Stress, Coping and Health Behaviors in Pregnancy
Condition: Pregnancy; Stress; Coping; Health Behaviors
Study type: Observational

Summary: 
      Stress is an important determinant of pregnancy health behaviors, maternal physiology and
      maternal-infant health outcomes. The purpose of this study is to explain the relationship
      between dimensions of lifetime stress and the stress hormone cortisol in pregnant women.
      Additionally, the study will examine how coping styles help pregnant women to better manage
      stress and improve their health behaviors to achieve the goal of having a healthy baby.
    

Detailed description: 
      Health behaviors are important modifiable factors for promoting maternal-infant health during
      pregnancy, and include behaviors such as diet, exercise, and avoidance of harmful substances.
      During pregnancy, women are often motivated to improve their lifestyle to achieve positive
      pregnancy outcomes; however, they may struggle to do so because certain behaviors such as
      excessive eating, smoking and drinking have become a means for coping with stress. Stress
      prior to and during pregnancy negatively impacts birth outcomes via complex behavioral and
      physiologic pathways. From a behavioral perspective, stress diminishes women's engagement in
      positive health behaviors during pregnancy. From a physiologic perspective, stress affects
      the regulation of cortisol, a hormone involved in fetal development and timing of delivery.
      Women use various coping styles to manage stress. It is unknown, however, whether certain
      coping styles attenuate the negative behavioral and physiologic effects of stress on birth
      outcomes. Therefore, the purpose of this descriptive, cross-sectional study is to examine the
      influence of coping styles on stress, physiologic cortisol regulation and health behaviors in
      a diverse sample of pregnant women (N=55) during 24-28 weeks gestation.

      A quantitative design with a qualitative arm will be used to:

        1. explain the relationship between cortisol regulation and lifetime stress,

        2. determine whether coping styles (active vs. disengaged) moderate the effect of stress on
           cortisol, health behaviors, and birth outcomes, and

        3. describe women's qualitative experience of stress and coping and determine the extent to
           which the qualitative findings converge with the quantitative findings.

      Data will be collected over three prenatal visits during the second half of pregnancy, and
      will include self-report questionnaires, multiple salivary cortisol sampling, medical record
      data, a structured stress interview and a semi-structured qualitative interview in a subset
      of participants (n=12). This study will use an interview-based stress assessment in tandem
      with physiologic (i.e. cortisol) stress measures in pregnancy. Additionally, the qualitative
      data will provide a contextual understanding of pregnant women's stress and coping
      experiences. The research findings will inform the future development and testing of a
      psychosocial, coping-based intervention to promote positive health behaviors in pregnancy and
      birth outcomes. Furthermore, this training will provide a solid scientific foundation for the
      applicant to develop a career as an independent nurse-scientist in maternal-infant health
      promotion research, under the guidance of an experienced interdisciplinary team of mentors
      with complementary expertise in stress, coping health behavior, and pregnancy related
      research. The proposal is consistent with the National Institute of Nursing Research's (NINR)
      mission to support research that promotes health and prevents disease across the lifespan,
      builds the scientific foundation for clinical practice, and invests in the training of the
      next generation of nurse-scientists.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Pregnant women aged 19 to 45 years old.