Perceived discrimination and depressive symptoms, smoking, and recent alcohol use in pregnancy.

Women with low socioeconomic status are at greater risk of depressive symptomatology and health-compromising behaviors in pregnancy than women from less vulnerable populations (1-4). These characteristics are all associated with poor maternal-child outcomes, including low birthweight, developmental delay, and chronic illness in infancy (5-9). Smoking in pregnancy is associated with placental insufficiency, low birthweight, and preterm birth (5). Fetal exposure to alcohol is related to poor neurodevelopmental outcomes (7). Depressive symptoms, smoking, and alcohol use are all targets of major public health interventions for pregnant women, and the identification of social factors that contribute to their disproportional prevalence among vulnerable populations is critical to the development of effective risk reduction strategies. Perceived discrimination, or unfair treatment based on personal characteristics identifying membership in a group perceived as inferior (e.g., racism, classism, sexism), is associated, in nonpregnant samples, with poor mental and physical health as well as health compromising behaviors among adults in low-income populations (10-13). Framed as a psychosocial stressor linking the social environment with physiologic state, perceived discrimination has been proposed to have negative consequences for mental and physical health (11). Adults who report discrimination are more likely to report greater depressive symptoms and major depression, poor cardiovascular health, and health compromising behaviors including smoking and alcohol use (13-15). Interestingly, the type of discrimination has also been suggested to influence the strength of the association with outcomes; chronic low level “everyday” discrimination has been theorized to have a stronger association with health outcomes than more severe but infrequent discrimination (13). This suggestion has important implications for the design of potential mitigating strategies. Despite the evidence of links between depressive symptoms, health compromising behaviors, and perceived discrimination, little research has been conducted on this topic among pregnant women. In the few studies that have explored consequences of perceived discrimination in pregnancy, this exposure has been associated with higher levels of self-rated stress and adverse birth outcomes, including low birthweight and preterm birth for women with high depressive symptoms compared with women who have lower levels of symptoms (12, 16-20). In the only published study to date that assessed discrimination and depressive symptomatology in pregnancy, a positive and significant association was found (16). However, no analysis of links to health behaviors has been undertaken. In the present study we investigated whether perceived discrimination was associated with depressive symptoms and two health-compromising behaviors -- smoking during pregnancy and recent alcohol use -- in a sample of pregnant low- income inner-city women. We also assessed the relative contribution of chronic, low level “everyday” discrimination versus reported experiences of major discrimination.