. I didn’t do it as often, but it’s something that’s very nice to do now.” |
Advised to exercise | 76 | Participants mentioned the ways they were informed about exercising during pregnancy. | “My doctor said that prenatal yoga is a really good way to stretch and keep your muscles loose.” |
Learned benefits to exercise | 30 | Participants mentioned the benefits they learned from engaging in exercise during pregnancy. | “Well, I used to have a lot of back problems and now I don’t notice it as much. |
What forms of stress management used? | |||
Sources of stress management | 46 | Participants mentioned where they learned about or were taught about some of the relaxation exercises in which they engaged. | “I heard about breathing because I took my nursing classes.” |
Learned benefits to stress management | 37 | Participants mentioned some of the benefits they experienced after engaging in relaxation exercises during pregnancy. | “I’ll buy a relaxing CD and then play it when I’m in the bath or just home alone.” |
Interest in learning more about stress management | 45 | Participants mentioned some of the relaxation exercises they were interested in learning more about. | “Muscle relaxation. I’ve never heard of that. I mean I’ve heard of it, but I haven’t tried it. I guess that would be something new.” |
% Endorsing * | |
---|---|
Types of Exercise | |
Brisk walking | 52 |
Heavy housework | 20 |
Aerobic fitnesss | 10 |
Leisure-recreational sports | 5 |
Yardwork | 5 |
Bicycling | 4 |
Jogging/running | 3 |
Competitive sports | 3 |
Strength training | 1 |
Swimming | 1 |
Badminton | 1 |
Types of Stress Management | |
Massage | 9 |
Diaphragmatic breathing | 8 |
Meditation | 8 |
Muscle relaxation | 4 |
Aromatherapy | 3 |
Visualization | 2 |
Acupuncture | 1 |
Other Self-Care/Relaxation Activities | |
Praying | 5 |
Bathing/showering | 5 |
Sleeping/napping | 3 |
Listening to music | 3 |
Reading | 2 |
Sewing | 1 |
Watching TV | 1 |
Eating ice chips | 1 |
Positive thoughts about baby | 1 |
Going on a walk | 1 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Urizar, G.G., Jr.; Murillo, J.; Miller, K. Factors Associated with Prenatal Health Behaviors among Low-Income, Ethnic Minority Women. Int. J. Environ. Res. Public Health 2023, 20, 1695. https://doi.org/10.3390/ijerph20031695
Urizar GG Jr., Murillo J, Miller K. Factors Associated with Prenatal Health Behaviors among Low-Income, Ethnic Minority Women. International Journal of Environmental Research and Public Health. 2023; 20(3):1695. https://doi.org/10.3390/ijerph20031695
Chicago/Turabian StyleUrizar, Guido G., Jr., Joshua Murillo, and Karissa Miller. 2023. "Factors Associated with Prenatal Health Behaviors among Low-Income, Ethnic Minority Women" International Journal of Environmental Research and Public Health 20, no. 3: 1695. https://doi.org/10.3390/ijerph20031695