WITHDRAWN: Contextual Risk Factors for Poor Maternal Health during Pregnancy: Mediation By Maternal Mental Health and Prenatal Care

Introduction: Inadequate prenatal care and women’s mental health predict poor maternal physical health and fetal health during pregnancy. However, little quantitative research has examined what factors predict inadequate prenatal care and maternal mental health. Identifying possible contextual risk factors is an important first step in reducing health disparities in pregnancy outcomes. The purpose of this study was to explore how income and an index of contextual risk factors predicted perceived barriers to care and maternal mental health, and to examine whether maternal mental health and adequate prenatal care mediate the relation between contextual risk and poor maternal physical health.

Method: Data collection is ongoing; currently 150 pregnant women are enrolled in the study, with a recruitment goal of 200. The current sample consists of pregnant women between the ages of 20 and 42 who attended new patient appointments in high-risk and low-risk pregnancy clinics (53% Black; 40% White; 4% Latino; 47% in poverty) at a regional women’s health center. Patients completed a survey reporting on contextual risk factors (food insecurity, housing instability, intimate partner violence, exposure to community violence), perceived barriers to care, perceived stress, and depressive symptoms. Information about adequate prenatal care (i.e., number of attended appointments compared to national recommendations) and maternal health (e.g., preeclampsia, gestational diabetes, smoking) will be obtained through an electronic health record review (EHR).

Results: Hierarchical linear regressions were conducted to predict perceived barriers to care, depressive symptoms, and perceived stress. Although race and poverty did not predict perceived barriers to care, contextual stress did (β = .33, p < .001). Being African American, living in poverty, and having higher rates of contextual stress all uniquely predicted greater depressive symptoms (βs = -.28, -.25, and .32, respectively; ps ranged from .01 to less than .001). Race did not uniquely predict perceived stress, but poverty and contextual stress did (β = -.22, p < .05; β = .30, p < .001, respectively). Upon completion of the EHR, a path analysis will be conducted to test whether maternal mental health and adequate prenatal care mediate the relation between contextual risk and maternal physical health.

Conclusions: As hypothesized, contextual risk factors predicted perceived barriers to care and maternal mental health, above and beyond race and poverty. Given the established relations between maternal mental health, prenatal care, and maternal and fetal health, contextual risk is an important target for programs that promote maternal and fetal health.