439

Social Class Differences in Maternal Stress Appraisal During Pregnancy

MELISSA HAWKINS,

a

JANET A. D

I

PIETRO, AND KATHLEEN A. COSTIGAN

Department of Population and Family Health Sciences, Johns Hopkins University, Baltimore, Maryland 21205, USA

INTRODUCTION

Well-designed prospective studies in the past 10 years have provided cumulativeevidence that both maternal exposure to psychosocial stress and low socioeconomicstatus (SES) during pregnancy significantly increase the risk for adverse reproduc-tive outcomes. Prenatal stress is likely to be mediated by contextual features of theenvironment, and the contribution of low SES to maternal appraisal of stress is cur-rently unknown. Furthermore, studies that have investigated stress during pregnancyhave typically used methods to quantify stress that do not include factors related topregnancy and so may underestimate prenatal stress.

METHOD

This study was designed to examine the contribution of SES to maternal appraisalof pregnancy specific and nonspecific stress during the second half of pregnancy andis part of a larger longitudinal project examining the effect of each on fetal develop-ment. Two samples of healthy women with normal pregnancies, stratified by SES(

n

=

52 middle/high SES,

n

=

51 low SES), were assessed at three gestational ages(24, 30, and 36 weeks) using multiple measures of psychosocial functioning. Thehigher SES group consisted of employed, older, well-educated (

M

=

16.3 years edu-cation), primarily nonminority (77%) women; subjects in the lower SES group werepredominantly unemployed, less educated (

M

=

11.8 yrs), and African-American. Ateach time, existing scales for report of daily stressors (DSI

1

) and emotional intensity,independent of hedonic tone (AIM

2

) were administered. In addition, we developedthe Pregnancy Experience Scale (PES

3

) to assess negative and positive aspects ofpregnancy (i.e., hassles and uplifts), which are not often operationalized in studiesof prenatal stress.

Data were subject to repeated measures analyses and group comparisons. Resultsindicated the following: (1) Measures of pregnancy specific and nonspecific stress(PES and DSI) were highly stable over pregnancy (T

ABLE

1) for both groups. Thecorrelations are comparable, although somewhat lower, than those for the AIM,which is a trait measure (AIM

r

values range from 0.74 to 0.90). This suggests that

a

Address for correspondence: Melissa Hawkins, Johns Hopkins University, Department ofPopulation and Family Health Sciences, Hampton House, Rm. 393, 624 N. Broadway, Balti-more, MD 21205. 410-614-6130 (voice); 410-955-2303 (fax).

e-mail: mhawkins@jhsph.edu

440 ANNALS NEW YORK ACADEMY OF SCIENCES

“stress” scales administered during pregnancy may actually index trait characteris-tics. (2) Contrary to expectations, middle/high SES women reported higher levels ofdaily stress than low SES women (

F

(1,98)

=

10.79;

p

<

0.001; F

IG

. 1) and there wasa significant interaction: women in the lower SES group reported decreasing stressover time (

F

(2,196)

=

6.24;

p

<

0.05). Despite this, women in the lower SES groupdescribed themselves as having greater emotional intensity (

t

(101)

=

−

3.79;

p

<

. 0.001). (3) Women in both SES groups endorsed similar items (e.g., clothes notfitting; feeling the baby move) as the most common pregnancy hassles and uplifts.However, women in the low SES group reported both fewer hassles (

F

(1,98)

=

4.37;

p

<

0.05) and more uplifts (

F

(1,98)

=

5.62;

p

< 0.05).

TABLE 1. Stability of stress measures over time: correlation coefficients for DSI andPregnancy Experience “frequency of hassles/uplifts” by SES

a

a

p

<

0.001.

High SES (

n

=

52) Low SES (

n

=

51)

Daily Stress Inventory 30 weeks 36 weeks 30 weeks 36 weeks

24 weeks 0.62 0.58 0.71 0.61

30 weeks — 0.67 — 0.82

Pregnancy Experience Scale

24 weeks 0.66 0.68 0.54 0.78

30 weeks — 0.66 — 0.42

FIGURE 1. Daily Stress Inventory values during pregnancy: �, low SES; �, high SES.

441HAWKINS

et al.

: SES DIFFERENCES IN MATERNAL STRESS

CONCLUSIONS

The experience of pregnancy does not seem to be perceived as a negative stressoramong low SES women as is often presumed. In contrast to women in the low SESgroup, employed and more educated women reported significantly more daily stres-sors, which did not decline during pregnancy. Both groups of women were similarin the features of pregnancy considered to be stressful, and both reported more preg-nancy-specific uplifts than hassles. However, women in the lower SES group weremore uplifted and less hassled by pregnancy, indicating that perceptions of pregnan-cy also differ by social class. We suggest that role strain in the high SES group maycontribute to the increased appraisal of pregnancy-specific and nonspecific stress.These results highlight the role of social context in understanding the processes thatmediate stress appraisal during pregnancy and related outcomes.

ACKNOWLEDGMENT

This research was support by 2R01 HD27592, NICHD, awarded to the second author.

REFERENCES

1. B

RANTLEY

, P.J.

et al.

1987. A daily stress inventory: development, reliability, andvalidity. J. Behav. Med.

10:

61–73.2. L

ARSEN

, R.J.

et al.

1986. Affect intensity and reactions to daily life events. J. Pers.Soc. Psyol.

51:

803–814.3. D

I

P

IETRO

, J.A.

et al.

1999. Psychosocial stress in pregnancy: development and valida-tion of the Pregnancy Experience Scale. Submitted.