Doctoral Dissertation Improvement: The Impact of Globalization and Psychosocial Stress on Gestation Length and Pregnancy Outcomes on the Pacific Island of Tutuila

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Short-term, retrospective, cross-sectional studies set in western countries have discovered a pattern of pregnancy disruption associated with stressful events. Incidences of spontaneous abortions, stillbirths, low birth weights and premature delivery have all been quantitatively associated with increased maternal stress. Little is known, however, about how disparities in the social status of non-western women can impact pregnancy outcomes and resultant infant health. The objective of the proposed research is to determine the association of social status and chronic psychosocial stress on spontaneous abortion, gestation length and neonate body size. This longitudinal, prospective, biocultural study measures psychosocial stress in women prior to conception, through pregnancy and concludes with a postpartum follow-up on the health of their infants. Early pregnancy loss will be determined using fertility monitors and urine based pregnancy tests. Two interrelated indicators of psychosocial stress, Epstein-Barr virus (EBV) antibody concentration and status incongruence, will be used to assess the effects of stress on pregnancy outcomes of 108 women on the American Samoan island of Tutuila. Fingertip dried blood spots are collected from mothers prior to and throughout the course of their pregnancy and analyzed for EBV and C-reaction protein levels (CRP). CRP levels detect infection and are then used to control EBV levels. Combined with interviews and maternal and infant anthropometrics, these techniques make it possible to identify the impact of psychosocial stress on all stages of pregnancy and to assess the role of maternal stress on health outcomes of infants. These data provide an opportunity to assess pregnancy outcomes in terms of psychosocial stress over the course of gestation and information regarding a specific type of psychosocial stress on pregnancy. Data from this study provides insight into pregnancy loss, the least well understood component of reproduction. Additionally, the co-PI is participating in community outreach and education programs for girls and women in Tutuilla.