Depressive symptoms and birth outcomes in African American women: A socioeconomic position life course perspective

Depression during the prenatal period may be an important factor underlying the African American/White disparity in low birth weight (LBW) and preterm delivery (PTD), which is one of the most persistent and least understood public health concerns in the United States (Hoffman & Hatch, 2000; Kvale et al., 2000; Deal & Holt, 1998; Din-Dzietham & Hertz-Picciotto, 1998). Although the overall infant mortality rate has been declining since 1933, in any given year, African American women are twice as likely as White women to give birth to a LBW and/or deliver preterm (Ventura et al., 1999; Singh & Yu, 1995). The racial disparity in birth outcomes is compounded by the fact that the incidence of LBW and PTD among African American women always exceeds those of White women with similar educational and social backgrounds (Guyer et al., 1999; David & Collins, 1997).;Using a socioeconomic position life course (SEP) perspective as a theoretical framework, this dissertation research investigated the association between depressive symptoms during the second trimester of pregnancy to the occurrence of PTD among African American women. Using data collected by The Michigan-based Pregnancy Outcomes and Community Health (POUCH) study, this dissertation research addressed two research questions. (1) Does the assessment of low childhood SEP along with other risk factors known to be associated with depressive disorders explain the higher prevalence of depressive symptoms among African American women than among White women? (2) Is there a direct association between low childhood SEP and PTD, and does the higher prevalence of depressive symptoms among African American women further amplify/modify the effect of low childhood SEP on PTD?;The findings indicate that low childhood SEP was positively associated with risk of depression (CES-D score of 16 or more) among African American and White women, however, low childhood SEP did not in part explain the higher prevalence of depressive symptoms among African American women. In addition, low childhood SEP was positively associated with PTD; specifically, African American women who grew up poor were more likely than non-African American women to deliver moderately preterm infants. Finally, there was no empirical support that women at risk for depression were more likely than women not at risk for depression to deliver preterm infants.