psychosocial stress; maternal health; maternal morbidity; PRAMS; pregnancy


Maternal and Child Health | Medicine and Health Sciences | Public Health | Women's Health


Introduction: Significant racial disparities persist in maternal morbidity rates, disproportionately affecting Black women. Experiencing high levels of stress during pregnancy is associated with increased risk for preterm birth, infant mortality, and preeclampsia. This study investigates the impact of psychosocial life stressors on maternal morbidity and racial disparities utilizing the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset.

Methods: Participants (N=24,209) included were from Phase 8 (2016-2018) of the PRAMS survey across five states. Stressors were grouped into traumatic, partner-related, financial, or emotional. Maternal outcomes included gestational diabetes, hypertensive disorders of pregnancy, prenatal depression, and postpartum depression. The association between life stressors and maternal morbidity was evaluated using modified Poisson regression models with robust error variance to estimate adjusted prevalence ratios.

Results: Black women were more likely to report all stressors, and Hispanic women had an increased prevalence of partner-related and financial stressors. Experiencing any maternal morbidity was associated with partner (38.0% versus 22.0%; p<0.001), trauma (20.9% versus 10.9%; p<0.001), financial (40.5% versus 25.7%; p<0.001), and emotional stress (36.4% versus 28.3%; p<0.001). Compared to mothers who reported no stressors, mothers who reported 1-3 stressors, 4-6 stressors, and ≥ 7 stressors had a 1.14, 1.38, and 1.45 higher adjusted prevalence ratio of maternal morbidity, respectively.

Conclusions/Implications: Psychosocial stress has a substantial impact on maternal outcomes. Pregnant women should be screened and connected with resources to alleviate the burden of their respective stressful life events.